In the late 1990s several policy issues concerning the Canadian public health care system became the subject of public debate in Canada. These included the rising costs of the system, including cost per capita; which level of government should bear rising costs; whether and what forms of privatization should be introduced; delays in receiving treatment; the quality of treatment; differences in access to treatments in different provinces (so-called "uneven coverage"); and the extent to which health care service delivery was disaggregated.
The financial and economic crisis, of which we have heard so much discussion since 2007-8, is only one aspect of a whole series of underlying political trends which have been apparent for much longer: a crisis of (in)equality and of increased precarity of the workforce, a human rights crisis, a demographic crisis, an ecological crisis, a crisis in civil liberties, and above all a crisis in democracy.
As of 2010, Portsmouth, New Hampshire (population 20,000) has sustained the practice of organized, public dialogue and deliberation for over ten years. Since 1999, diverse community groups in Portsmouth have organized at least six rounds of large-scale dialogue-to-action circles (study circles) initiatives. This case study provides brief descriptions of four of these initiatives from 1999 through 2004. Descriptions of Portsmouth’s later public engagement initiatives will be added to this entry at a later date, or posted as separate entries.