Background: Public deliberation can be used in a number of decision-making processes to make the health system more responsive to public values, and to help inform and refine health system policy decisions. This study evaluates how the McMaster Health Forum implements the key elements of public deliberation and identifies both areas of strength and potential areas for improvement. Methods: An evaluative case study approach was used. Data were collected from three sources: quantitative and open-ended responses to questionnaires from 19 panels (200 respondents); panel summaries from 13 panels; and transcripts of 2 panel deliberations. Thematic analysis was used to assess four key elements of deliberation: the representativeness of participants, the information supports provided to them, the procedural criteria used, and the focus on explicit reasoning in coming to conclusions. Results: Participants felt that the McMaster Health Forum recruited a representative sample of participants based on gender and diversity of opinion. However, participants noted that the panels could be improved by striving for more age and ethnocultural diversity while also including health professionals or policymakers. Participants mostly occupied the role of a ‘consumer’ of health services. They viewed the information presented in citizen briefs as credible but had questions about the brief-development process. Procedurally, the panels fostered openness without impeding consensus and facilitators fostered mutual respect among participants. Finally, the groups incorporated values, showed an ability to come to a deeper understanding of policy options and harnessed the diverse experiences of their fellow participants as they reasoned. Discussion: This case study is part of a larger evaluation process that assesses all of the McMaster Health Forum citizen panels which aim to elicit citizens’ values and preferences about health system issues in Canada. The framework used to assess the public deliberation process can be used to evaluate other processes in the future. / Thesis / Master of Science (MSc)

The representative democracy has become weakened during the last decades. At the same time the United Nations declared at the Rio de Janeiro meeting in 1992 that environmental problems can best be solved by involvement of all concerned citizens in decision-making. The main purpose of this study has been to examine if citizens panels is a possible way to involve citizens in environmental decision-making and what the outcomes can be. Furthermore the study has investigated what the participation has contributed to environmental politics and how representative the results have been. This has been carried out by investigating the Piteåpanel in the municipality of Piteå by conducting interviews. The result of the study shows that the involvement of the citizens in the decision-making influenced the environmental politics of the municipality. The most striking result is that involving the citizens in the process of forming a climate and energy plan made the final plan more explicit and ambitious. However regarding the representativity the decisions can’t be considered fully representative from a political equality point of view. Despite this the decisions that have been made can be regarded as more legitimate because the citizens have been a part of the decision-making. The study argues in a careful way that increased participation in environmental decision-making in the form of citizens panels can be one of several approaches to both overcome the problems with the representative democracy and solve the environmental problems. / Den representativa demokratin har under de senaste årtiondena blivit försvagad. Detta samtidigt som FN vid Rio de Janeiro mötet 1992 deklarerade att miljöproblemen bäst kan lösas med att involvera alla berörda medborgare i beslutsfattandet. Syftet med denna undersökning har i huvudsak varit att se närmare på om medborgarpaneler kan vara ett sätt att involvera medborgarna i miljöfrågor och vilken effekt det kan få. Vidare har studien också undersökt vilken inverkan deltagandet fått på miljöpolitiken och hur representativt resultatet varit. Detta har skett genom att undersöka Piteåpanelen i Piteå kommun med genomförandet av intervjuer. Studiens resultat visar att involverandet av medborgarna i beslutsfattandet har påverkat kommunens miljöpolitik. Framförallt visar det sig att i arbetet med att ta fram en klimat och energiplan bidrog deltagandet till att den slutgiltiga planen blev mer tydlig och ambitiös. Gällande representativiteten visar det sig dock att resultaten ifrån panelen inte kan anses fullt representativa utifrån aspekten politisk jämlikhet. Trots detta har dock besluten som fattats fått en större legitimitet på grund av att medborgarna fått vara med i beslutsprocessen. Studien ställer sig försiktigt positiv till att ett ökat deltagande i miljöfrågor i form av medborgar-paneler kan vara ett av flera tillvägagångssätt i att både överbrygga problemen med den representativa demokratin samt lösa de miljöproblem som finns.