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There is a growing trend toward public engagement in health policy making. But despite widespread enthusiasm, there remains a surprising lack of normative clarity about the what the specific goal (or goals) of public engagement in health policy making ought to be. This lack of clarity presents a barrier to sound policy development in this area. For without a clear sense of what public engagement in health policy making should aim at, it is difficult to know when, if at all, it should be pursued, what form (or forms) it ought to take, and which “publics” ought to be included

This presentation aims to shed some light on the normative foundations of public engagement in health policy making. I focus, in particular, on the notion that public engagement is justified because it enhances the legitimacy of the health policy making process. To orient the discussion, I begin with a question that is too often neglected by proponents of public engagement in health policy making. In a democratic society, where citizens vote on lawmakers who in turn set policy that it carried out by democratically accountable agencies, why do we need public engagement at all? Drawing on a theory of participatory policy making developed by Archon Fung, I argue that public engagement should be seen as a means of addressing various deficits in the representative policy making process. These deficits include the fact that citizens often have unclear or unstable policy preferences, that periodic elections send only blunt and infrequent signals to policymakers, and that administrative agencies often lack the capacity to achieve successful policy outcomes without the cooperation of actors in the public sphere. I provide examples of how each of these deficits play out in the health policy making process, and show how different forms of public engagement might be used to address them. I show that there is no “one size fits all” approach to be had, and that different desiderata of public engagement activities—such as being widely inclusive and being fully deliberative—are sometimes in tension with each other.

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