| Summary: | The concept of broad-based public participation is a fundamental element of
health promotion and citizenship. There is a gap, however, between the promise and
reality of citizen participation in health reform. The purpose of this study was to describe
the experience of public participation in a health reform initiative in one regional district;
to elucidate the perspectives of both participants and nonparticipants in a particular health
reform process entitled "New Directions for a Healthy British Columbia"; and, to assess
the utility of social marketing concepts as an analytical tool for understanding citizen
participation.
The study built on diverse literatures including health promotion, citizen
participation, citizenship and social marketing in order to provide a new way to
conceptualize citizen participation in health reform. The study utilized the data collection
methods of participant observation (n=76 meetings), key informant interviews (n=12),
focus groups (n=48), street corner interviews (n=5), and a documentary review of the
health reform process.
A social marketing framework was used to interpret the data, including the
concepts of understanding the consumer perspective, exchange, marketing mix and
segmentation. In contrast to the criticism that social marketing ignores the broader
context of individual behaviour, the analysis facilitated an understanding of the societal
circumstances that inhibited or fostered participation. Specifically, the analysis suggested that participation was influenced by (1) citizens' perceptions of a sense of belonging to,
and equality in, the community; (2) citizens' perceptions of their ability to shape policy;
(3) the attainment of a minimum threshold of social and economic well-being; (4) the
responsiveness of government to citizens' efforts; and, (5) the ways in which the
opportunity to participate was structured.
In this particular study neither the breadth of broad-based citizen participation, nor
the ability of participants to shape policy was realized. The findings suggest that
refraining the context of participatory democracy is necessary to facilitate citizens acting
on their right and responsibility to participate meaningfully. This may be accomplished
through (1) understanding, respecting and accommodating diverse citizens' perspectives
about participation; (2) providing different opportunities for participation; and, (3)
representing the needs and experiences of disempowered groups in health reform
initiatives. === Graduate and Postdoctoral Studies === Graduate
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