This critical review evaluates the use of co-design in the development of health policy affecting Aboriginal and Torres Strait Islander peoples in Australia. It critiques the proliferation of “faux-design”—superficial or tokenistic applications of co-design principles—and contrasts them with best-practice approaches that genuinely shift power and decision-making to Indigenous communities.
Drawing on theory, policy frameworks, and case studies such as Screen Your Way and the Eating Disorder Safe Principles, the review outlines the principles of authentic co-design, including Aboriginal leadership, community benefit, cultural grounding, and Indigenous data sovereignty. It also discusses the structural barriers to true co-design, such as hierarchical governance models, rigid funding structures, and the failure of non-Indigenous actors to cede control. The report offers practical strategies to transition from faux- to co-design, advocating for Indigenous-led evaluation, refusal of harmful engagements (“no-design”), and dedicated resources for culturally safe processes.
The paper concludes with key questions to guide future research and policy development, emphasizing the importance of Indigenous self-determination, accountability, and critical reflection in health policy co-design.
