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Santé publique France has been developing participatory approaches in the field of local environmental health investigations for around twenty years. An initial assessment of this activity was carried out in 2016. Comparing four types of participatory process implemented on different polluted sites, this work aims to reflect on the contributions and limits of such approaches. Local stakeholders’ involvement has allowed those involved to voice their health concerns and their expectations about the studies to be conducted, as well as for points of disagreement or misunderstanding, and questions about the results obtained to be expressed. In some cases, it has led to improving the quality of the scientific results produced, by integrating local knowledge and taking into account the needs expressed. It has also sometimes increased the acceptability of environmental pollution management options. The outcome of the process depends on a combination of multiple factors in which the subjectivity of those involved and the type of solicitation play a major role. The agency has since set up new modes of participation based on co-construction processes initiated ahead of investigations. Citizen workshops have been set up to design and promote, with committed and non-committed stakeholders, the health perception study that will be carried out around the Lacq industrial basin. Santé publique France is also developing various methods aimed in particular at evaluating its participatory processes.