Unpacking the ‘Public’ in Public Engagement: In Search of Black Communities
Reports
Overview
Overview
abstract
Public engagement in health policy encompasses several visions, mandates, frameworks, and approaches, which are aimed at including the broader public in health policy decision-making processes. This includes models that offer tools and methods (e.g., hearings, focus groups, citizen panels, etc.) for consulting and partnering with communities to facilitate their participation in policy decision-making. This kind of public engagement is often described as integral to policy decision-making and the quality of health services (Gauvin & Abelson, 2006; Ham, 2001, 85; Health Canada, 2000; Polletta, 2016). These approaches signal an openness to hearing the diverse views of Canadians and suggests a shift away from the more top-down approaches to health policy decision-making that governments have traditionally employed.
However, closer examination of these public engagement practices reveal gaps that call the true depth and breadth of these initiatives into question, therefore chipping away at their legitimacy and efficacy. Some scholars have argued that public engagement in health policy practices are often performative in nature, described by Polletta (2016) as “spectacles of public participation”. They can also be prone to political interference, are often inadequately resourced, can result in unfulfilled expectations (Gauvin & Abelson, 2006; Polletta, 2016; Shore & Williams, 2018), and can be self-selecting and designed in ways that make inclusive engagement difficult (Dhamanaskar et al., 2022). Other critical scholars have also pointed to a systemic privileging of amenable and acquiescent perspectives that do not disrupt the status quo, in addition to a devaluation, cooptation, and delegitimization of dissenting and critical voices (Glimmerveen, 2019).
In seeking out or privileging more agreeable voices, the gaps, inequities, and problems within health care systems can be left inadequately addressed. As a result, populations that are already marginalized and vulnerable, including those with lay expertise (i.e. lived experience with chronic health conditions), are further silenced and invisibilized (Tritter, 2006). There is also evidence to suggest that there are many community voices missing from these conversations when they do take place, such as Indigenous, racialized, and Black perspectives (Balkissoon, 2020; Datta et al., 2021; Dhamanaskar et al., 2022; Grant & Balkissoon, 2019; Lau, 2021; McKenzie, 2020). For example, in Dhamanaskar et al.’s (2022) recent review of government-initiated public and patient engagement activities in health policy from 2001-2021, only 8/132 (14%) of the cases mentioned prioritizing or engaging with marginalized populations, and it is difficult to assess the efficacy of even these few efforts to be inclusive.
This raises the question, who really is ‘the public’ in public engagement––and how legitimate and effective can these processes be with such critical gaps in representation?
