Reimagining Public Engagement: a reflection
By Joanna Massie, Roma Dhamanaskar, and Rana Saleh
On September 22, 2022, the Public Engagement in Health Policy project team at McMaster University hosted a one-day conference, Reimagining public engagement in a changing world. Community members, engagement practitioners, researchers, and policymakers gathered virtually and in person to discuss the opportunities and pitfalls of public engagement and to envision a way forward. Attendees explored questions such as, what does it mean to engage with communities ethically? How can researchers use new approaches to engagement to tackle contemporary health policy issues with communities? And what are the roots of mistrust between communities and researchers/policymakers?
Keynote: Transformative Public Engagement: Pitfalls, Possibilities, and Promise
The day opened with Dr. Jamila Michener, Associate Professor of Government and Public Policy at Cornell University. In her keynote presentation, she shared enriching insights on public engagement at the intersections of power, poverty, public policy and racism. Transformative and impactful public engagement continues to be hindered by a range of problems from insufficient resources to structural disincentives. Research must not only seek to avoid tokenism, to meaningfully create space for people to participate; it must also be reflexive. Researchers have a critical role in radically transforming engagement by understanding how their positionality affects their work. They should begin their work by asking: who am I, what are my values, what is my position and role? This reflexivity is essential as it shapes the very research questions we ask and our rationale for engaging with communities. It is from this intersectional lens that Dr. Michener proposed the values of equity, dignity, and democracy as anchors for ethical public engagement.
Dr. Michener further highlighted the importance of recognizing that all communities have power, but not all communities have equal opportunity to exercise this power within formal institutional structures. Instead of talking about “giving a voice to the voiceless,” we should be thinking about why certain communities are silenced, and asking which structures need to change to ensure all community voices are heard and valued. Structural change requires training, oversight, and accountability. But it also requires something more nuanced: humility and passion. Underpinning all this must lie a commitment: as Dr. Michener phrased it, “Why do we do this? To change the world.”
Panel Discussion: Rethinking Public Engagement: Representation, Inclusion, and Legitimacy
Following the keynote presentation was a panel discussion featuring recent and emerging research on engagement.
Dr. Alpha Abebe, Assistant Professor at McMaster University and Rhonda C. George, PhD Candidate at York University, opened the panel, presenting their research on Black community-led engagement in health policymaking. Their research was foregrounded by the profound health inequities facing Black communities during COVID-19 and the impressive mobilization of Black community leaders to address their communities’ needs. Community leaders had to respond quickly and were unable to work in traditional models of public policy which often have long time horizons. Abebe and George’s interviews with these community leaders highlight the failure of traditional models of public policy to engage these communities, such as lack of long-term capacity building, lack of commitment to long-term sustainable funding, and anti-racism work that is limited to symbolic rather than meaningful action. Their calls to action echoed Dr. Michener’s presentation: to shift away from piecemeal, ad hoc engagement initiatives to more genuine engagement that is sustainable and effective; to ensure processes are not only community-informed but also community-led; and finally, to commit to structural change alongside deeper, more meaningful engagement.
Joanna Massie, PhD Student at McMaster University, presented her research, which explored why policymakers choose deliberation as their method of engagement by examining two deliberative engagement initiatives in Canada. Deliberation is a type of public engagement in which citizens learn about and discuss policy issues, reaching reasoned conclusions that are in the public interest. While deliberation is intended to develop meaningful policy recommendations in complex systems with multiple conflicting needs and expertise, Massie found that the rationale for choosing deliberation was largely driven by situational factors, such as budget, risk of public exposure, and the desire to engage a wide range of people. In short, there is a lack of alignment between the potential benefits of deliberation and political actors’ reasons for choosing deliberation as their method of engagement. Massie concluded that more research is required to fully understand this gap. The fact that policymakers chose deliberation without considering its particular theoretical benefits suggests that some of these benefits may not be fully realized.
Finally, Dr. Genevieve Fuji Johnson, Professor of Political Science at Simon Fraser University, presented her work on engagement with sex workers in Canada. Her research focuses attention on the injustices that can occur within public engagement forums, and how this disproportionately affects racialized, stigmatized, and otherwise minoritized communities. In her research, Dr. Johnson points to the failure of policymakers to recognize sex workers as experts. This is a form of epistemic injustice, where individuals are wronged in their capacity as knowledge holders. Furthermore, the stigma of sex workers leads to the failure to recognize their expertise in the policy process, and this systematic exclusion further contributes to policy failures.
Responding to questions from the audience, the panel considered how policy structures may go about (re)building public trust. Not only must policymakers rethink the ways in which they approach engagement, adopting values of humility, honesty, and respect; they must also consider the roots of this mistrust. For many, this lack of trust is a natural response to systemic barriers; and those barriers will not be the same for every community. There is no silver bullet: starting from a position of openness may help develop trust, but it requires continuous action to be maintained.
The afternoon imagined a way forward for public engagement; topics included a public engagement resource guide, developing a course in public engagement and how to continue the conversation through innovative channels such as the Matters of Engagement podcast. Discussions centred around the mass of information that already exists and difficulties navigating these existing materials; the importance of knowing, but also articulating, the values that underpin public engagement work; and the power that comes from capturing success stories of public engagement and policy development.
What next?
The Public Engagement in Health Policy project will run until Summer 2023. Both Abebe and George and Massie’s research, and the resource guide, will be featured on the Public Engagement in Health Policy website (www.engagementinhealthpolicy.ca) when the outputs are published. For more information about the course in public engagement, please see www.engagementinhealthpolicy.ca/education.
To contact the team, please email publicengagement@mcmaster.ca.
Joanna Massie is a PhD student in Political Science at McMaster University. Her research explores deliberative democracy and public opinion, and relationships between citizen and state. She is a Fellow in the Digital Society Lab at McMaster University, and was an inaugural Fellow of the Public Engagement in Health Policy project. She is also a Research Assistant with the Public Engagement in Health Policy team.
Roma Dhamanaskar is a PhD student in the Health Policy program at McMaster University and a research fellow with the Public Engagement in Health Policy Project. Her research interests reside at the intersection of public engagement and health policy ethics. Roma holds a Master of Bioethics from the University of Pennsylvania and aims to apply theory from political philosophy to the field of public engagement in health policy. Roma is also a research assistant with the Public Engagement in Health Policy Project and Public & Patient Engagement Collaborative.
Rana Saleh is a PhD Candidate in Health Policy at McMaster University. She is interested in advancing the role of public engagement in health policy in developing countries. Her thesis work looks at the factors that influence the institutionalization of public engagement initiatives. Rana holds a Master’s degree in Public Health from the American University of Beirut with experience in knowledge translation and evidence-informed policymaking.
The authors would like to thank all virtual and in-person participants and the speakers, for their generosity in providing their time, thoughtful contributions, and honest reflections throughout the day.
This essay was prepared by members of the Public Engagement in Health Policy team, which is supported by the Future of Canada Project at McMaster University. Please visit www.engagementinhealthpolicy.ca for further research outputs and resources.
