This personal reflection considers the challenges in co-creation in public health over time. The concept of 'co-creation' has existed in community health promotion practice for decades, and points to the perennial challenge to understand context and increase local engagement to solve complex community-wide health problems. While co-creation has become a 'fashionable term' in health promotion, the challenge is that it remains a niche set of processes described in prevention programs. The schism between co-creation as 'process' and policy makers' need for health outcomes remains a barrier to widespread recognition and support. To fully realise the co-creation 'dream', we need a process of more committed co-production using democratised approaches to community engagement. This must be supported by long-term funding to mainstream the process and to demonstrate whether comprehensive co-creation makes an eventual difference in sustainable health outcome improvement.