News at Medicine - November 2010 - Public engagement in choosing health priorities

Public engagement in choosing health priorities
November 29, 2010
Dr. Roger Chafe, director of pediatric research, is the lead author of an editorial on the need for public engagement in choosing health priorities, released recently in the CMAJ.
The biggest threat to our public health care system, he argues, is not our ability to pay for the increasing cost of care, but rather a loss of public confidence. Increased public engagement has long been recognized as a way to foster greater confidence in our health care system.

"In Canada, numerous government reports and royal commissions dating back to the early 1970s have called for increased public engagement as a way to rejuvenate health reform and restore confidence. Unfortunately, too often the public have not been adequately engaged in decisions which affect them.”

In this editorial, Dr. Chafe cites evidence of neglect of public input even when it has been sought. “For instance, the Royal Commission led by Romanow held extensive public consultations only to have its report mothballed.”

Increased public engagement is more than running the health care system by opinion polls. Dr. Chafe says meaningful public engagement means carefully choosing committed and broadly representative members of the general public, providing them with the essential evidence, finding ways to adequately represent marginalized citizens, eliciting values and expectations from participants and receiving clear guidance from them. This type of public engagement allows citizens to not only weigh evidence but also deliberate on it and contextualize recommendations to local circumstances.

The editorial also explores reasons why leaders have failed to act despite repeated public demands for greater involvement. These reasons include poor or negative experiences with public consultations, the belief that the lay public cannot grasp complex issues, the perceived loss of influence in decision-making, and the time and costs needed for effective public engagement. 

“If we are to embrace substantial public involvement, a genuine commitment is needed from our health leadership,” writes Dr. Chafe. “Federal, provincial and territorial health ministers should articulate expectations for public engagement throughout the system and be prepared to allocate sufficient resources to sustain engagement activities.”

At a time when the sustainability of our health care system is often debated, increasing the transparency and perceived legitimacy of funding and major priority decisions at all levels should be a foremost concern for our health care leaders, says Dr. Chafe. “Providing more opportunities for public involvement and clearly reporting how input is used would reduce public cynicism. More important, we would add a legitimate new voice – that of the public – to aid in making difficult choices.”