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Citizens’ voices for better health and social policies

Representatives from Karolinska Institutet, the Knowledge to Policy Center and the McMaster Health Forum discuss the importance of citizen engagement in policy-making processes.

Citizen engagement is important to make health and social policies more inclusive and equitable, and to contribute to learning and responsive health and social systems. It is also valuable in understanding the complexities of the social structure and how to adequately respond to them with policies. By engaging citizens, we ensure that their tacit knowledge feeds into the policy-making process. What citizens know can be valuable in identifying feasible policy options, understanding contextual factors, and putting policies into practice. In addition, the benefit of citizen engagement extends much beyond improving health policy-making processes by making them more participatory and inclusive; being engaged in policy-making processes can build patients’ capacity and empower them to speak up for their own and their families’ health and social needs, and to hold policy-makers accountable. Moreover, apart from being involved in their own care, citizen-patients can contribute to quality improvement, research and education.

Most studies on citizen engagement to date originate from high-income countries. The engagement methods used are not necessarily applicable in low- and middle-income countries, and even the political support, the culture of engagement and established citizen engagement processes might be different. Still, published processes of engaging citizens can be helpful in identifying key components across different settings, e.g. in terms of levels of engagement, communication channels and methods of recruitment. Contextualizing the modes of engagement between and within countries is a must.

Examples of citizen engagement

There are many examples of ad hoc citizen engagement initiatives at local, national and international levels. Participedia, a repository of public participation initiatives around the globe, showcases that the field of citizen engagement is extremely vibrant.  In the United Kingdom, the Citizens’ Council of the National Institute for Health and Clinical Excellence (NICE) provides NICE with a public perspective on overarching moral and ethical issues that NICE has to take into account when producing guidance. In the United States of America, the National Issues Forum supports the implementation of deliberative forums on pressing national policy issues. Yet, there are few examples that have long-standing programs of engagement and that engage citizens in evidence-informed policymaking.

A pioneer in engaging citizens in health policy-making processes is the McMaster Health Forum in Hamilton, Canada. The citizens who are invited to engage in a “citizen panel” first receive a pre-circulated, plain-language briefing document to spark deliberation about a pressing health and social-system issue. During the panels, citizens then discuss the problem and its causes, options to address it and implementation considerations. The values that they believe should underpin action to address the issue are captured in a panel summary which is used to inform a policy dialogue on the same topic, also organized by the McMaster Health Forum.

Previous citizen panels have deliberated on topics such as improving access to palliative care in Ontario or planning for the future health workforce of Ontario. Preliminary evaluation findings have shown that the citizen panel is a robust approach to systematically elicit citizens’ core values, preferences and insights to spark action, and where appropriate, in empowering citizens to address health and social issues.

Inspired by the McMaster Health Forum, the Knowledge to Policy (K2P) Center at the American University in Beirut, Lebanon, is another pioneer in citizen engagement, especially in the Arab world. Acknowledging that many factors influence citizen engagement (from human and financial resources being available to support such processes, to citizen’s being used and able to contribute to policy-making processes, to policymakers being ready to listen to and act upon what citizens have to share with them), K2P has gone through an iterative learning process to contextualize citizen engagement processes. Adaptations were required to the selection criteria, recruitment of participants, engagement process, and the reliance on data visuals and animated videos more than the briefing documents. This learning process also led to a qualitative study to develop a contextual model for citizen engagement in health policymaking in the country.

Most recently, K2P engaged citizens in discussing the political and interest-charged issue of childhood obesity in Lebanon (pdf). These consultations contextualized the evidence-informed policies to fit the Lebanese context and to facilitate their effective implementation. Furthermore, the outcome of these citizen consultations shaped the discussions during the national policy dialogue and steered it towards citizens’ preferences and values, especially around the controversial aspects of the policy.

Lessons learned

To learn more on how to engage citizens from varied backgrounds in different health and social topics, we must: 1) ensure having an inclusive, engaging, transparent and contextualized recruitment and implementation plan, 2) establish a robust evaluation platform to assess citizen engagement activities in order to learn from different organizations’ experiences and scale up effective practices, 3) investigate efforts to optimally package research evidence to inform citizen deliberation, and 4) explore how to harness new information and communication technologies to support meaningful citizen engagement, and finally 5) create a demand for citizen engagement among decision-makers and researchers working in health and social policies. Citizens’ views are not nice to have, but necessary to develop inclusive, responsive and equitable health and social policies and enhance accountability levels for policy implementation.


Olivia Biermann is a PhD student at the Department of Public Health Sciences at Karolinska Institutet, Sweden. With a passion for evidence-informed health policy and practice, she is currently investigating the development and implementation of community-based tuberculosis screening policies in Nepal and Vietnam. Follow her on Twitter: @olibiermann. No competing interests declared.

Rana Saleh is the Advocacy and Evidence Lead Specialist at the Knowledge to Policy (K2P) Center at the American University of Beirut, Lebanon. She is leading the advocacy, citizen engagement and capacity building arm at the K2P Center and is involved in multiple knowledge translation initiatives. Follow her on Twitter: @ranasaleh91. No competing interests declared.

François-Pierre Gauvin leads the citizen engagement initiatives and the maintenance and development of Health Systems Evidence and Social Systems Evidence at the McMaster Health Forum, Canada. His research interests focus on evidence-informed policymaking, as well as citizen and patient engagement in addressing pressing policy issues. Follow him on Twitter: @forumCDNhealth. No competing interests declared.

Rima Nakkash is an Associate Professor at the Department of Health Promotion and Community Health and Associate Director of the Knowledge to Policy Center at the American University of Beirut, Lebanon. She is the coordinator of the university’s tobacco control research group and co-directs the WHO Framework Convention on Tobacco Control water pipe tobacco smoking knowledge hub. She is also the Co-Director of the WHO FCTC Knowledge Hub on Waterpipe Tobacco Smoking. Follow her on Twitter: @rimanakkash. No competing interests declared.  

Fadi El-Jardali is the Founder and Director of the Knowledge to Policy Center (WHO Collaborating Center for Evidence-Informed Policy and Practice), Professor of Health Policy and Systems Research and Chairperson at the Department of Health Management and Policy at the American University of Beirut. He is also the Co-Director of the Center for Systematic Reviews in Health Policy and Systems Research (SPARK). Follow him on Twitter: @feljardali @k2pcenter. No competing interests declared.


Featured image credit: Knowledge to Policy Center

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