Creating conditions to empower local people is an important determinant of health, and crucial in addressing health inequity. Yet, experimentation with initiatives to support public participation at a local level is threatened by enduring global economic instability. A better understanding of how different participatory approaches might address the social determinants of health would support future prioritisation of actions and investment.We reviewed recent literature and theories on initiatives to increase peoples’ influence in local decision-making and on social determinants of health. Our synthesis found little detail about the form and function of initiatives, but diverse factors deemed influential in achieving outcomes. Studies highlighted that pressure on resources undermines individual and community capacities to participate, and requires organisational leaders to think/act differently.Suggested priorities for local governance are: supporting capabilities and relationships between organisations and communities; creating safe and equitable spaces for interaction and knowledge-sharing; and changing institutional culture.