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Trust between citizens and the institutions that govern them is essential for effective policy, especially in public health. Across the world, higher levels of trust in government are associated with higher uptake of public health guidance, from vaccinations and use of preventive health services to physical distancing recommendations during epidemics.1,2 However, against a backdrop of escalating political polarization and rising levels of misinformation, there has been a stark decline in public confidence in government and health institutions. In 1966, 73% of people expressed a “great deal of confidence” in those running the medical system. By 2012, only 34% did.3 In 2024, the Edelman Trust Barometer revealed that 70% of US respondents worried government leaders were purposely trying to mislead them.4 This trend has a negative impact on health care delivery at almost every level, from patient–doctor relationships to national population health efforts. Public participation in decision making is one strategy policymakers can use to strengthen trust in health governance. Citizen engagement has historically been used to inform policies across a range of social issues, often to great success, yet it is still largely underused in the health sector.5 When efforts have been made to engage communities, they have often been through quantitative and nondeliberative frameworks favored by many health economists, such as discrete choice experiments, surveys, and polls.6 Meaningful public reasoning is essential to address moral and civic questions, especially in areas of scarce resources that necessitate transparent and inclusive decision-making processes.7 In an increasingly divided political atmosphere, there is a pressing need for policymakers to explore innovative ways to engage the public, gather diverse perspectives, and build common ground on controversial and complex issues of public health policy. Democratic deliberation offers such a framework. We argue that, by facilitating formal and goal-driven discussion between leaders and the public, deliberation can be used as a tool to build understanding between participants with competing viewpoints and can ultimately improve the quality and responsiveness of public health policy. Here we examine the potential of democratic deliberation to improve health sector governance. We discuss the unique benefits of deliberative approaches, limitations, and how deliberation can be scaled up to influence public health policy.