Scoping the shape of an iceberg: the future of public involvement in heath policy: reflecting on 'Public involvement policies in health: exploring their conceptual basis'

Colleen M. Flood
2015 Health Economics, Policy and Law  
Writing in HEPL in 2006, Wait and Nolte scoped out the vague conceptual framework and hazy research base of public involvement in health policy. In doing so, they highlighted: 1. that the meaning of the term 'public' has not been clearly defined, and is used in differing ways across decision-making contexts; 2. that little is known about the motivations and impact of individuals assuming the mantle of 'public' in different decision-making contexts; 3. that there is no firm theoretical
more » ... eoretical foundation specifying the rationale for involving the public in decision making; and 4. that attempts to evaluate the impact of public involvement in decision making raise a host of methodological challenges. Over the past nine years, the science of public participation has evolved, but still problems of definition and clarity bedevil the field, underscoring the essential problem of a lack of a firm theoretical foundation. Asked for a candid assessment, leading Canadian expert Julia Abelson concedes that the field is still very much in its nascencewith progress over the past decade consisting mainly of clarifying the conceptual terrain, and articulating the myriad challenges involved in defining and achieving 'high-quality' public participation. Despite the limited research base, senior decision makers want evidence that public participation makes a difference and evidence as how to best implement public participation in decision making. In what follows, I provide a few reflections on this field, arguing that public participation confers legitimacy on public institutions, quite independently of its quantifiable impact on policy making, but this means that there are great dangers associated with insincere or ineffectual attempts at public participation.
doi:10.1017/s1744133115000092 pmid:25998467 fatcat:grosmfb54bachotr62ozyo73ay