Towards a deliberative approach in public health policy making

Abstract The time when public health policies could be based solely on expert opinion has gone. Public opinion has a real impact on the effectiveness of public health policy. However, for complex issues such as vaccination, screening, GMO’s, privacy and data governance, public opinion is divided. How to integrate divided public opinions into a well-structured health policy? In Belgium, as in many other countries, policy makers have started to turn to deliberative processes to guide policy making with citizen involvement, especially in ethically contentious areas. Deliberative processes aim to involve citizens in policy making in a setting where individual opinions and interests are weighed honestly and fairly, so that through well informed deliberation common ground can emerge. Participants are informed by a neutral information package, a variety of experts and facilitated discussions. In a very transparent way, these positions are molded into tailored policy inputs. In Belgium, such initiatives have recently been organized on biobanking, genomics, e-health, reimbursement policies and more. In France, the government is obliged by law to organize a comprehensive deliberative public consultation on bioethical issues every seven years. Especially in areas that require a large degree of trust, a deliberative approach ensures policies that can be supported by people with diverse views. They offer a viable alternative to traditional models of power and conflict that is more suitable to governance in 21st century democracies. They allow citizens to make a meaningful contribution to topics they may not have been familiar with beforehand, but that do touch on their private lives and interests. The most recent Belgian initiative resulted in nine concrete policy inputs for the implementation of genomics in health care, presented directly by the citizens to the Minister of Public Health. The French initiative is the basis for the current review of the law on bioethics in parliament. Key messages Public health issues touch the interests of all citizens: citizen deliberation should be regarded as an important input for public health policies. A deliberative approach enhances public trust, especially in areas of social or ethical contention.

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Policy Success and Public Health: The Case of Public Health in England

Journal of Social Policy ◽

10.1017/s0047279411000985 ◽

2012 ◽

Vol 41 (2) ◽

pp. 391-408 ◽

Cited By ~ 3

Author(s):

ROB BAGGOTT

Keyword(s):

Public Health ◽

Health Policy ◽

Public Health Policy ◽

Policy Making ◽

Health Policies ◽

The Political ◽

Public Health Policies ◽

Policy Success ◽

Political Analysis ◽

Political Dimensions

AbstractLike many countries, England has introduced a range of policies and strategies on public health since the early 1990s. Using concepts drawn from the policy success and failure literature, this article concludes that recent governments in England achieved only ‘precarious success’ in McConnell's typology. It demonstrates, with wider significance, that success or failure is not merely about policy achievement in programme terms, but that policy processes and the political dimensions of policy must be included in any evaluation. It also highlights the adversarial nature of public health policy, the subjectivity of judgments about effectiveness and the political problems this creates for government. The article pinpoints the relevance of public health policies for judgements about government competence, trustworthiness and accountability. It argues that failures of public health policy, including poor evaluation and failures to learn from experience, may be more comprehensible by adopting a political analysis of public policy making in this field.

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Paternalism, Autonomy, and the Common Good

10.1093/oso/9780192844057.003.0005 ◽

2021 ◽

pp. 89-109

Author(s):

James Wilson

Keyword(s):

Public Health ◽

Public Policy ◽

Health Policy ◽

Public Health Policy ◽

Common Good ◽

Health Policies ◽

Public Health Policies ◽

Individual Level ◽

The Common Good ◽

The Common

Public health policies are often accused of being paternalistic, or to show the ‘Nanny State’ in action. This chapter argues that complaints about paternalism in public health policy are, for a variety of reasons, much less convincing than is often thought. First, for conceptual reasons, it is difficult to specify what it would be for a policy to be paternalistic. Second, two of the elements that make paternalism problematic at an individual level—interference with liberty and lack of individual consent—are endemic to public policy contexts in general and so cannot be used to support the claim that paternalism in particular is wrong. The chapter concludes that instead of debating whether a given policy is paternalistic, it would be better to ask whether the infringements of liberty it contains are justifiable, without placing any weight on whether or not those infringements of liberty are paternalistic.

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Public health policy in developed countries

10.1093/med/9780198816805.003.0022 ◽

2021 ◽

pp. 323-338

Author(s):

John Powles ◽

Hebe Gouda

Keyword(s):

Public Health ◽

Health Policy ◽

Public Health Policy ◽

Good Deal ◽

Developed Countries ◽

Health Policies ◽

Relative Importance ◽

Public Health Policies ◽

Underlying Theme ◽

Improve Health

Public health policies might thus be thought of as the policies that guide these ‘organized efforts’ to protect and improve health. The scope of such policies depends a good deal, however, on what is considered to be entailed by ‘organized efforts’. and on how centrally ‘organized efforts’ are understood to be related to efforts that are more decentralized, more informal, less organized, perhaps even ‘spontaneous’. The relative importance and legitimacy of centralized versus decentralized uses of knowledge in protecting and enhancing health is a common underlying theme in discussion of public health policy. This chapter discusses public health policy, and differences in outcomes, across different developed countries.

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Physicians, the State and Public Health in Chile, 1881–1891

Journal of Latin American Studies ◽

10.1017/s0022216x00011603 ◽

1995 ◽

Vol 27 (3) ◽

pp. 551-567 ◽

Cited By ~ 29

Author(s):

Carl J. Murdock

Keyword(s):

Public Health ◽

Health Policy ◽

Public Health Policy ◽

Central Government ◽

Health Policies ◽

Medical Professionals ◽

Government Officials ◽

Deep Roots ◽

Public Health Policies ◽

The Social

AbstractThis study of public health policy in Chile uncovers some of the social tensions in that country during the 1880s, and illustrates the fragmentation of the Chilean elite prior to the Revolution of 1891. The Chilean government's controversial and contested public health policies implied the increasing bureaucratic organisation and regulation of society. The justifications offered for these policies by central government officials reveal both the deep roots in Chilean politics of a powerful Executive, and the early linkage between the ‘scientific discourses’ of medical professionals and the bureaucratic centralisation of state power.

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Food industry influence on public health policy, research and practice in Latin America

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.321 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Mialon ◽

E Perez ◽

C Corvalan ◽

C Monteiro ◽

P Jaime ◽

...

Keyword(s):

Public Health ◽

Latin America ◽

Health Policy ◽

Public Health Policy ◽

Food Industry ◽

Policy Research ◽

Health Policies ◽

Policy Makers ◽

Public Health Policies ◽

Research And Practice

Abstract One of the key barriers to the development of public health policies, such as restrictions on marketing of unhealthy foods to children, is the influence of corporations, also known as corporate political activity' (CPA). This project aimed to identify the CPA of the food industry in Brazil, Colombia and Chile, over a 2-year period. This research consisted of a document analysis of publicly available information triangulated with interviews. It contributed to, and was based on methods developed by INFORMAS (International Network for Food and Obesity / non-communicable Diseases Research, Monitoring and Action Support), which aims to monitor food environments. In all three countries, the food industry lobbied against public health policies and had direct access to high ranking officials and policy makers. It also shifted the blame away from its products in the obesity and non-communicable diseases epidemic onto individuals and their lack of education. In Brazil, the food industry was active against a new front-of-pack labeling, setting up its own website to promote an alternative model and self-regulation. In Colombia, the food industry captured the media and had strong ties with the government, including through nutrition programmes. Public health advocates felt unsafe when speaking against the industry or its products. In Chile, despite advances with the introduction of public health policies to limit the sales and marketing of unhealthy products, the food industry, including the sweeteners industry, which was not affected by the recent legislation, was still influencing policy, research and practice. Food industry actors, including local companies and transnationals, used several CPA strategies in Latin America to try and influence public health policy, research and practice. It is urgent that policy makers, academics and other individuals in public health are aware of these practices and equipped with solutions to address undue influence by the food industry Key messages In Latin America, the food industry used several CPA practices, which collectively could have a negative influence on public health policy, research and practice. These practices could delay efforts to protect and promote public health in the region.

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Defending public health policies from objections of paternalism

University of Western Ontario Medical Journal ◽

10.5206/uwomj.v85i2.4131 ◽

2016 ◽

Vol 85 (2) ◽

pp. 50-52 ◽

Cited By ~ 1

Author(s):

Matthew Greenacre

Keyword(s):

Public Health ◽

Quality Of Life ◽

Health Policy ◽

Social Welfare ◽

Public Health Policy ◽

Sufficient Reason ◽

Health Policies ◽

Public Health Policies ◽

Common Criticism

Paternalism is defined as an action that infringes a person’s liberty and is performed without their consent, but is intended to improve a person’s welfare. As such, many public health policies are criticized as being paternalistic because they attempt to influence citizens’ behaviours to prevent disease or injury. Therefore, public health advocates ought to be aware of what justifies paternalism. Arguments based on the harm principle are the strongest defense of paternalistic policies in Western culture, but reinforcing an individual’s integrity and improving social welfare may also be considered sufficient reasons. In practice, what is considered sufficient reason for paternalism depends upon the culture of the affected society. Collectivist cultures are willing to accept a paternalistic policy in exchange for a better quality of life for their whole community, but individualist cultures are very averse to such a trade. This article provides examples of how these principles arise in the debate over implementing anti-obesity legislation. Advocates must recognize paternalism and know when it is acceptable in order to defend public health policy from that common criticism.

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