Analysis of Public Health Policy and Citizen Engagement

This report analyzes public health policy and program formulation aimed at achieving positive health outcomes at the public level. It critiques existing literature on citizen involvement and localized partnerships, highlighting the complexities of public health policy. The report discusses Arnstein’s ‘Ladder of Participation’ model, its limitations, and the alternative paradigm of social learning. It examines the importance of collaborative engagement, the role of self-determination theory in motivating stakeholders, and the need for culturally competent community participation. The report emphasizes the significance of considering indigenous meanings and involving minority groups in policy formulation. The conclusion stresses the importance of providing intrinsic motivational factors for citizen involvement in addition to engagement. References from various research papers are included to support the analysis.

Running head: PUBLIC HEALTH AND SOCIAL LEARNING
PUBLIC HEALTH AND SOCIAL LEARNING
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1PUBLIC HEALTH AND SOCIAL LEARNING
Introduction
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.
Discussion
Social Learning and Ladder of Participation
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.
Engagement
As discussed by Huxham and Vangen (2004), collaborative engagement is often
accompanied by collaborative inertia, where partnerships can seem to be tedious, despite the

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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.
Community Concepts
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.
Indigenous Meanings
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.

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Conclusion
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.

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References
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

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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.