Education And Debate

Giving citizens a voice in healthcare policy in Canada

BMJ 2003; 326 doi: (Published 10 May 2003) Cite this as: BMJ 2003;326:1031
  1. Judith Maxwell, presidenta,
  2. Steven Rosell, presidentb,
  3. Pierre-Gerlier Forest (, associate professorc
  1. a Canadian Policy Research Networks, Suite 600, 250 Albert St, Ottawa, ON, Canada K1S 2B7
  2. b Viewpoint Learning Inc, 2236 Avenida de la Playa, La Jolla, CA 92037, USA
  3. c CAPP/Département de science politique, Université Laval, Québec, QC, Canada G1S 2R3
  1. Correspondence to: P-G Forest
  • Accepted 5 March 2003

In many countries people are struggling to set up good ways of eliciting the views of patients. In England, the model of citizens' juries has been pursued. In Canada, dialogue sessions with members of the public have been used to reframe the healthcare contract

The legitimacy and sustainability of any major policy decision increasingly depends on how well it reflects the underlying values of the public. 1 2 Experts and stakeholders provide essential technical input but their role is distinct from that of the citizen and cannot replace it. As governments ponder difficult and at times unpalatable choices on health care, policy needs to be informed by ordinary “unorganised” citizens, as well as powerful “organised” interest groups.

The Romanow Commission on the Future of Health Care in Canada adopted an innovative approach to eliciting the views of “unorganised” citizens using the “ChoiceWork dialogue” method created by Viewpoint Learning, based on the research by its chairman, Daniel Yankelovich. 3 4 This entailed a full day of dialogue with representative cross sections of the Canadian population. This article gives a brief description of the process, the outcome, and the effects to date.5

Summary points

Citizens' values should define the boundaries of action in a democracy

The Romanow Commission on the Future of Health Care in Canada opted for a “ChoiceWork dialogue,” wherein representative groups of ordinary “unorganised” citizens work through complex issues and make value based choices

Combining their roles as patients, taxpayers, and members of the community, participants reframed the healthcare contract, redefining both individual and collective responsibilities. This had an important impact on the commission's report and the ensuing debate

Such engagement of the public is more costly than polling, but it is essential when opinions are unstable and difficult decisions must be made

The process

ChoiceWork dialogues engage members of the public …

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