The Art of the Possible: A Researchers Reflections on Public Engagement and Health Policy

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The Art of the PossibleA Researchers
Reflections on Public Engagement and Health Policy

• Julia Abelson, PhD
• Voices and Choices Public Engagement in Health
  Care Policy
• February 22, 2007, Vancouver, BC

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The Task

• What advice would I give to policy makers at
  different levels of government seeking to engage
  the public in their policy processes?

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Terminology

• Public Engagement in Health Care Policy
• Publics
• Citizen/lay consultants and decision makers who
  vote, lobby politicians, voice opinions, attend
  public meetings, etc.
• Service users/patients
• Advocates for patients, citizens, consumers

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Terminology (2)

• Public Engagement
• Interaction
• Information exchange
• Power sharing
• Response to
• Citizen centered public management ethos
• Changes in state-society relationships
• Past failures (baggage associated with
  consultation)
• Opportunity to
• re-establish trust between citizens and
  government officials

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Terminology (3)Public Engagement in Health Policy

• Contribution
• Opinions, attitudes, values
• Priorities
• Experiences

• Policy process
• Financing and delivery arrangements
• Technology assessment, adoption and funding
• Resource allocation and re-allocation
• Planning and service design

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Guiding Principles

• Strive for evidence-informed public engagement
• What works and what doesnt re public engagement
  and under what circumstances?

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Guiding Principles (2)

• Recognize the realities of politics-constrained
  public engagement
• Politically contested and value-laden concept
• more so than other health system inputs/goals
  (e.g., quality, accessibility)
• Reluctant consensus about its importance among
  policy makers
• Highly critical and cynical public

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The State of the Research Evidence

• there is a striking imbalance between the
  amount of time, money and energy that governments
  in OECD countries invest in engaging citizens and
  civil society in public decision making and the
  amount of attention they pay to evaluating the
  effectiveness and impact of such efforts.
• (OECD, 2005)

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Enduring Evaluation Challenges

• Complexity and value-laden nature of public
  participation as a concept
• Absence of widely held criteria for judging
  success and failure
• Lack of agreed-upon evaluation methods
• Paucity of reliable measurement tools
• (Rosener, 1981)

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Some Glimmers of Hope

• Growing inventory of engagement frameworks and
  typologies
• Continuous improvement and refinement through
  application and rigorous evaluation
• Resonance between decision makers and citizens
  about what constitutes successful public
  participation
• (Abelson and Gauvin, 2006 Abelson et al. SSM,
  forthcoming)

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Still Needed

• Consistency in categorizing methods/approaches
• Understanding role of contextual influences
• Reconcile different conceptualizations of public
  engagement
• Technical vs. socially constructed processes

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Key Messages I. Process

• Process matters
• Transparency Clear communication of objectives,
  format and how input will be used
• Legitimacy Credible, trustworthy facilitators
  and information mediators
• Accountability Ability to demonstrate engagement
  decision links

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Key Messages I. Process (2)

• Information
• WHAT what is accessible content?
• HOW what formats to use how to tailor to
  different education levels, learning styles
• WHO who are credible and trusted sources of
  information

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Key Messages I. Process (3)

• Context also matters
• exerts fostering and inhibiting influences that
  contribute to more (and less) successful
  implementation
• some aspects matter more than others
• e.g., issues, decisions and timelines,
  organizational resources/commitment vs. community
  characteristics, political culture/history,
  pre-existing organizational expertise
• (Beierle, 2002 Abelson et al. SSM,
  forthcoming)

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Key Messages I. Process (4)

• Match method to context
• E.g, deliberative methods are better suited to
  issues
• Where there are clearly articulated, acceptable
  decision options
• Where tangible links can be drawn between the
  consultation and the decision process (not as
  useful for planning processes)

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Key Messages II. Outcomes

• Impacts on participants
• Public engagement processes produce
• increased levels of interest in and knowledge of
  public issues
• improved capacity for future public involvement
• increased propensity for social bond formation
  and
• improved trust of fellow citizens

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Key Messages II. Outcomes (2)

• Impacts on policy and political processes
• Fewer compelling, coherent messages
• What to measure? How to measure? Over what time
  frame?
• Impacts on decision makers and organizations
• Needs further exploration

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Reflections on Current Public Engagement
Initiatives

• Public engagement, health technology assessment
  and coverage policies
• How do we infuse expert-driven, highly technical
  processes with public values and social
  judgments?

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Institutionalizing Public Engagement in HT
Assessment/Policy

• Canadian Expert Drug Advisory Committee (CEDAC)
  appoints two public members to its committee to
  bring a lay perspective to drug review process
• Ontarios Bill 102 The Transparent Drug System
  for Patients Act, 2006 recommends establishment
  of a citizens council

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Pursuing the Art of the Possible

• Be clear about the purpose or
• Consolidate and act on what you have before going
  out to the public again
• Engage the public about meaningful things (dont
  just engage meaningfully!)
• Be open to ideas and lessons from other
  jurisdictions but be wary of the panacea
• Aim high re public engagement standards and
  associated public debates

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Fostering a Public Engagement Agenda Through

• Nurturing political institutions and culture
  required (can/should we be more like Denmark?)
• Supportive civic organizations that promote civic
  literacy and participation
• Promotion of health literacy through media
  channels (clone Andre Picard?)
• Democratic dialogue and civic-minded journalism
  vs. fear-mongering through advocacy journalism

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News Release MCGUINTY GOVERNMENT HOLDING PUBLIC
CONSULTATION ON FUTURE OF HEALTH CARE Government
Wants To Hear From Ontarians on 10-Year Strategic
Plan
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