The Health Canada Policy Toolkit for Public Involvement in Decision Making

Departmental Policy
Health Canada's Public Involvement Continuum

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Inform, Consult or Engage?

This section provides guidance that is useful to consider during the preparation phase of any public involvement initiative.

The delivery of health services is a complex, multijurisdictional responsibility. Success depends on collaboration and coordination among many partners and stakeholders, including federal, provincial and territorial governments; First Nations and Inuit organizations; the voluntary and community sector; health professionals; the private sector; and individual Canadians. Health Canada's mission - to help the people of Canada maintain and improve their health - goes to the core of the federal role in health and highlights the collaborative nature of health service delivery in Canada.

Before deciding to involve the public, one needs to ask fundamental questions:

• What is the main purpose of the public involvement exercise?
• Is it to inform/educate, gather information/views, discuss through a two-way dialogue; fully engage on complex issues; or partner in the implementation of solutions

It may be appropriate to involve the public in:

• Matters of health, promotion, safety and other areas
• Development and implementation of legislation and regulations
• Development of policies, statutes and new programs
• Preparation of business plans
• Issues with social, economic, cultural or ethical implications
• Sharing or disseminating information
• Resolving questions that revolve around conflicting values.

Levels of Involvement

Health Canada's five levels of public involvement are highlighted below, together with criteria for selecting each level. These criteria are intended to guide the planning process by highlighting the main objectives of the public involvement levels. Combinations or hybrids of techniques may be required depending on objectives, available resources and other factors.

Level 1 Inform/Educate when:

• Factual information is needed to describe a policy, program or process
• A decision has already been made (no decision is required)
• The public needs to know the results of a process
• There is no opportunity to influence the final outcome
• There is need for acceptance of a proposal or decision before a decision may be made
• An emergency or crisis requires immediate action
• Information is necessary to abate concerns or prepare for involvement
• The issue is relatively simple

Level 2 Gather Information/Views when:

• The purpose is primarily to listen and gather information
• Policy decisions are still being shaped and discretion is required
• There may not be a firm commitment to do anything with the views collected (we advise participants from the outset of this intention to manage expectations)

Level 3 Discuss or Involve when:

• We need two-way information exchange
• Individuals and groups have an interest in the issue and will likely be affected by the outcome
• There is an opportunity to influence the final outcome
• We wish to encourage discussion among and with stakeholders
• Input may shape policy directions/program delivery
• What is the main purpose of the public involvement exercise?
• Is it to inform/educate, gather information/views, discuss through a two-way dialogue; fully engage on complex issues; or partner in the implementation of solutions

Level 4 Engage when:

• We need citizens to talk to each other regarding complex, value-laden issues
• There is a capacity for citizens to shape policies and decisions that affect them
• There is opportunity for shared agenda setting and open time frames for deliberation on issues
• Options generated together will be respected

Level 5 Partner when:

We want to empower citizens and groups to manage the process

• Citizens and groups have accepted the challenge of developing solutions themselves
• We are ready to assume the role of enabler
• There is an agreement to implement solutions generated by citizens and groups

Canadians expect their governments to provide appropriate opportunities for their involvement. The key word here is appropriate. Canadians do not expect their governments to involve them extensively in every issue. That would paralyze policy making and quickly exhaust citizen participants. A rough guideline on whether to involve citizens/groups at the higher level of the continuum is the extent to which the issues at play involve potential conflicts in values or identity, difficult choices or trade-offs that would entail a major impact on either citizens' health or the health system. The greater the impact in these areas, the more likely the issue should be considered for citizen engagement.

A key component at levels four and five of the public involvement continuum is also the potential political implications of an engagement process. In order to ensure integration of results from an engagement process into the policy making and program planning of the department, it is important that political support, as well as departmental, is strong and clear.

To summarize, the decision to inform, consult or engage and the related selection of a public involvement strategy is dependent on a number of complex, interrelated factors:

• Tailoring of approaches for involvement with goal and phase of policy making
• Level of influence and involvement participants expect to have
• Nature and complexity of issues
• Participant profiles (e.g. mix of citizen vs. group representatives)
• Previous experience of organizers with various techniques
• Level of concern and media attention around the issues
• Timelines
• Financial costs
• Human Resources and expertise
• Degree of federal/provincial/territorial collaboration required
• Level of support from stakeholders/partners
• Level of political support in department or across government.

What Is Citizen Engagement?

This section provides an overview of what the department means when it refers to citizen engagement. Citizen engagement is a process that:

• Involves citizens, not just the public as represented by associations, health professionals, lobbyists and interest groups, in policy formulation, priority setting and program delivery
• Is a key component of "governance," namely the process and traditions that determine how a society steers itself and how citizens are accorded a voice on issues of public concern, and how decisions are made on these issues
• Builds on, complements and generally moves beyond information distribution and consultation practices. It does not replace "traditional" consultation with stakeholder organizations, nor does it replace citizens' role in the broader democratic process. Its purpose is to provide new opportunities to bring interested parties together as civic-minded individuals concerned about health issues.

The process of engaging citizens may be differentiated
from a more formal citizen engagement process.

• Process of engaging citizens - Individual Canadians can become "engaged" in an issue in a number of ways - as citizens, consumers, parents, community association members or experts. In this context, citizen engagement may be as simple as taking part in a focus group, answering an opinion poll, signing a petition or making a presentation to an advisory panel or board of trustees. It also refers, in this context, to the daily contact that citizens have with the department across the country on many aspects of health.
• Formal citizen engagement process - Broader, more formalized citizen "engagement" means becoming more actively involved in an issue over a longer period of time, ideally through a substantive, deliberative dialogue that promotes mutual learning, shared decision making, and possibly ongoing partnership or collaboration.

Formal citizen engagement processes:

• Occur throughout the policy development process
• Begin from the assumption that citizens add value and bring important new perspectives
• Broaden the flow of communication among participants in the process, by creating opportunities for citizens to talk to and learn from one another
• Are open-ended processes, in which the specific outcomes are unknown at the outset
• Allow for serious, substantive, deliberative, in-depth consideration of values and principles, choices, trade-offs in search for common ground
• Are supported by factual, balanced information that is written in plain language and delivered in a transparent, meaningful and timely way
• Are based on a mutual two-way learning between citizens and decision makers
• Take time, are resource intensive and can often be an ongoing process
• Can empower communities close to the location of action or concern to define the resources they need, establish their own timelines and terms of reference, and determine an appropriate role for governments on the basis of the expertise, input or buy-in required to support community goals
• Involve non-traditional evaluation methods, including the following key components:
  • the results are public
  • citizens are involved in the evaluation process
  • the focus is on outcomes (impact for clients and citizens), not merely outputs (e.g. the number of units of service provided or number of clients served). Outcomes include many different types of benefits or changes (e.g. changes in knowledge, attitudes, values, skills, behaviour, conditions or status).

Citizen engagement processes or techniques may be distinguished from "traditional" public consultation methods. "Traditional" public consultation is known for the following:

• Tends to focus on groups of stakeholders
• Seeks to test, validate or prioritize policy options that have already been developed, at least in preliminary form
• Tends to take place after the initial stages, and sometimes after the middle stages, of the policy development process when certain parameters have by then been set
• Establishes clear parameters within which stakeholders' views will be accepted
• May involve "relatively" tight deadlines.

Citizen engagement techniques are located at the high end of the public involvement continuum. The response to the Sydney Tar Ponds contaminants issue in Cape Breton, Nova Scotia illustrates a community based citizen engagement model at the partnership end of the public involvement continuum. This controversial health and environmental matter is addressed through a community-driven process, in which the government is invited to participate - rather than a government-led process in which the community participates. This approach allows the community to take on a major lead role in designing and implementing the process, and ultimately sharing responsibility for the success or failure of efforts to address this problem.

In summary, citizen engagement refers to the public's involvement in determining how a society steers itself, makes decisions on major public policy issues and delivers programs for the benefit of people. Citizen engagement is closely linked to the concept of social cohesion. Social cohesion refers to the building of shared values, reducing disparities in wealth and income, and enabling people to have a sense that they are engaged in a common enterprise and face shared challenges as members of a same community.