1. No category

EExploring why and how l i
h
dh
deliberative processes can support the development
of healthy public policies yp
p
Web Presentation│March 2013
François‐Pierre
François
Pierre Gauvin, PhD
Gauvin PhD
1
National Collaborating
National
Collaborating Centre for Centre for
Healthy Public Policy (NCCHPP)
Our mandate
– to increase the expertise of public health actors across Canada in healthy public policy through the development, sharing and use of knowledge.
Our areas of expertise
–
–
–
–
The effects of public policies on health
Generating and using
and using knowledge about policies
about policies
Intersectoral actors and mechanisms
Strategies
g to influence policy
p y makingg
2
The National Collaborating Centres for Public Health
3
Obesity
(Groupe de travail sur la problématique du poids, 2004, p. 12)
4
A few assumptions about the world we live in…
A few assumptions about the world we live in…
1. We are facing complex public health problems
y
p y p
g
2. There is a lot of uncertainty about the policy options for addressing these problems (i.e. effectiveness, unintended effects, feasibility, costs, acceptability, equity, etc.)
3 We can’tt act alone to address these problems
3. We can
act alone to address these problems
5
© iStockphoto.com/ john shepherd
We need mechanisms…
We need mechanisms…
1. To develop a shared understanding of these problems
2 To better understand what policy options work and in what context
2. To better understand what policy options work and in what context
3. To reach agreement and trigger action
6
© iStockphoto.com/ john shepherd
Deliberative processes appear promising for tackling complex public health problems
tackling complex public health problems
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© iStockphoto.com/alxpin
Objectives
1.
What is a “deliberative process”?
2
2.
What do they have in common and how do they vary?
What do they have in common and how do they vary?
8
Part 1.
What is a deliberative process?
9
© iStockphoto.com/alxpin
Deliberation
1. thoughtful, careful, or lengthy consideration 2. formal discussion and debate, as of a committee, jury, etc.
3. care, thoughtfulness, or absence of hurry, esp. in movement or speech
Consulted on November 6, 2012: http://www.collinsdictionary.com/dictionary/english/deliberation?showCookiePolicy=true
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Deliberative process
Deliberative process
A process allowing a group of actors to receive and exchange information, to critically
i i ll examine an issue, and to come to an agreement which
i
i
d
hi h will
ill
inform decision making
(Inspired by: Fearon, 1998)
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Two bodies of literature
Deliberative democracy
Knowledge translation
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Two bodies of literature
Deliberative democracy
Knowledge translation
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Abelson (2010) on ‘deliberative processes’
“Individuals with different backgrounds, interests, and values listen, learn, and potentially persuade and ultimately come to more reasoned, informed, and public spirited judgments.”
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Why deliberate?
‰ Increase the public accountability of decision‐making processes
‰ Consider the values, needs, preferences, and experiential knowledge of the public
‰ Implement a governance model facilitating consultation and partnership
‰ Provide guidance in the context of social and ethical dilemmas
‰ Ensure that decisions are both relevant and acceptable 15
Two bodies of literature
Deliberative democracy
Knowledge translation
16
Different kinds of e e t ds o
evidence
Political judgment
Professional P
f i
l
experience and expertise
Habits and tradition
Values
Scientific evidence
Resources
Pragmatics Pragmatics
and contingencies
Lobbyists and pressure groups
(Lomas, Culyer, McCutcheon, McAuley & Law, 2005, p. 17)
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CHSRF(2006) on ‘deliberative processes’
“A deliberative process is a tool for producing guidance based on heterogeneous evidence. It is a participatory process that includes representation from experts and stakeholders, face‐to‐
face interaction, criteria for the sources of scientific evidence and their weight, and a mechanism for eliciting colloquial
and their weight, and a mechanism for eliciting colloquial evidence while making it subsidiary to the science.”
Canadian Health Services Research Foundation, 2006, p. 7
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Why deliberate?
‰ Promote the co‐production and co‐interpretation of research
‰ Generate new evidence based on experiential knowledge
Generate new evidence based on experiential knowledge
‰ Contextualize evidence
‰ Provide
Provide policy guidance that considers
policy guidance that considers all the different sources of all the different sources of
evidence
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Part 2.
What do they have in common and how do they vary?
y y
20
© iStockphoto.com/alxpin
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What do they have in common?
What do they have in common?
‰ A group of persons who meet face‐to‐face and/or virtually
‰ Receive and exchange information about an issue
‰ Critically examine the issue
‰ An explicit process for gathering individual and collective input
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At least four dimensions can vary
‰ Goals ‰ Composition of group
f
‰ Policy‐making proximity
‰ Procedural aspects
(Adapted from: Lavis, Boyko, Oxman, Lewin et Law, 2009)
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Goals
+
Develop strategic plan
Formulate recommendations
Formulate value statements
Particip
pants’ degree of pow
wer
Make a decision
Dialogue
Inform
© iStockphoto.com/Keith Webber Jr.
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Group composition
Group composition
Experts
Civil Civil
society
Decision
makers
25
Group composition (2) – the size
Group composition (2) the size
26 50
26‐50
15‐25
100
100+
51‐100
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Group composition (3) – selection
Group composition (3) Random
C it i
Criteria‐
based
((e.g., civil g,
lottery)
Open to all
Participants
27
What is policy‐making proximity?
Proximal
Initiated and Initiated by
Initiated by db
NGO(s) but sponsored by sponsored by gov’t.
IInitiated and iti t d d
sponsored by NGO(s)
gov’t.
Distal
(Adapted from: Dobrow, 2010)
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Procedural aspects
‰ Information / material (e.g., workbook, statements)
( g,
ggroup vs. plenary)
p
p
y)
‰ Deliberative format (e.g., small
‰ Deliberative rules (e.g., Chatham House Rule)
(Lavis et al., 2009) 29
Two examples
Two examples
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Example 1
The Strategic Meeting on Health
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The Strategic Meeting on Health • Initiated in 2005 by the Institut
Initiated in 2005 by the Institut du Nouveau Monde
du Nouveau Monde
• 8 regional public dialogues across the province of Québec
• 1 national public dialogue in Montréal
• 175 citizens and 20 expert witnesses
175 iti
d 20
t it
Overarching objective
Overarching objective
• Achieve a vision of the Québec that citizens aspired to live in 20 years from now
Five dilemmas
1.
2
2.
3.
4.
5
5.
Is health an individual or a collective responsibility?
Is the role of the state to prevent or cure?
Is the role of the state to prevent or cure?
What should be the public and private sector roles in healthcare?
Should we pay more or should we reduce the Medicare basket?
Wh h ld d id b
Who should decide: bureaucrats, physicians, politicians or citizens? t h i i
liti i
iti
?
32
E.g.
- Health Impact Assessment
- Creating an “Office for Public
…Hearings on Health”
www.inm.qc.ca
q
(Institut du nouveau monde, 2005)
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Example 2
The Stakeholder Dialogue on Housing for
people with HIV/AIDS
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The Stakeholder Dialogue
The Stakeholder Dialogue
• Organized in 2010 by the McMaster Health Forum, with support from the Ontario HIV Treatment Network, CIHR, and MOHLTC
Overarching objective
•Examine issues that make it difficult to provide services that meet the housing and health needs of people with HIV/AIDS, 3 options for g
p p
/
, p
addressing these issues, and key implementation considerations
4‐step process
1. Preparatory consultations to frame and characterize the problem and th
three possible policy options to address it ibl
li
ti
t dd
it
2. Before the event, prepare and circulate an evidence brief that mobilizes relevant research evidence about the problem, as well as three p
,
policy options and their implications
3. Fifteen to eighteen officials, leaders, citizens and researchers are convened for an off the record dialogue (Chatham House Rule)
convened for an off‐the‐record dialogue (Chatham House Rule)
4. After the event, prepare and circulate a dialogue summary
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www.mcmasterhealthforum.org
(Lavis, 2010)
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Comparison
Example
The Strategic
Meeting on Health
McMaster Health
Forum
Deliberative
trend
Deliberative
D
lib ti
democracy
Knowledge
translation
Main goal
Group
Formulate
recommenda
tions
Civil society
Dialogue
Hybrid
(i.e., policy
makers, experts and
experts,
civil society)
Size
+175
18‐22
Policy‐
making
proximity
Procedural
aspects
Open to all
Initiated and sponsored by NGO
E.g., Experts’ statements
dd b t
and debates, small group and plenary
deliberations
Purposeful
Initiated by NGO but sponsored by gov’t.
E.g., evidence
brief, plenary
deliberation, Chatham
Chatham House Rule
Selection
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Conclusion & Wrap up
Conclusion & Wrap‐up
38
Deliberative processes appear promising…
Deliberative processes appear promising…
1. To develop a shared understanding of these problems
2 To better understand what policy options work and in what context
2. To better understand what policy options work and in what context
3. To reach agreement and trigger action
39
© iStockphoto.com/ john shepherd
References
•
Abelson, J. (2010). Délibération publique et gouvernance démocratique : théories, pratiques et données probantes. Journées annuelles de santé publique du Québec Montréal March 12 2010 [PowerPoint slides] Retrieved from: publique du Québec, Montréal, March 12 2010. [PowerPoint slides]. Retrieved
from:
http://www.ncchpp.ca/docs/DeliberationJASP2010_AbelsonEN.pdf
•
Canadian Health Services Research Foundation. (2006). Weighting up the evidence: Making evidence‐informed guidance accurate, achievable, and acceptable. Ottawa, Canada: Canadian Health Services Research Foundation. Retrieved from: http://www.chsrf.ca/migrated/pdf/weighing_up_the_evidence_e.pdf
•
deliberation. (n.d.). Collins English Dictionary. Consulted on November 6, 2012: http://www.collinsdictionary.com/dictionary/english/deliberation?showCookiePolicy=true
•
Dobrow, M. (2010). Deliberative methods for combining different types of evidence in the development of policy recommendations. Journées annuelles de santé publique du Québec, Montréal, March 12 2010. [PowerPoint slides]. Retrieved from: http://www.ncchpp.ca/docs/DeliberationJASP2010_DobrowEN.pdf
•
Fearon, J. D. (1998). Deliberation as discussion. In J. Elster (Ed.), Deliberative democracy. (pp. 44‐68). Cambridge: Cambridge University Press.
•
Groupe de travail sur la problématique du poids. (2004). Weight problems in Québec: Getting mobilized. Montréal, Québec: Association pour la santé publique du Québec. Retrieved from: http://www.aspq.org/uploads/pdf/4cd97591b55139‐weight‐problems‐in‐quebec‐getting‐mobilized.pdf
•
Institut du nouveau monde. (2005). 100 idées citoyennes pour un Québec en santé. Fides.
•
Lavis, J. N. (2010). Dialogue summary: Adressing housing challenges faced by people with HIV in Ontario. Hamilton, Canada: McMaster Health Forum. Retrieved from: http://digitalcommons.mcmaster.ca/mhf_dialogue‐summaries/16/
•
Lavis, J. N., Boyko, J. A., Oxman, A. D., Lewin, S., & Fretheim, A. (2009). SUPPORT Tools for evidence
Lavis
J N Boyko J A Oxman A D Lewin S & Fretheim A (2009) SUPPORT Tools for evidence‐informed
informed health Policymaking (STP) 14: (STP) 14:
Organising and using policy dialogues to support evidence‐informed policymaking. Health Research Policy and Systems, 7(Suppl. 1), 1‐8. doi: 10.1186/1478‐4505‐7‐S1‐S14
•
Lomas, J., Culyer, T., McCutcheon, C., McAuley, L., & Law, S. (2005). Conceptualizing and combining evidence for health system guidance. Ottawa, Canada: Canadian Health Services Research Foundation. Retrieved from: http://www.chsrf.ca/Migrated/PDF/insightAction/evidence_e.pdf
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You’re interested in this topic? Visit us at www.ncchpp.ca for more resources on deliberative processes.
Author: François‐Pierre Gauvin, PhD
Editor: Marie‐Christine
Editor: Marie
Christine Hogue
Hogue
Narrator: Michael Keeling
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