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The formulation of public health policy is a complex process involving multiple stakeholder partnerships, often resulting in unpredictable outcomes. There has been a growing trend towards citizen involvement and localized partnerships for optimum public health policy (Rutter et al., 2017). The following briefly critiques existing literature relevant to the same.
Arnstein’s ‘Ladder of Participation’ is one of the prevalently used models to understand citizen partnerships and empowerment in policy formulations (Kotus & Sowada, 2017). However, the model has been criticized by Tritter and McCallum (2006), to be overly simplistic, with the sole emphasis on citizenship power couple with ignorance of intrinsic factors driving citizen participation and empowerment – factors rightly explored in the self determination theory by Patrick and William’s (2012). Alternatively, a novel paradigm of social learning, as discussed by Collins, Kevins and Ison (2006), might be considered as novel approach since it necessitates consideration of environmental factors contributors to the public health problem and educating or inducing learning across citizens on the same, for improved understanding of drivers and not just the means underlying collaborative participation.
As discussed by Huxham and Vangen (2004), collaborative engagement is often accompanied by collaborative inertia, where partnerships can seem to be tedious, despite the prevalence of a common goal. However, as criticized by Patrick and William’s (2012), incorporation of self determination theory involving personal and not collective factors of motivation for each stakeholder in policy partnerships can assist in sustained collaborative achievement of public health outcomes and initiatives.
Considering that a nation’s population comprises of multiple cultural backgrounds, determinants of community participation in public health programs must also be multifaceted and culturally competent (Betancourt et al., 2016). Indeed, as researched by Cyril et al., (2015), community concepts contributing to the complexity of participation include: collaborative sharing of power, two way learning involving both community groups and leaders and involvement of multicultural workers. However, in criticism, as denoted by Huxham and Vangen (2003), often the perception that partnerships are grinding, complex and ambiguous may result in collaborative inertia.
A nation’s population comprises of a number of the ethnicities and minority groups, all of which must be considered during public health policy formulation (Betancourt et al., 2016). As evidenced by the Relationship Building with First Nations and Public Health Research Team. (2017), policy formulators must involve minority groups such as the first peoples of their nation by instilling a sense of respect and trust for their culture along with inducing localized participation with a long term commitment for self-engagement. However, gaining trust and participation from minority groups are far more complex, which is why, as per Patrick and William’s (2012), policy formulators must seek to target aspirations, hopes and psychological contributors which can motivate minorities to regain trust in participation.
This paper hence demonstrates the multiple social facets underlying the process of policy and program formulation aimed at achieving health positive health outcomes at the public level. Policy formulators must not only focus on citizen engagement but also consider providing intrinsic motivational factors for citizenship involvement.
Betancourt, J. R., Green, A. R., Carrillo, J. E., & Owusu Ananeh-Firempong, I. I. (2016). Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public health reports.
Collins, K., & Ison, R. (2006). Dare we jump off Arnstein's ladder? Social learning as a new policy paradigm.
Cyril, S., Smith, B. J., Possamai-Inesedy, A., & Renzaho, A. M. (2015). Exploring the role of community engagement in improving the health of disadvantaged populations: a systematic review. Global health action, 8(1), 29842.
Huxham, C., & Vangen, S. E. (2003). Doing things collaboratively: realizing the advantage or succumbing to inertia?. University of Strathclyde, Graduate School of Business.
Kotus, J., & Sowada, T. (2017). Behavioural model of collaborative urban management: extending the concept of Arnstein's ladder. Cities, 65, 78-86.
Patrick, H., & Williams, G. C. (2012). Self-determination theory: its application to health behavior and complementarity with motivational interviewing. International Journal of behavioral nutrition and physical Activity, 9(1), 18.
Relationship Building with First Nations and Public Health Research Team. (2017). Relationship building with First Nations and public health: Exploring principles and practices for engagement to improve community health – Literature Review. Sudbury, ON: Locally Driven Collaborative Projects
Rutter, H., Savona, N., Glonti, K., Bibby, J., Cummins, S., Finegood, D. T., ... & Petticrew, M. (2017). The need for a complex systems model of evidence for public health. The Lancet, 390(10112), 2602-2604.
Tritter, J. Q., & McCallum, A. (2006). The snakes and ladders of user involvement: moving beyond Arnstein. Health policy, 76(2), 156-168.
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