What is known about this topic dCommunity engagement is central to many health improvement programmes. dCommunity engagement involves a range of strategies from simple consultation to community control. Evidence of the impact of community engagement on 'engaged' individuals is limited. What this paper adds dThe majority of individuals perceive benefits from community engagement -for physical and psychological health, self-confidence and esteem, personal empowerment and social relationships. For some individuals there are unintended adverse consequences of community engagement, such as exhaustion and stress, which may pose a risk to well-being. Potential adverse consequences need to be considered by those planning community engagement initiatives. AbstractCommunity engagement is central to strategies to promote health and well-being and reduce health inequalities in many countries, particularly interventions which focus on improving health in disadvantaged populations. Despite the widespread use of community engagement approaches, however, there have been relatively few attempts to review the evidence on the impact that participation has on the lives of individuals involved. Drawing on a wider review of evidence carried out on behalf of the National Institute for Health and Clinical Excellence (NICE), this article reports on a rapid review of evidence of the effectiveness of initiatives which seek to engage communities in action to address the wider social determinants of health, to explore individuals' subjective experiences of engagement. The rapid review process was guided by NICE's public health methods manual, adapted to suit the diversity of the evidence. A total of 22 studies were identified containing empirical data on subjective experiences of community engagement for individuals. The findings of the rapid review suggest that the majority of 'engaged' individuals perceived benefits for their physical and psychological health, self-confidence, selfesteem, sense of personal empowerment and social relationships. Set against these positive outcomes, however, the evidence suggests that there are unintended negative consequences of community engagement for some individuals, which may pose a risk to well-being. These consequences included exhaustion and stress, as involvement drained participants' energy levels as well as time and financial resources. The physical demands of engagement were reported as particularly onerous by individuals with disabilities. Consultation fatigue and disappointment were negative consequences for some participants who had experienced successive waves of engagement initiatives. For some individuals, engagement may involve a process of negotiation between gains and losses. This complexity needs to be more widely recognised among those who seek to engage communities.

Community engagement is central to national strategies for promoting health, yet there have been few attempts to systematically review the evidence on the impact of initiatives that aim to engage communities. This rapid review fills this gap by exploring the population impact of initiatives which sought to address social determinants of health. It took a novel approach to synthesizing a sample of the enormous UK literature on community engagement. The synthesis found no evidence of positive impacts on population health or the quality of services, but initiatives did have positive impacts on housing, crime, social capital and community empowerment. Methodological developments are needed to enable studies of complex social interventions to provide robust evidence of population impact in relation to community engagement.

This paper describes a systematic review of qualitative studies of children living in material disadvantage, which compares and confirms experiences across a pool of studies that meet predetermined quality criteria. The review found that, according to children's narratives, the costs of poverty are not only material but also profoundly social. The evidence suggests that, despite their efforts to maximise their resources, many poor children experience a gradual narrowing of their horizons, both socially and economically. In conclusion the paper suggests the need for further research from children's viewpoints, given the UK government's commitment to reducing child poverty and associated problems of social exclusion.

Diet is a key issue for UK health policies, particularly in relation to poorer socio-economic groups. From a public health perspective, the government's role is to help low-income families to make healthy food choices, and to create the conditions to enable them to make healthy decisions. Arguably, however, current policy on nutrition and health is influenced by individualist and behavioural perspectives, which fail to take into account the full impact of structural factors on food choices. This paper draws on a systematic review of qualitative studies that prioritize low-income mothers' accounts of 'managing' in poverty, synthesizing a subset of studies that focus on diet, nutrition and health in poor families. Synthesis findings are explored in the context of dominant discourses concerning individual responsibility for health and gendered societal values concerning 'good' mothering. The paper concludes that a shift in emphasis in health policies, affording a higher priority to enabling measures that tackle the underlying determinants of health, would be advantageous in reducing nutritional inequities for low-income mothers and their children.

This systematic review highlights the value of social resources available to children living in poor circumstances, but also points up their limitations. Poverty, by its very nature, compromises the worth of these resources.