Lessons Learned from Putting the Public in Public Health Policy Making at a US Federal Agency - PowerPoint PPT Presentation


PPT – Lessons Learned from Putting the Public in Public Health Policy Making at a US Federal Agency PowerPoint presentation | free to view - id: 274d63-OTNiY


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation

Lessons Learned from Putting the Public in Public Health Policy Making at a US Federal Agency


'Your CDC research is 'dead on arrival' ... Greater social capital more connections between people, enhanced trust. TM. Immunization ... – PowerPoint PPT presentation

Number of Views:71
Avg rating:3.0/5.0
Slides: 40
Provided by: rhb2


Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Lessons Learned from Putting the Public in Public Health Policy Making at a US Federal Agency

Lessons Learned from Putting the Public in Public
Health Policy Making at a US Federal Agency
  • Roger Bernier, PhD, MPH
  • Presented at the Democracy and ParticipationThre
    e Days in Montaione First Edition, Conference
  • Montaione, Italy
  • Nov 12-14, 2009

Why Latest Enhanced Version of Public
Engagement Was Started?
  • Citizen comment at a congressional public hearing
    in 2001
  • Your CDC research is dead on arrival
  • Working together on policy decision was chosen as
    a trust-building approach
  • Goal was to build more trust over the long term
    between government and citizens

Background on Public Engagement At CDC
  • 1. Citizens have legal rights to access
    information and to participate in a limited way
    in advisory committee meetings, though
  • 2. Agency not regulatory, and has not legal
    requirement for public participation
  • 3. Agency has a long history of working with
    non-government partners to implement programs,
    but not to make policy

Background on Public Engagement At CDC
  • 4. 2005-2006 Public deliberation pilot projects
    on pandemic influenza --- proof of principle
    that the public can reach a productive outcome on
    an important CDC policy question.
  • 5. CDC has had a strategic imperative to be
    customer centric
  • 6. Workshop on Public Deliberation in 2007
  • 24 previous projects involving some form of
    public participation

Workshop ConclusionCommon Ground at CDC
  • We share a conviction that creating a genuine
    sense of ownership in public health endeavors
    among persons affected by or interested in the
    outcomes of our work is an effective but
    under-utilized approach for improving and
    achieving our objectives.
  • In short, we believe participation works!

Working Definition of Public Engagement In This
  • The practice by which the agency very actively
    involves members of the public-at-large and
    representatives of stakeholder organizations in
    group dialogue and deliberation sessions to
    better inform a pending policy decision.

The Rationales for Public Engagement
  • Main Product
  • Better decisionsmore correct, feasible, and with
    greater integrity
  • Byproducts
  • Greater sense of ownership and possible support
    for decisions made
  • Greater development of individual capacities and
    sense of self-efficacy and well-being
  • Greater social capitalmore connections between
    people, enhanced trust

Quote from Michael MarmotThe Lancet, Sept 2007
  • At the heart of the concern with social
    determinants of health, and health inequity, is
    concern for people without the freedom to lead
    flourishing livesPeople need the basic material
    requisites for a decent life, they need to have
    control over their lives, and they need political
    voice and participation in decision making

  • Democracy is good for y(our) health!

2x10 Principles of Consequential Public Engagement
  • 1. Both the desire for advice the decision on
    the table are real.
  • 2. Both adequate time to deliberate clarity of
    purpose are provided.
  • 3. Both knowledge of facts attachment to values
    underlie the choices to be made.

2x10 Principles of Consequential Public Engagement
  • 4. Both active agency staff sufficient
    resources are committed to the process.
  • 5. Both impartial citizens-at-large partisan
    stakeholders participate.
  • 6. Both a critical mass diverse group of
    persons participate.

2x10 Principles of Consequential Public Engagement
  • 7. Both unbiased information neutral
    facilitation are provided.
  • 8. Both genuine dialogue thoughtful
    deliberation occur.
  • 9. Best option is chosen and agreed-upon
  • 10. Publics advice receives serious
    consideration participants obtain candid
    feedback about the decision

Model of a Consequential Public Engagement Table
  • 4 geographic areas represented
  • 100 citizens representative of the population by
    age, race, and sex in each area (N400)
  • Day long dialogue and deliberation events
  • Stakeholder representatives from key sectors
    affected (N30-40)
  • Two day long meetings for stakeholders before and
    after the citizens meetings

Projects To Date 2005-09
  • 1. Vaccine priorities I for pandemic flu--2005
  • 2. Community control measures for pandemic
  • 3. CDC goals selection--2006
  • 4. Vaccine priorities II--2008
  • 5. Identification of at risk populations for
    pandemic influenza---2008

Projects to Date 2005-09
  • 6. Six State Demonstration Projects on Pandemic
    Influenza Policy, 2008-09
  • 7. Priorities for the National Vaccine Plan, 2009
  • 8. Criteria and Priorities for the CDC Vaccine
    Safety Research Agenda, 2009
  • 9. Target Level of Preparedness for the H1N1 Mass
    Vaccination Program, 2009
  • 10. Components of a National Vaccine Safety
    System, 2009-10

Pending Decision for the H1N1 Project
  • Should the US take a full-throttle or a
    go-easy approach to vaccination against novel
    H1N1 or an approach somewhere in between?
  • In other words, what should be the target level
    of preparedness? Should we get ready to achieve a
    low, moderate, or high level of vaccination

Results from Citizen Meetings
  • 1000 Participants in 12 Meetings
  • Go Easy 23
  • Moderate 52
  • Full Throttle 25

Stakeholder Meeting (N30)
  • Go Easy 3
  • Moderate 40
  • Full Throttle 57

  • There appears to be strong consistency in the
    judgments of citizens across ten geographic areas
    of the US and in web engagement that a moderate
    intensity mass vaccination program against H1N1
    influenza virus is the preferred approach

  • Stakeholders from 8 key sectors (advocacy,
    minority, professional, federal agencies, local,
    state, military and manufacturing) prefer a
    full-throttle approach.

  • For the public and the stakeholders, the most
    important values are protecting the most people
    against H1N1 and preventing the most
    hospitalizations and deaths.

  • No change adopted in the unofficial full
    throttle approach
  • Currently, vaccine supplies have been more
    limited than projected.
  • Public demand exceeds supply in many areas

  • Overview of the public engagement experience
    between 2001-2009

Accomplishments to Date
  • Never doubt that a small group of thoughtful,
    committed citizens can change the world. Indeed,
    it is the only thing that ever has.
  • Margaret Mead

Accomplishments to Date
  • We have raised awareness of public engagement and
    increased expectations for both citizens and some
    government professionals that the public can and
    should be involved in some decisions.
  • We have obtained additional evidence (proof of
    principle) that public engagement can be done
    productively and can provide useful advice
    adopted by policy makers

Accomplishments to Date
  • We have articulated a set of sound principles for
    guiding agency work in this area.
  • We have developed a feasible model for engaging
    productively with citizens
  • We have increased the capacity of agency
    representatives to conduct public engagement

Lessons Learned to Date
  • There is nothing more difficult to carry out,
    nor more doubtful of success, nor more dangerous
    to handle, than to initiate a new order of
  • Niccolo Machiavelli

Lessons Learned to Date
  • It is difficult to identify and get support for
    public engagement projectsthe culture has not
    changed significantly.
  • The benefits of engaging with citizens are not
    appreciated or valued
  • There are many examples of bad public
  • No CDC structure created yet to conduct public

Lessons Learned to Date
  • Even when supported, the nature and purpose of
    public engagement is poorly understood---there is
    no common agreement about what public engagement
  • Degrees of involvement are not differentiated
  • Seen more as persuasion than consultation and

Lessons Learned to Date
  • Obtaining clarity about the decision to be made
    and the purpose of the project are the most
    difficult tasks
  • These most difficult tasks are also the most
    critical to the success
  • It is as if we needed a process before the real
    process to get the kind of clarity needed for
  • Too much preparation is not feasible

Lessons Learned to Date
  • Public engagement is not rocket science! Its
    more difficult than rocket science!
  • Citizen interest is low
  • Getting representative participants for open
    meetings can be difficult
  • Getting unbiased information and truly neutral
    facilitation is challenging
  • Genuine dialogue and deliberation is difficult in
    a limited time frame
  • Assuring the use of the information always a
  • Getting real feedback is impractical and rare

Lessons Learned to Date
  • It is difficult to isolate and measure the
    contribution of the publics advice in the larger
    stream of all inputs that are used in the final
    decision making.
  • Multiple parties contribute to decision making
  • There can be a long delay between the
    consultation and the final decision

Lessons Learned to Date
  • Honest, accurate evaluation is a difficult.
  • People do not want to say that talking with
    citizens is not a worthwhile thing to do in a
  • The perception is that there are many intangible
    benefits to engaging the public

Possible Results From and Responses To a Public
Summary of the Evidence
  • When done well, public participation improves
    the quality and legitimacy of a decision and
    builds the capacity of all involved to engage in
    the policy process
  • US National Research Council, 2008

Summary of the Evidence
  • Public participation should be fully
    incorporated into environmental assessment and
    decision-making processes, and it should be
    recognized by government agencies and other
    organizers of the processes as a requisite of
    effective action, not merely a formal procedural
  • US National Research Council, 2008

For the Future
  • We need to try more letting-go in a new
    letting-go world
  • Adapted from remarks by Walker Smith at the
    CDC/NCHM conference this month.

For the Future
  • We need to move from the leader as the hero, to
    the leader as the host.
  • -Margaret Wheatley

Favorite Quote
  • When big things are at stake, the danger of
    error is great. Therefore, many should discuss
    and clarify the matter together so the correct
    way may be found.
  • Shotoku Taishi, first Buddhist emperor, 604 AD
About PowerShow.com