In practice, co-creation changes outcomes. Participatory budgeting in Porto Alegre redirected spending toward underserved neighborhoods; studies found increased investment in sanitation and health, with associated reductions in infant mortality (Gonçalves, World Development, 2014). Likewise, Kerala’s long-run emphasis on public health, literacy, and civic participation helped deliver social indicators outpacing income levels (Drèze and Sen, India: Development and Participation, 2002). These cases illustrate Sen’s claim: when people articulate what impedes their freedoms, policy targets become sharper and delivery more credible. [...]
