Citizen participation has been included as part of health reform, often in the form of lay health authorities. In Canada, these authorities are variously known as regional health boards or councils. A set of challenges is associated with citizen participation in regional health authorities. These challenges relate to: differences in opinion about whether there should be citizen participation at all; differences in perception of the levels and processes of participation; differences in opinion with respect to the roles and responsibilities of health authority members; differences in opinion about the appropriate composition of the authorities; differences in opinion about the requisite skills and attributes of health authority members; having a good support base (staff, good information, board development); understanding and operationalizing various roles of the board (governance and policy setting) versus the board staff (management and administration); difficulties in ensuring the accountability of the health authorities; and measuring the results of the work and decisions of the health authorities. Despite these challenges, regional health authorities are gaining support as both theoretically sound and pragmatically based approaches to health-system reform. This review of the above challenges suggests that each of the concerns remains a significant threat to meaningful public participation.
Every couple of decades governments decide that they need to involve citizens more in public decision-making processes. The significant changes that have occurred over the past decade, including a growing loss of faith in the traditional institutions of government, have once again prompted political decision-makers to explore options for enhanced citizen participation. In the health care sector, reforms occurring during the 1990s were couched in terms such as "enhanced responsiveness," "improved accountability," and "increased citizen participation." In the new millennium, governments and regional health authorities have been relatively silent on this issue. As has been the case in the past, a wide range of opinions exist about what citizen participation is and how governments should proceed. Without either conceptual clarity or practical direction, governments have been slow to articulate what they hope to achieve or how they intend to get there. The purpose of this paper is to examine the concept of citizen participation within the context of a series of basic questions from which decision-makers might draw some policy relevance. Rather than taking a particular disciplinary perspective (i.e. health promotion), the authors have chosen to review a broad spectrum of existing literature to provide a better understanding of what is known about citizen participation, both good and bad. As such, the paper is meant to be a point of departure for an informed discussion of the possibilities for improved citizen participation in health (care) decision-making.
The process of technology assessment is evolving. The process of policy development for technology is the least understood in the cycle of technology assessment. The process of policy development, which should involve extensive consultation and a broad-based research and evaluation program, is often fraught with difficulties and can cause further analysis or the assessment process to come grinding to a halt. This article reviews some social, political, and ethical issues and the role of civil society in influencing the technology assessment process for new reproductive technologies in Canada. It is written from the perspective of one of the Deputy Directors of Research and Evaluation for the Royal Commission on New Reproductive Technologies and highlights the strengths and difficulties of technology assessment when civil society and technology assessment come face to face. A brief update by a policy analyst in Health Canada on the current situation of legislation on new reproductive technologies has been provided and is included at the end of this article.
This paper presents the organisation, progression, and main findings from a community-based substance use prevention project in five municipalities in western Norway. At the central level, this project was organised with a steering committee and a principal project leader, who is situated at the Department of Health and Social Welfare at the county level. Locally, the way of organizing differed, as one would expect from the community-based model. Top-down/bottom-up strategies can apply both in the way a community organises its efforts, as well as in the relationship between the central project organisation and the participating local communities. It is argued that it can be beneficial for the success of community action programs if one attains a "good mix" between top-down and bottom-up strategies. Factors of importance for such "mix" in the Hordaland project were that the municipalities applied for participation, the availability of economic funding, the venues for meetings between central and local project management, the position of local coordinators, the possibilities for coupling project work to otherwise existing community planning, and the extent of formal bureaucracy.
Since the beginning of the 1970s, the province of Quebec has undergone a major reform of its health and social services system. Following this reform, the state has become a major protagonist, and the participation of the population is a built-in element in the system, guaranteed by law. Now, about 20 years later, there is a major effort to reorganize health services, in the wake of a "dewelfarization" mood that has reached Canada and Quebec. This article reviews the successes and pitfalls of public participation in Quebec's health system, presents the way in which participation is dealt with in current reform proposals, and draws lessons for people in many countries who have recently been encouraged to jump onto the bandwagon of participation as a strategy to promote the health of populations.
I present ideas about how community psychologists, as researcher-activists, can influence public policy. I begin by describing the current neo-liberal era, noting the immense obstacles it poses to progressive policy change. Next I contrast two approaches to understanding policy formation, evidence-based policy and discursive policy analysis, and argue that transformative policy change can benefit from both approaches. I then propose three types of policy outcomes that community psychology research and activism should aim to promote: (a) shaping problem definition, (b) controlling channels for debate and participation, and (c) allocating resources. I use examples from community psychologists' involvement in policy, mostly in Canada, to illustrate how such policy change can be both achieved and constrained. I conclude by discussing implications for theory and practice related to policy change.
This essay considers the arenas of advocacy, politics, and self-reflection in strengthening conservation and resource management initiatives. It frames key questions that reflective conservation practitioners may address in seeking to enhance the results of conservation projects, including equity and more inclusive participation by nonprivileged groups. The essay touches on the importance of understanding conservation work within particular political and historic dynamics, including the need to understand non-Western and/or indigenous or traditional perspectives on conservation. The author makes the case that Western or privileged conservation practitioners are uniquely situated to advocate effectively for change.