The Use of Public Involvement in Canadian Health Policy Decision-Making

Abstract

<p>In this age of accountability, responsiveness, and transparency, governments are increasingly pressured to develop ways to demonstrate the value of public involvement in policy decision-making. Yet the extent to which policy decisions actually reflect citizens’ views and input from public involvement processes remains relatively unknown. The main purpose of my dissertation is to examine the internal dynamics of how public involvement is used in the health policy decision-making process. It is guided by two research questions: i) How is public involvement used in the health policy decision-making process; and ii) What factors influence the use of public involvement in the health policy decision-making process? These questions are explored through three independent but complementary studies: i) through a concept analysis, to clarify the concept of public involvement use in health policy decision-making; ii) through a document analysis, to examine the values and assumptions that underpin current and proposed relationships between publics and government, how these have evolved over time, and the meaning of public involvement itself; and iii) through a literature review and key informant interviews, to identify the range of factors influencing the nature of how public involvement is used. The concept of public involvement use, as presented in this thesis, is a complex<strong><em> </em></strong>concept that may be understood, interpreted and operationalized through three interrelated questions: What is the meaning of use in relation to other similar concepts? What is public involvement used for? And, how do we know public involvement was used in health policy decision-making? The results of this dissertation also reveal numerous tensions that characterize the dynamics of how public involvement is used in policy decision-making. Taken together, the three studies provide insights into ways in which public administrators and policy decision-makers could respond to calls for greater accountability and transparency regarding the use of public involvement in policy decision-making.</p>