Towards a deliberative approach in public health policy making

Abstract

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.