INTRODUCTION:
Contemporary public health policy increasingly emphasizes inclusive, equitable, and sustainable approaches to addressing complex health challenges through community participation. Within this framework, social activism has emerged as an important mechanism for expanding public engagement in health systems and ensuring the representation of vulnerable populations in public health decision-making. Activist initiatives often function as intermediaries between communities and state institutions, translating lived experiences into policy-relevant knowledge and highlighting unmet health needs.

OBJECTIVE:
This study aims to examine vulnerable social activism as a structural driver of public health policy development. It explores how civil society initiatives influence policy agendas, promote health equity, and contribute to participatory and sustainable health governance. Russia is analyzed as a contextual case illustrating both the opportunities and limitations of activist-driven policy transformation within a global perspective.

METHODS:
The study employs a qualitative research design combining document analysis and expert interviews (N = 25). Interviewees included activists and leaders of organizations working in HIV/AIDS prevention, mental health, and related public health fields. The analytical framework integrates concepts from participatory governance, health equity and social movement studies.

RESULTS:
The findings demonstrate that social activism plays a significant role in identifying unmet health needs, mobilizing public awareness, and advancing policy reforms aimed at improving healthcare accessibility and quality. In the Russian context, patient organizations and medical communities have influenced health programs, and resource allocation decisions through advocacy efforts, public expertise, and institutional dialogue. Activist engagement contributes to responsiveness within public health systems. At the same time, some structural barriers moderate the long-term impact of activist initiatives on policy outcomes.

CONCLUSIONS:
Social activism should be recognized as an integral component of public health policy. Systematic integration of activist participation into governance frameworks can support equitable health outcomes and foster sustainable, inclusive public health reforms across diverse socio-political contexts.