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Engaging on health

By Viola Korczak - posted Friday, 24 March 2006

Reform of the Australian healthcare sector is on the agenda. There is a chronic shortage of doctors, nurses and other health professionals, especially in rural and remote areas, as outlined in the December 2005 Productivity Commission report (pdf file 1.52MB).

There is an insufficient focus on prevention and primary health care and an inefficient allocation of government resources due to the states and federal funding structure. Much has been written about the shortcomings of the Australian health care system, so let’s not waste time outlining the problems but instead, focus on the experiences of other countries and what we can learn. A new approach needs to be adopted which considers these failings and engages stakeholders who have previously not been consulted. The Federal Government needs to take the lead and ask the people.

Citizen engagement means asking members of the community who are not traditionally consulted to provide feedback on the health care system. Similar processes have been undertaken in Canada and the UK with much success. Citizen engagement offers a way for citizens to have a more direct say in how their tax dollars are spent.


Informed and deliberative advice from citizens is of great value to health decision-makers, because the advice comes from a cross section of the population. The voices of those who are not involved in the policy debate can be heard; the community can learn more about our complicated health system; and, in the process, decision-makers gain the trust of the community.

What is citizen engagement?

Citizen engagement can take many forms but it is ultimately about including the wider population in prioritising public resources. The trend towards citizen participation in health-care policy reform has its roots in the consumerism of the 1960s - a time which saw a wider group of stakeholders consulted for the first time. Citizen engagement promotes the sharing of experience and draws on the expertise of different stakeholder groups, so generating more options than would otherwise be offered by more limited policy development processes. Participation became central to the concept of primary health care in the 1970s and by the 1990s became a key feature of policy development in health.

Citizen engagement can take many forms, for example workshops, public opinion surveys and televotes. Regardless of the method employed, the underlying principles remain the same. It is about engaging citizens who are normally left out of the debate including in particular, people with chronic illnesses and traditionally hard to reach groups, such as people with disabilities. As high-end users, they are acutely aware of the deficiencies in service delivery and have the potential to offer real insights. Citizen engagement ensures that we are led by communities and rather than by only the federal and state governments.

Citizen engagement in Australia

A great example of citizen engagement in Australia was the Consensus Conference organised by the Australian Consumers’ Association (ACA) in 1999. The Consensus Conference dealt with gene technology and was carried out over three days at Old Parliament House, Canberra. It sought to redress the power imbalance between lay people and perceived experts.

The success of the Consensus Conference was built on effective planning: it took two years from the genesis of the idea to the actual realisation of the conference. Some valuable lessons were learnt in the process. A Consensus Conference does not mean that everyone has to agree, it is about accepting differences and developing joint recommendations.

Citizen engagement processes have also been used in other parts of Australia. The Royal Melbourne Women’s Hospital consulted over 100 women about the location of the hospital and type of services that should be offered. However in Australia to date, there has been no large-scale government initiative of the types carried out overseas.


Experience from overseas

Citizen engagement techniques have been applied in Canada and the UK and have proved to be extremely useful in gaining valuable feedback from a variety of stakeholder groups.

The Romanow Commission on the future of health care in Canada spent $C1.3 million and was financed by the Commission on the Future of Health in Canada. The participants were given two main tasks. The first was to develop a vision of the health system they would like to see in ten years' time and the second was to make choices and trade offs to realise that vision.

The overwhelming consensus was that service delivery should be reorganised and include increased public investment in doctors, nurses and equipment through tax increases. The engaged citizens agreed to increase taxes if they were earmarked and spent only on health. The recommendation of earmarking increased taxes for health is an idea which would be worth exploring in Australia.

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About the Author

Viola Korczak is a health policy officer with the Australian Consumers' Association (ACA).

Creative Commons LicenseThis work is licensed under a Creative Commons License.

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