True Co-Design: Buzzword or Breakthrough? The Value of Authentic Relationships in Aboriginal and Torres Strait Islander Health Promotion.

As Aboriginal women, Registered Nurses, and health promotion and public health academics, our perspectives are shaped by both our lived experiences and our professional practice. We have worked across clinical care, health promotion, public health, research, and academia, partnering with Aboriginal and Torres Strait Islander communities, health services, and organisations to improve health and wellbeing. These experiences have reinforced our understanding that meaningful and sustainable health promotion is built on relationships, trust, and shared decision-making, rather than simply the application of participatory methods. We wrote this commentary because we have become increasingly concerned that the term co-design is being used widely across research, policy and practice without always reflecting the principles it was intended to represent. Too often, co-design is reduced to consultation, workshops or the collection of community feedback, while decision-making power, and control remain with researchers, institutions or health services. In our experience, this not only undermines the intent of co-design but also risks reinforcing the very inequities that health promotion seeks to address. Our understanding of authentic co-design is informed by Aboriginal ways of knowing, being and doing, which recognise that relationships are not peripheral to the work; they are the work. Genuine partnership requires time to build trust, reciprocal relationships, mutual accountability, respect for community knowledge, and a willingness to share power throughout every stage of a project. These principles are not unique to Aboriginal and Torres Strait Islander contexts; rather, we believe they represent the foundations of effective health promotion with all communities. As nurses and health promoters, we have seen firsthand that programs developed with communities are more relevant, culturally safe, acceptable and sustainable than those developed for communities. Conversely, we have also witnessed the consequences of tokenistic engagement, where communities are invited to participate after key decisions have already been made. These experiences have shaped our conviction that authentic co-design is not a methodology to be applied, but a way of working that is grounded in humility, reciprocity and respect. We acknowledge that our perspectives are informed by our identities as Aboriginal women and by our professional experiences. While we do not claim to speak for all Aboriginal and Torres Strait Islander peoples or communities, we offer this commentary from a position of shared experience and commitment to strengthening health promotion practice. We hope this paper contributes to an ongoing conversation about moving beyond co-design as a buzzword and toward approaches that genuinely redistribute power, privilege community expertise and foster authentic relationships capable of creating meaningful and lasting health change.