Deliberative Process Research Articles

Pakistan's Progress on Universal Health Coverage: Lessons Learned in Priority Setting and Challenges Ahead in Reinforcing Primary Healthcare.

Pakistan developed an essential package of health services at the primary healthcare (PHC) level as a key component of health reforms aiming to achieve universal health coverage (UHC). This supplement describes the methods and processes adopted for evidence-informed prioritization of services, policy decisions adopted, and the lessons learned in package design as well as in the transition to effective rollout. The papers conclude that evidence-informed deliberative processes can be effectively applied to design affordable packages of services that represent good value for money and address a major part of the disease burden. Transition to implementation requires a comprehensive assessment of health system gaps, strong engagement of the planning and financing sectors, serious involvement of key national stakeholders and the private health sector, capacity building, and institutionalization of technical and managerial skills. Pakistan's experience highlights the need for updating the evidence and model packages of the Disease Control Priorities 3 (DCP3) initiative and reinforcing international collaboration to support technical guidance to countries in priority setting and UHC reforms.

The Use of Evidence to Design an Essential Package of Health Services in Pakistan: A Review and Analysis of Prioritisation Decisions at Different Stages of the Appraisal Process.

Pakistan embarked on a process of designing an essential package of health services (EPHS) as a pathway towards universal health coverage (UHC). The EPHS design followed an evidence-informed deliberative process; evidence on 170 interventions was introduced along multiple stages of appraisal engaging different stakeholders tasked with prioritising interventions for inclusion. We report on the composition of the package at different stages, analyse trends of prioritised and deprioritised interventions and reflect on the trade-offs made. Quantitative evidence on cost-effectiveness, budget impact, and avoidable burden of disease was presented to stakeholders in stages. We recorded which interventions were prioritised and deprioritised at each stage and carried out three analyses: (1) a review of total number of interventions prioritised at each stage, along with associated costs per capita and disability-adjusted life years (DALYs) averted, to understand changes in affordability and efficiency in the package, (2) an analysis of interventions broken down by decision criteria and intervention characteristics to analyse prioritisation trends across different stages, and (3) a description of the trajectory of interventions broken down by current coverage and cost-effectiveness. Value for money generally increased throughout the process, although not uniformly. Stakeholders largely prioritised interventions with low budget impact and those preventing a high burden of disease. Highly cost-effective interventions were also prioritised, but less consistently throughout the stages of the process. Interventions with high current coverage were overwhelmingly prioritised for inclusion. Evidence-informed deliberative processes can produce actionable and affordable health benefit packages. While cost-effective interventions are generally preferred, other factors play a role and limit efficiency.

Adaptation pathways for effective responses to climate change risks

AbstractClimate related changes are already affecting every area of our world and will increasingly do so as global warming increases, resulting in compounding and cascading risks across multiple locations and sectors. Deliberative processes and anticipatory actions are required to adapt to the associated complex and uncertain systemic risks, with dynamic and long‐term planning needed even where there is limited knowledge of the effectiveness of adaptation. In this focus article, we examine the adaptation pathways developed for the Europe Chapter of the IPCC AR6. We argue that illustrative pathways built on quantitative and qualitative assessment of adaptation effectiveness can inform adaptation planning to manage the increasing severity of risks. We find that as the global warming level increases adaptation pathways can diverge, leading to radically different futures, for example, adaptation responses to sea level rise. We illustrate how adaptation measures for different risks interact resulting in trade‐offs, for example, increasing water scarcity. Although pathways offer a useful framework to address multiple adaptation challenges, other supporting conditions are needed for the successful implementation of adaptation, such as establishing legitimacy and buy‐in through collaboration of various actors and effective governance. Ultimately, adaptation will be increasingly more complex and constrained in a warmer world, increasing risks of losses and damages to people and nature.This article is categorized under: Vulnerability and Adaptation to Climate Change > Institutions for Adaptation The Social Status of Climate Change Knowledge > Climate Science and Decision Making Assessing Impacts of Climate Change > Evaluating Future Impacts of Climate Change Vulnerability and Adaptation to Climate Change > Learning from Cases and Analogies

Precedent and rest stop convergence in reflective equilibrium

The method of reflective equilibrium is typically characterized as a process of two kinds of adjustments: hold fixed one’s current set of commitments/intuitions and adjust rules/principles to account for them, then hold fixed those rules while making adjustments to one’s set of commitments. Repeat until no further adjustments are required. Such characterizations ignore the role of precedent, i.e., information about the commitments and rules of others and how those might serve as guides in one’s own process of deliberation. In this paper we develop a model that narrows in on a local part of a reflective equilibrium process in which a group of peer agents start with identical lists of commitments and work towards finding the rule that captures that set. If successful, we say they reach rest stop interpersonal convergence. The trouble is that, without precedent, reaching this convergence rests on implausible deterministic assumptions. We analyze how far the inclusion of a kind of soft precedent goes towards aiding the group in reaching said convergence when those assumptions are relaxed.

O desafio de reforçar a capacidade mundial de responder de forma equitativa a futuras pandemias

The COVID-19 pandemic, despite the sustained global efforts prior to its emergence under the coordination of the World Health Organization (WHO), demonstrated its insufficiency. Today, debates on how to improve equity in future responses to new pandemics and on how to approach the next World Health Assembly in May 2024 remain imprecise and suffer criticisms regarding the deliberation processes, both in the Working Group on International Health Regulations (IHR) Amendments (WGIHR) and the Intergovernmental Negotiating Body for a new Pandemic Agreement (INB). There is little time left, and WHO and PAHO authorities are urging WHO Member States not to miss this opportunity. However, it is the WHO, as the leader of this process, that bears the primary responsibility for considering "equity" as the foundational value that originated both ongoing initiatives, remembering that containing risks at their source was a guiding principle of the IHR (2005). This commits the community and the international industry to accept that the greater the vulnerability and poverty of a population, the higher the risk of suffering infectious outbreaks, which can contribute to the start of a pandemic. Therefore, no one can be left behind, urging support for the most delayed in improving their capabilities for alert, surveillance, response, resilience, and their technological development and/or access to essential health goods and supplies, with additional financial and organizational resources.

Media Exposure, Political Predispositions, and Conspiracy Theories: Explaining Chinese Beliefs in COVID Origins

Abstract This article examines the underpinning mechanisms of the Chinese public’s belief in two opposing conspiracy theories on the origins of coronavirus disease 2019. Utilizing survey data from 4,251 Chinese internet users, our study reveals both the universality and distinctiveness of mechanisms involved in conspiracy theory beliefs. The distinctiveness primarily emanates from the political system and its media environment, while universality is mainly attributed to the cognitive style of intuitive thinking. In China’s political system, exposure to either domestic or foreign media sources exerts substantial influence on public conspiracy beliefs. Notably, we emphasize the mediating role of political ideologies in domestic media exposure. Exposure to domestic media is more likely to lead conservative individuals to reject the conspiracy asserting COVID-19 originated in a lab in China. Concurrently, nationalism mediates foreign media exposure, reinforcing convictions of U.S.-centered conspiracies. This research shows how media narratives, molded by the political context, generate divergent perspectives on conspiracy theories in China. Furthermore, given the role of intuitive thinking in conspiracy beliefs, our findings highlight the potential for cultivating a more rational society through the promotion of analytical thinking, which requires the public to employ a deliberative and conscious cognitive process when exposed to highly politicized media content.

Collaborative Governance in Government Administration in the Field of State Security Along the Republic of Indonesia (RI)-Malaysia Border Area

In recent decades, new forms of government have emerged to replace managerial models in policy making and execution. According to (Chris Ansell & Alison Gash, 2007), collaborative governance is a concept used by the government to regulate the involvement of nongovernmental parties in formal, consensus-oriented, and deliberative collective decision-making processes that aim to create and implement public policies and manage public programs or assets. This study aims to analyze and describe the collaborative government carried out in the Implementation of the State Mission in the Field of State Border Security between the Republic of Indonesia and Malaysia in North Kalimantan Province. The results show that the collaboration carried out to combat crime in the RI-Malaysia border area has not been optimal. This is based on the high crime rate that occurred in 2018 in the North Kalimantan Province area, which is directly adjacent to Malaysia in the form of illegal logging (as much as 200,000 m³). Foreign fishermen who abet illegal fishing amounted to 474 vessels, the arrest of illegal Indonesian migrant workers captured in Malaysia in 2018 was 6,135 people, and the number of drug smuggling cases increased due to 890 incidents in the border area of Malaysia in North Kalimantan Province. Therefore, to overcome these problems, powerful collaboration among government institutions, the private sector, and the community is needed to support effective communication and coordination to create a conducive atmosphere, crime eradication, and rules of order between the RI-Malaysia border area in North Kalimantan Province.

IDENTIFICATION OF THE LEVEL OF UPBRINGING BY APPLYING THE DIAGNOSTIC METHODOLOGY OF N. P. KAPUSTIN

In Armenian society, the socioeconomic and political developments result in an active reformation of all facets of daily life. The contemporary school is in modernization process. Any competitive educational institution needs ongoing organizational modifications to be competitive and flexible in the face of changing circumstances. There is a conflict between ideas, moral principles, stances, and points of view when society is updated and reformatted. In this respect, among the methodological and theoretical issues with education, in particular, the issues with personality development, upbringing, and preparation to live in the changing circumstances of a worldwide society, as well as the need to express one's uniqueness, are prioritized. In the schools, a variety of pedagogical processes are continually used. Knowledge acquiring, the development of skills and aptitudes, the formation of a scientific worldview, ideological-political and moral-labor education, the process of students' aesthetic and physical development, and other elements of the entire educational process are all geared toward the formation of a harmonious, fully developed personality. Education as a deliberate process for personality development will involve the growth of a knowledgeable personality, life and active pursuits, and readiness for the standards recognized in society. A welleducated person's requests, substance, and tactics differ depending on the social circumstances. What should a modern individual be like to satisfy the demands of a changing society? This is one of the most crucial concerns in the educational process. How can this be achieved in the school environment during the educational process? Today, more than ever before, it is essential to develop a certain set of skills and expertise in a person as well as work toward making this process the major internal need of a person as well as the objective of society and the state. This can be accomplished through forming new worldviews, idealistic and value systems, safe social norms, and cultural traditions through education. 40 Betty Kilerjian The approach of resolving this issue involves pedagogical diagnostics. This is a collection of measurable diagnostic instruments. methods, exams, and questionnaires developed by the author, whose usage will make it evident how well education and personality development have gone, and which will serve as the foundation for future educational work planning.

Complex Interventions for a Complex System? Using Systems Thinking to Explore Ways to Address Unhealthy Commodity Industry Influence on Public Health Policy.

Interventions are needed to prevent and mitigate unhealthy commodity industry (UCI) influence on public health policy. Whilst literature on interventions is emerging, current conceptualisations remain incomplete as they lack considerations of the wider systemic complexities surrounding UCI influence, which may limit intervention effectiveness. This study applies systems thinking as a theoretical lens to help identify and explore how possible interventions relate to one another in the systems in which they are embedded. Related challenges to addressing UCI influence on policy, and actions to support interventions, were also explored. Online participatory workshops were conducted with stakeholders with expertise in UCIs. A systems map, depicting five pathways to UCI influence, and the Action Scales Model were used to help participants identify interventions and guide discussions. Codebook thematic analysis was used to analyse the data. Fifty-two stakeholders participated in 23 workshops. Participants identified 27 diverse, interconnected and interdependent interventions corresponding to the systems map's pathways that reduce the ability of UCIs to influence policy. These include, for example, reform policy financing; regulate public-private partnerships (PPPs); reform science governance and funding; frame and reframe the narrative, challenge neoliberalism and gross domestic product (GDP) growth; leverage human rights; change practices on multistakeholder governance; and reform policy consultation and deliberation processes. Participants also identified four potential key challenges to interventions (ie, difficult to implement or achieve; partially formulated; exploited or misused; requires tailoring for context), and four key actions to help support intervention delivery (ie, coordinate and cooperate with stakeholders; invest in civil society; create a social movement; nurture leadership). A systems thinking lens revealed the theoretical interdependence between disparate and heterogenous interventions. This suggests that to be effective, interventions need to align, work collectively, and be applied synchronously to different parts of the system, including multiple levels of governance. Importantly, these interventions need to be supported by intermediary actions to be achieved. Urgent action is now required to strengthen healthy alliances and implement interventions.

Evaluating the Role of Public Hearings within Deliberative Democracy: Operationalising the Democratic Standards as a Framework

Public hearings are used widely in policy and decision making. Hearings have been subject to criticisms in some academic quarters. While some of these criticisms are valid, hearings have been overlooked in terms of the democratic value at a relational level. It has been suggested in theory that they are valuable for a deliberative approach to democracy, yet very little evidence exists to support this or to illustrate how hearings can best be utilised as part of a deliberative democratic system. This article contributes to the deliberative literature in two key ways. First, I introduce the democratic standards set out by Smith (2009) in a comparative framework, the Democratic Standard Enactment Index (DSEI), which offers a systematic way to analyse public hearing’s capacity to enact core democratic norms inclusiveness, popular control, transparency and considered judgement. Second, using four case studies, I highlight the strengths and weaknesses of hearings, evaluate how effectively they can be coupled with other democratic institutions, and consider where there are best placed to contribute to a deliberative democratic policy making process. Overall, the democratic norms are consistently fulfilled by the hearings. Their limitations can be overcome by changes to the format and by linking the hearings with other participatory and deliberative processes. The findings provide important nuance to our understanding of the role of public hearings as part of a deliberative democratic system.

From inside the head to putting it on the table – supporting reflexive decision-making for unpaid female carers considering higher education

ABSTRACT When unpaid female carers consider whether to pursue higher education (HE), they frequently experience decision-making uncertainties which stem from the structural and cultural challenges associated with their roles as carers. Reflexivity is a critical part of decision-making, as it empowers individuals to mediate between the present and future within the structural and cultural conditions which impact and guide their actions. To investigate the reflexive deliberation processes unpaid female carers engage in as part of their HE decision-making processes, this study analysed data from an in-depth, qualitative Australian study with 15 unpaid female carers who were considering higher education. Dialogic processes including narrative interviews and a card sort activity made visible the array of mental activities involved in reflexive decision-making by carers. Considering the more and less productive types of reflexive inner conversations which had been identified enabled participants to reflexively adjust the efficacy of some of their decision-making processes. This study contributes to the reflective and career counselling literature by theorising the cognitively and emotionally complex personal and structural demands of HE decision-making. By conceptualising reflexive decision-making anew, unpaid female carers and HE institutions can better identify and address the structural and cultural conditions which may be influencing their HE decision-making.

“You’re Really Stuck”: Housing Strategies and Compromises in the San Francisco Bay Area

Over the past decade, housing prices in many regions of the United States have increased precipitously. This is especially true in the San Francisco Bay Area, a region that has experienced an influx of highly paid tech workers and a tightening of the housing market. Against this backdrop, this article examines the strategies and compromises that a racially and socioeconomically diverse group of Bay Area residents use to maintain housing. Drawing on survey and interview data, the article finds that both homeowners and nonhomeowners described feeling “stuck in place” as prices rose around them. Yet nonhomeowners made greater compromises to maintain housing, including (1) living in structurally inadequate housing; (2) moving in with friends and relatives; and (3) accepting legally precarious living arrangements. Although research on housing often focuses on why families move, this article reconfigures immobility as a deliberate process, documenting the trade-offs families make to keep their homes.

The Washington Climate Assembly: note-taking modalities as deliberative guidance in an online citizens’ assembly

ABSTRACT In this essay, we use applied rhetorical criticism to analyze how facilitators navigate online deliberation in the Washington Climate Assembly, a public deliberation process held virtually in January and February 2021. We draw on interviews with organizers and facilitators and from observational notes taken by the research team during Assembly deliberations. This analysis focuses on the Assembly's online note-taking practices. Previous research has recognized note-taking as an important element to the design of democratic processes, and we argue that note-taking modalities constitute a form of deliberative guidance. We examine the Assembly’s use of note-taking modalities for deliberative guidance across spatial and temporal dimensions, thus expanding the concept of deliberative guidance into other forms of communication. Additionally, results revealing shortcomings in note-taking suggest employing augmented note-taking practices during online public deliberation processes, with implications for scoping, staffing, and budgeting of such processes, as well as the potential application of artificial intelligence.

Great in Theory, but . . .: Planner’s Perceptions of Queensland’s Performance-Based System

Performance-based planning (PBP) is an approach to regulatory planning that aims to achieve strategic objectives without mandating how those objectives are achieved. After more than twenty years of use in Australia, there has been little consideration of planners’ views of PBP. We survey planners about PBP and find that while there is in-principal support, considerable challenges are involved in successful implementation. Our findings highlight the conflicted and politicized landscape in which planners operate and indicate that the specific mechanisms used to deliver planning outcomes are perhaps less important than matters of trust, professionalism, and deliberative processes of plan development.

Forward‐Looking Responsibility and Political Corporate Social Responsibility

AbstractThis paper contributes to the literature on political corporate social responsibility (PCSR) by considering the forward‐looking, political responsibilities of corporations in relation to structural injustice, based on a critical engagement with Iris Marion Young's Social Connection Model (SCM) of responsibility. Although Young's SCM serves as a key reference point in the PCSR literature, engagement with her work tends to be superficial and lacks critical engagement. By offering a more developed engagement with Young's SCM, this paper addresses several themes that have been highlighted as being insufficiently developed in the PCSR literature. In particular, this paper considers (i) the grounds for corporate political responsibility in relation to structural injustice rather than globalization; (ii) the scope of corporate political responsibilities vis‐à‐vis other actors; and (iii) the role of power in relation to deliberative processes and in relation to scope.

Can Deliberation Have Lasting Effects?

Does deliberation produce any lasting effects? “America in One Room” was a national field experiment in which more than 500 randomly selected registered voters were brought from all over the country to deliberate on five major issues facing the country. A pre-post control group was also surveyed on the same questions after the weekend and about a year later. There were significant differences in voting intention and in actual voting behavior a year later among the deliberators compared to the control group. This article accounts for these differences by showing how deliberation stimulated a latent variable of political engagement. If deliberation has lasting effects on political engagement, then it provides a rationale for attempts to scale the deliberative process to much larger numbers. The article considers methods for doing so in the context of the broader debate about mini-publics, isolated spheres of deliberation situated within a largely non-deliberative society.

Epistemic Vice Rehabilitation: Saints and Sinners Zetetic Exemplarism

AbstractThis paper proposes a novel educational approach to epistemic vice rehabilitation. Its authors Gerry Dunne and Alkis Kotsonis note that, like Quassim Cassam, they remain optimistic about the possibility of improvement with regard to epistemic vice. However, unlike Cassam, who places the burden of minimizing or overcoming epistemic vices and their consequences on the individual, Dunne and Kotsonis argue that vice rehabilitation is best tackled via the exemplarist animated community of inquiry zetetic principles and defeasible‐reasons‐regulated deliberative processes. The vice‐reduction method they propose is made up of four distinct yet complementary components: (1) positive exemplarism of epistemic virtue (saints), (2) negative exemplarism of epistemic vice (sinners), (3) direct teaching/instruction, and (4) cognitive apprenticeship. Dunne and Kotsonis argue that this pedagogical intervention appropriately considers learnings deriving from forensic scrutiny of both ideal and non‐ideal interpersonally calibrated zetetic features integral to knowledge acquisition as well as wider societal influences impacting the development of agents' epistemic character. It bridges research on vice epistemology (Cassam's obstructivist theory), social epistemology (corrupted social processes mitigating against vice rehabilitation), virtue epistemology, and moral exemplarism.

Disutility of climate change damages may warrant much stricter climate targets

Cost-benefit integrated assessment models (IAMs) inform the policy deliberation process by determining cost-optimal greenhouse gas emission reduction pathways based on economic considerations. These models seek to maximise economic utility and treat estimates of climate impacts (damages) and mitigation costs at par as GDP losses, having the same impact on utility reduction. However, prospect theory suggests that a certain level of climate damages could be valued higher by society than the same level of mitigation costs, as climate damages often occur as sudden unexpected events. In this paper, we show how this concept could be taken into account in cost-benefit IAMs and explore possible consequences on optimal mitigation pathways. Our results suggest that compared to the standard utility approach, capturing explicit aversion to climate impact incidence shows optimal pathways with earlier and deeper emission reduction, lowering both net-negative emissions and mid-century temperature peaks in line with stringent Paris Agreement targets.

A new conceptual framework for understanding and implementing train-the-trainer professional development on a large scale

ABSTRACT Professional development (PD) is critical to improving practice across all professional fields, including education. However, implementation of PD on a large scale is far from straightforward. Although train-the-trainer (TTT) approaches are widely used, there are numerous recognised weaknesses with implementation and limited analyses of the mechanisms that underlie such PD. In this paper, we propose a new conceptual framework to strengthen the adoption of TTT approaches by addressing three interconnected domains: substantive (content), structural (delivery), and relational (relationships). The framework was derived from analysis of our own approach to PD for teachers, Quality Teaching Rounds (QTR), which has shown significant positive effects for teachers and students through robust research. Our analysis demonstrates that QTR involves deliberate processes in each domain that counter the common weaknesses of TTT approaches. We argue that systematic attention to all three domains of the proposed conceptual framework will bolster successful implementation of PD using TTT approaches.

Creating pathways to just and sustainable food systems with citizen assemblies

Food systems affect and are affected by the interrelated crises of climate change, biodiversity loss, resource depletion and health, amongst others. Transforming to sustainable approaches is vital, yet entangled with uncertainties, complexity and a great value diversion with stakeholders. Deliberative processes such as citizen assemblies offer a valuable contribution to such a transformation, since the crises and their responses affect everyday life, and therefore inviting individual and collective action. Still, who is included and whose knowledge counts affects outcomes. Theoretically anchored in concepts of environmental justice, our study analyses three nation-wide citizens’ assemblies on climate change and food systems from Western Europe. It assesses (a) how citizens’ assemblies can incorporate a broad set of viewpoints and design more substantive political answers to current crises, and (b) whether citizens’ assemblies include environmental justice aspects to facilitate social change. The paper argues that systematic and methodologically reflected inclusion of various positionalities can inspire decision-making processes in that they incorporate procedural, recognition, and distributional justice to address problems of climate change or modern food systems. It concludes with offering further approaches to include more than scientific knowledge in deliberative processes for a just transformation towards sustainability.