Unit 7

Question 1

discuss the concept of public participation, its related concepts and the conceptual framework.

Answer 1

A useful means of gaining a better understanding of citizen participation is to view it along a spectrum or ladder:

• At the lower end of the ladder (considered to be non-participation, according to Arnstein’s ladder) are processes in which power holders seek to educate the public on particular issues (public forums).
• Slightly higher on the ladder (referred to as tokenism) are mechanisms or processes for consulting individuals and groups who are potentially affected by proposed or current policy (royal commissions, advisory bodies, round tables).
• Still higher on the rungs of the ladder (citizen power), individuals or groups are invited to share in decision making or assume full responsibility and authority for decisions. At this higher level, a fundamental transfer of decision making power from traditional decision makers (politicians, bureaucrats, health providers) to citizens must occur.

The concept of empowerment, the way(s) in which individuals or communities gain control over issues that affect them

By definition, participation is a social process through which individuals or groups attempt to define their needs, make decisions, and establish the means to meet their needs. Thus, individuals or groups must be empowered to participate fully.

Question 2

identify what past experience has taught us about public participation in health care.

Answer 2

While the research in this area has been limited, what has been carried out indicates community boards in health care, whether elected or appointed, have not been overly successful in fostering public participation or empowerment

In recent years, however, public participation in health care decision making has been clearly advocated in many health systems of the world in, including Canada. One example is the Health Canada Policy Toolkit for Public Involvement in Decision Making, published in 2000 to support Health Canada’s mission to maintain and improve the health of Canadians by providing direction for Health Canada employees on public involvement. The document affirms the department’s commitment to public involvement.

Question 3

identify future possibilities for public participation in health care decision making.

Answer 3

Increasingly we realize that health care decisions are more than technical: they have a strong value component, including quality of life concerns.

Research has shown that, when given appropriate information of choices for treatment, patients are able to, and want to, make decisions for themselves. Of greater interest is that they tend to choose less aggressive and cheaper courses of action than their physicians choose. This finding suggests that public participation has the potential to make similar decisions which could reduce health care costs.

A second area of consideration for future directions is the capacity of communities to participate—that is, the community’s “social capital.” Health care reformers have assumed that communities are willing and able to take on new roles that were previously the responsibility of government or providers.