A population health approach promotes citizen participation in health improvement. Citizens are provided opportunities to contribute in meaningful ways to the selection of health priorities, the development of strategies, and the review of outcomes.
What are mechanisms for public involvement?
A population health approach includes a public involvement process, which recognizes the importance of the public’s contribution, and the shared accountability of stakeholders, citizens and governments in the development of policies for health improvement. Public is defined as individuals, consumers, citizens, special interest groups, industry, and scientific and professional associations. Involvement refers to the level of participation, which can vary.
To be involved, the public must have:
- interest in the issue
- capacity to become involved
- opportunities for involvement.
Resources to Increase Understanding:
What are the different mechanisms for public involvement in health promotion?
- Count me In! Inclusion Project – Health Nexus
- A Ladder of Citizen Participation – Sherry Arnstein
- Romanow Discussion Paper No. 33: How Can the Public Be Meaningfully Involved in Developing and Maintaining an Overall Vision for the Health System Consistent with Its Values and Principles?
- How will the public be involved?
A) How will the public be involved?
All levels of public involvement represent valid contributions.
A population health approach clearly defines the reason for public involvement. Appropriate techniques for involvement are chosen by asking: “What is the need, and what is the best strategy to address it?” Public involvement strategies and techniques can be grouped into five levels:
- Level 1: Inform and educate while making sure that the presentation and the language are suitable for the target group or audience. When the aim is to notify the public about a decision, to share the results of a process/initiative, to generate support, or to set the stage for more in-depth public involvement at a later time, Level 1 is the preferred strategy. Examples of Level 1 techniques include advertising and social marketing, information kits, and toll-free telephone numbers.
- Level 2: Gather information and views. Level 2 techniques are used to listen and gather information, to get input on evolving policy decisions, or to seek comment on issues, all without any firm commitment to act on those views. (Participants are advised of this from the outset in order to manage expectations.) Examples of Level 2 public involvement techniques include bilateral meetings with stakeholders, community or public meetings, and citizen questionnaires.
- Level 3: Discuss or involve through consultation. Level 3 techniques are the strategy of choice when two-way information exchange is needed, and individuals and groups are affected by and expected to influence the final outcome. Advisory committees, boards or councils, online discussion groups, list servers, and workshops are examples of Level 3 techniques.
- Level 4: Engage citizens. Citizens are engaged when their input is sought on complex and value-laden issues, and when they contribute to shaping policies and decisions that affect them. Examples of Level 4 techniques include Delphi review processes, retreats and round tables.
- Level 5: Partner with citizens. Level 5 techniques for public involvement are most useful when the aim is to empower citizens and groups to manage the planning/policy process. Partnering is also effective when there is an agreement between citizen groups and government to jointly implement solutions. Citizens’ juries, citizens’ panels, and study groups represent examples of Level 5 techniques.
The selection of public involvement strategies is dependent on a number of factors. They include:
- the nature and complexity of the issue
- the goal and phase of the planning/policy process
- the expected level of participant influence
- the participants (e.g. ordinary citizens, interest group representatives)
- the previous experience of facilitators with public involvement techniques
- the time lines, financial costs, human resources and expertise
- the degree of intersectoral collaboration required
- the level of support for public involvement processes from stakeholders and government partners.
How is public involvement achieved?
7.1 Capture the public’s interest
A population health approach not only informs the public of health as a matter of concern, but aims to generate interest and excitement about health within the public mind; the “green environmental movement” of the past few decades is a good example of this. The population health approach tries to place health and its determinants as relevant and sustainable concepts in the public’s mind. It also seeks a broad-based public acceptance and endorsement of various health issues and agendas.
Keeping the issue on the “public agenda” requires watching for and using windows of opportunity, such as piggybacking on media coverage of related issues. The tools of media advocacy (working with the mass media to advance policy solutions) can help to create, pitch, package and present news related to the issue.
7.2 Contribute to health literacy
By engaging citizens, the population health approach advances health literacy. Health literacy refers to a level of knowledge and skills at which personal and community health action can be achieved. Public education campaigns are a common way to develop health literacy. Such campaigns draw upon social marketing concepts and make use of various media including print, television, radio, and the Internet. They also include alternate formats, such as braille, talking books, and closed captioning for persons with physical disabilities. Health literacy efforts help citizens become better health consumers, more prepared to make informed choices about their own health and that of their communities. Besides advancing health literacy, the population health approach works with the existing level of health literacy within populations, as part of the program/policy development process, so that messages are understood and well-received by citizen groups.
7.3 Apply public involvement strategies that link to the overarching purpose
There are many options and opportunities to move citizen involvement beyond simple attempts to “educate” or “cure” an uninvolved population. Simply informing, consulting or reassuring without offering any real power to the public should be avoided. It is better to make a clear decision about the degree to which the public is a partner, so that power or control can be appropriately assigned. Choose the degree that is most desirable, and work openly and clearly within that framework.
Resources that Build Capacity:
What frameworks or guides can help facilitate effective use of mechanisms to involve the public in health promotion initiatives?
- HPFB Public Involvement Framework – Health Canada
- Policy Toolkit for Public Involvement in Decision Making – Health Canada
- Primer on Public Involvement – Health Council of Canada
What do you have at the end of Key Element 7?
- An action plan, which will achieve public involvement.
How does this Key Element relate to the others?
- In order to build involvement, it is important to communicate understandings of health issues, determinants, and context in a clear, convincing and compelling manner (Key Elements 1 and 2).
- It relies upon and must complement the intersectoral partnership structure (Key Element 6).
- The public has keen interest in actual measurable results (Key Element 8).
Why is this Key Element important?
- It increases the level of public acceptance and ownership of decisions and policies.
- It can be used to build relationships based on trust, transparency, accountability, openness and honesty.
- It integrates a wide range of public needs, interests and concerns into decision-making.
- It serves to resolve problems more effectively, through collaborative means.
- It ensures that decisions and solutions incorporate perspectives, knowledge and technical expertise that would not otherwise be available.
- It places issues and projects within a broader technical, social, cultural or ethical context.
- It places citizens as active participants in creating and maintaining health across the lifespan.
Examples Illustrating Application:
What are some examples of public involvement in health promotion initiatives?