Democratising health policy with deliberative mini-publics: Responsibilities, pathologies, and paradoxes
Date
2016
Authors
Settle, Catherine
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Abstract
Throughout the last couple of decades there has been an
unprecedented level of global interest in
democratically-deliberative methods of citizen engagement [now
collectively referred to as deliberative mini-publics -
hereafter, mini-publics]. Part of the allure of mini-publics is
that they provide a more meaningful and effective way for
governments to exchange knowledge and engage in decision-making
with their citizens. Mini-publics are also known to generate
transformative insights for citizens and government
decision-making bodies; demonstrated in the shifting of
pre-formed preferences, the creation of shared understanding, and
collective decision-making. What this transformative potential
might have to offer for citizens when they deliberate on health
policy has not been fully explored, however, especially in
Australian health policy settings where these engagement
techniques are quite novel, with very little known of citizens’
experiences of deliberating and exchanging knowledge in such
circumstances. For instance, it is not really known whether an
exchange of knowledge even occurs, let alone, whether a just
exchange occurs.
This cross-disciplinary, qualitative research reduces this gap in
knowledge and demonstrates how the competing rationalities of the
health policy process and the product-dominant logic within
health service delivery exacerbate the challenges facing health
policy administrators as they grapple with the unfamiliar nature
of mini-publics. Many unintentional consequences with disabling
outcomes for citizens’ experiences of exchanging knowledge and
expressing their deliberative capacities ensue. Two types of
epistemic injustice also became apparent: testimonial injustice,
during which the citizens were not given credibility in their
capacity to convey information; and hermeneutical injustice
whereby the citizens were not given credibility in their capacity
to understand certain things that would be in their best
interests to understand.
So what do these things matter when citizens deliberate over
health policy development? They matter a great deal, not least,
when we consider that one of the fundamental aims of a
mini-public is that the process works toward enabling citizens to
gain a clearer understanding of not only what they might want,
but what is also in their best interests to know. Viewed
holistically, these findings demonstrate why it is important to
pay attention to citizens’ experiences if mini-publics are to
be institutionalised into Australian health policy settings as
anything more than simply a promise of their
democratically-deliberative ideal.
Paradoxically, the potential for democratic conversations to
create an intersubjective space that facilitates a transformative
exchange of knowledge was also evident. Although fleeting, this
became apparent in such things as improved self-esteem, a greater
sense of personal and community empowerment, and increased social
capital and health literacy: these factors are known to
contribute to people being healthier. Notably, when these
findings were evident, the citizens also experienced instances of
epistemic justice.
Bringing together the insights gained from the empirical findings
of this research and that which has been garnered from the
literature, this thesis goes on to reframe the unintentionally
disabling factors found, to propose an Intentionally enabling
approach to the exchange of knowledge and deliberative capacity
when mini-publics are applied in health policy settings.
Essentially, the propositions put forward reconsider the use of
mini-publics as a more substantively equal, empowering,
egalitarian, educative, and epistemically just means of health
policy development.
Description
Revised version uploaded 11 Feb 2018. Shortly after we last corresponded I found two sentences, one following the other, each beginning with ‘Clearly’! I’ve removed one of them [on page 14] in my final version but need your help again please to upload the PDF version of it to the repository without breaking its hyperlink? My final PDF version is attached and dated 11 Feb 2018.
Keywords
democratic deliberation, citizen engagement, democratising health policy, democratizing health policy, epistemic justice/injustice, transformative exchange of knowledge, substantive equality
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Deliberative pamphlet