Public Engagement and Democratic Deliberation
in Health and Healthcare
The idea that ordinary people and patients should have a voice in health research, policy, and practice is now widely accepted in the US and abroad. Participatory processes vary in name and method, but all share key democratic and egalitarian aspirations. They seek to involve people of diverse backgrounds and experiences in setting priorities, informing research and policy, designing systems, and disseminating results—all aimed at more effective and equitable healthcare and health for all.
Participatory processes have a long history in public health and primary care, dating back to the 1978 Alma Ata Declaration, which formalized public participation as a guiding principle of health promotion and clinical services. Today, processes as varied as patient-centered outcomes research, community advisory boards, and community-based participatory research are institutionalized within the structures and funding mechanisms of public health and healthcare.
More recently, democratic deliberation – also known as public deliberation – has taken root in the US health sector. Deliberative engagement has been increasingly used over the past two decades to bring informed public perspectives into policy debates about, for example, health reform, resource allocation, pandemic planning, biotechnology, and genomic research.
Although there is no consensus definition of deliberative engagement, in general “public deliberation engages ordinary citizens with diverse perspectives in reasoned and respectful discussion about important social issues in search of well-informed proposals that deliberators will view as legitimate” (Blacksher E, et al. 2012; see also Burkhalter et al. 2010). A controlled trial of deliberative methods conducted by the Agency of Healthcare Research and Quality showed that deliberation increases knowledge among diverse participants, impacts deliberants’ reasoning, and is valued by participants, particularly members of racial and ethnic minority groups and those with lower levels of education (Carman KL, et al. 2015, Wang G, et al. 2015).