Public consultation is a difficult and multi-layered process, with no single approach working effectively for all situations (Doubleday & Wilsdon, 2013). Governments must implement clear goals and techniques when engaging in public consultation (OECD, 2001). Networking, using tools that are fit-for-purpose, and ensuring citizens are aware of their legal and ethical rights are elements needed in the public consultation process. Citizens are demanding that they be involved in influencing “policies and decisions that affect them” (Health Canada, 2000, p. 11), especially with health care. Health Canada has developed a public involvement continuum, which attempts to guide policy makers in how to consult with the public on health related matters, depending on the situation at hand.
Three Main Themes
Governments are increasingly interested in moving toward a model of active participation, where they gather the opinions of the public and other organizations, and factor this information into policy making (OECD, 2001). Three main themes were identified regarding the types of activities and considerations involved in public consultation. The first is the importance of networking and creating cohesiveness across organizations (Doubleday & Wilsdon, 2013; Pal, 2010). This outcome may have been easier to accomplish in hierarchical organizations, but with the rise of social media, flat structures, and open innovation, it becomes more difficult (Doubleday & Wildson, 2013). Furthermore, some networks are more isolated, while others are strongly connected through multiple organizations. If information is not communicated properly to all relevant parties, this uneven distribution creates a barrier to forming a single coherent goal. To increase the chances of reaching the highest number of networks, it is important to target the networks with the most influence and connections (Doubleday & Wilsdon, 2013). Governments might also take on a form of “horizontal management,” where they help coordinate the activities of different organizations, and create cohesiveness among diverse interests (Pal, 2010). Sometimes, tension may occur between different groups, and it is important to keep this in check and encourage collaboration instead of conflict (Doubleday & Wilsdon, 2013; Health Canada, 2000).
The second theme focuses on citizen engagement, and using tools that are fit-for-purpose when consulting with the public. Countries have different infrastructures and societal needs, and therefore will require different tools to achieve the best results. For example, a country where many people can access the internet could benefit from online communication tools like surveys, forums, and blogs. On the other hand, a country with poor or unreliable internet service might benefit more from public hearings (OECD, 2001). Additionally, it is important for governments to understand the limits of citizen engagement. Online conversations could easily become emotionally fueled or hostile, and the original purpose of the consultation could be derailed and buried (Doubleday & Wilsdon, 2013).
The second theme ties in closely with the third, and focuses on the importance of ethical consultation. A good example is the use of text mining to analyze the public’s opinions (Bisquelet & Weale, 2011). With growing participation through online channels, policy makers need to be aware of issues with privacy and confidentiality. People should be informed of how the government will analyze their opinions and how this information will be presented (Bisquelet & Weale, 2011). It is essential to predict the types of challenges and requirements that may arise, and ensure that the proper infrastructure is in place. This helps the government remain transparent and accountable with its actions and decision making procedures.
Health Canada’s Public Involvement Continuum
Rooted in practicality, Health Canada’s (HC) citizen engagement policy is an excellent example of the above themes in practice. With about half of Canadians believing the federal government needed to improve how it involved the public on health care decisions (Health Canada, 2000, p. 11), the government began making changes to how it consulted with the public. The government recognized that health care was not solely a technical issue, but a social one as well. As a social issue, health care is connected with Canadian values; therefore, engagement plays an important role in improving health care services (Health Canada, 2000). Additionally, consulting with citizens contributes to public confidence in the government because it can foster “honesty, transparency, [and] openness” (Health Canada, 2000, p. 14) in the decision making process.
HC established a policy surrounding citizen engagement in federal health decisions by creating a public involvement continuum. HC believes that the public should be consulted at varying levels, depending on the issue. Five public involvement levels exist, each one building upon the degree of citizen engagement. Recognizing the importance of fit-for-purpose tools, HC’s public engagement efforts must complement its overall objectives and available resources (Health Canada, 2000; OECD, 2001). HC has presented each level with examples of key tools and their required resources. According to Health Canada (2000), the five levels are as follows:
- Level 1 focuses on informing and educating citizens, and should be used when “the issue is simple, when a decision has already been made” (p. 32) or when the decision needs to be accepted by the public, due to the urgency of the issue. A call for briefs, community mapping, 1-800 numbers, information kits, mailouts, and advertising are appropriate techniques to inform or educate citizens.
- Level 2 focuses on gathering information and opinions. This should be used when decisions have not been made, and are currently being developed. Questionnaires, polling, Parliamentary committees, public meetings, bilateral meetings, and royal commissions are used to gather information from the public to help inform a decision.
- Level 3 focuses on discussing and involving citizens in the development of policy. This should be used when stakeholders will be affected by the decision. Some of the tools that are used in level 3 include advisory committees, workshops, and the use of computer-assisted participation technology, which includes electronic conferences, online discussion groups, list servers, and televoting.
- Level 4 focuses on engaging the public when the issue at hand is complex, value-laden, and requires citizen input. When citizens’ capacity to guide policy and programs is recognized and brought to bear, the results are more publicly trusted and respected. Constituent assemblies, Delphi processes, retreats, roundtables, and charrettes are appropriate tools for engaging the public.
- Level 5 focuses on partnerships. This level goes beyond recognizing public capacity and aims to empower citizen groups. This level should be used when governments are ready to act as enablers, and when citizens and groups indicate they wish to develop solutions themselves. Within this partnership, it is crucial that there is agreement to implement solutions generated by citizens and groups. Some of the tools used in level 5 include citizens’ juries, consensus conferences, study groups, and think tanks.
HC wanted to create a new regulatory framework for pharmaceutical companies wishing to advertise their drugs to consumers. Many stakeholders believed the current regulations were too restrictive, and harmed free commercial speech. HC decided to make changes to its regulations using public engagement tools because policy outcomes would directly affect certain stakeholders such as drug companies, health practitioners, consumers, and internal departments (Health Canada, 2000). HC’s public engagement efforts in this case served as an example of a situation warranting the use of level 3 tools and techniques.
HC used workshops and web-based communication technologies to facilitate consultation at every stage of the policy development process. Numerous workshops were conducted with stakeholders, whereby policy options were generated and assessed, and documents were posted on the department’s website to enhance transparency. To support the workshops and web-based communication, HC coordinated research efforts between both federal and provincial levels of government (Health Canada, 2000).
The selection of workshops may allow stakeholders with diverse perspectives to collaborate. This approach has the potential to lead to better understanding of the perspectives and issues at play. A disadvantage to the workshop process is that stakeholders may be unaware of the limited resources available to implement ideas. Additionally, posting documents online may be limiting stakeholders who can be engaged in the consultation process to those with internet access (Health Canada, 2000).
The process was not without two significant barriers. The first was the presence of a variety of opinions during the discussion. It became evident that many competing interests existed amongst stakeholders, which may create challenges in making policy decisions. Second, the public consultation may not have been as inclusive as it could have been. Participants were selected by HC based on staff opinion of who would add to the debate, and by participants’ interest in the matter (Health Canada, 2000). This selection excluded potentially influential stakeholders that HC staff had overlooked and stakeholders that had little interest.
Overall, the consultative process and web-based communication were deemed effective in informing key stakeholders. Stakeholders gained a better understanding of each other’s perspectives and available options. As a result of the fit-for-purpose approach and level 3 engagement tools, HC achieved more internal cohesiveness and collaboration on issues regarding advertising drugs to consumers.
Bisquelet, A., & Weale, A. (2011). Coping with the cornucopia: Can text mining help handle the data deluge in public policy analysis? Policy & Internet, 3(4), Article 5.
Doubleday, R., & Wilsdon, J. (2013, April). Section 4, networks, publics and policy. In Future directions for scientific advice in Whitehall (pp. 86-120). A collaborative initiative of the University of Cambridge; University of Sussex, Alliance for Useful Evidence; Institute for Government; and Sciencewise.
Health Canada. (2001). Health Canada policy toolkit for public involvement in decision making. Ottawa, Ontario: Public Works and Government Services Canada.
OECD. (2001, July). Engaging citizens in policy making: Information, consultation and public participation. Paris: OECD.
Pal, L. A. (2010). Public issue management in turbulent times. In Beyond policy analysis (4th ed.) (pp. 255-303). United States of America: Nelson Education.
Authors: Spencer Covey, Jaq-Lin Larder, and Meghan Murphy
This blog post is part of a series of posts authored by students in the graduate course “The Role of Information in Public Policy and Decision Making,” offered at Dalhousie University.