Problems and Purpose

In April 2001, the Canadian Prime Minister appointed the Commission on the Future of Health Care in Canada (also known as the Romanow Commission after Roy J. Romanow, the Commission's Chair). One of the Commission's charges was to conduct a dialogue with Canadian citizens about "the future of Canada's public health care system." This dialogue was called the Citizens' Dialogue on the Future of Health Care in Canada. The dialogue had two purposes: (1) "to contribute ... to a process of collective learning" in Canada about the nation's public health care system, and (2) to "gain insight into [Canadian] citizens’ values and their preferred choices [about Canadian public health care policy] when they are asked to make difficult trade-offs."

Background History and Context

In the late 1990s, several policy issues concerning the Canadian public health care system became the subject of public debate. 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.

During the 1990s, several public deliberations on public health care policy were held in Canada. According to the Report on Citizens' Dialogue on the Future of Health Care in Canada, none of these public deliberations used a method that allowed participants to make the trade-offs necessary to form feasible policy recommendations. In addition, according to the Report on Citizens' Dialogue on the Future of Health Care in Canada, most of these public deliberations did not use methods that allowed participants "to reconcile conflicting values."

The Canadian government responded to this debate with several measures. In September 2000, the Canadian First Ministers agreed on a Health Action Plan providing for increased public funding for the Canadian public health care system, greater public access to health services, and increased use of information technology to improve the public health care system.

In April 2001, the Canadian Prime Minister appointed the Commission on the Future of Health Care in Canada. The Commission was charged with:

• inquiring into the policy issues respecting the Canadian public health care system;
• conducting "a dialogue with Canadians on the future of Canada's public health care system";
• recommending health care policy reforms intended to "ensure... the long term ... sustainability of a universally accessible, publicly funded health system, that offers quality services ... and strikes an appropriate balance between investments in prevention and health maintenance [on the one hand] and care and treatment [on the other]." 

Organizing, Supporting, and Funding Entities

The originating entities for the Citizens' Dialogue on the Future of Health Care in Canada (Citizens' Dialogue) were the Commission on the Future of Health Care in Canada, the Canadian Policy Research Networks (CPRN), and Viewpoint Learning. The opinion survey was carried out by Ekos Research Associates. The Citizens' Dialogue was funded by the Canadian government. According to Maxwell, Rosell, and Forest (2003) the cost of the Citizens' Dialogue was $C1.3 million. 

Participant Recruitment and Selection

The Citizens' Dialogues on the Future of Health Care in Canada consisted of 12 dialogues, each having approximately 40 participants. The total number of participants was 489. Three dialogues were held in the Atlantic region (two in Halifax and one in Bathurst), three in Quebec (two in Montreal — one in French and one in English — and one in Québec City), three in Ontario (one each in Ottawa, Toronto, and Thunder Bay), and three in the West (one each in Calgary, Regina, and Vancouver). According to the Commission's report about the Citizens' Dialogue, "participants [for each dialogue] were randomly selected in a manner designed to provide a representative cross-section of the Canadian population." According to Woodford and Preston (2011), "the majority" of those sampled actually "participated in the dialogues."

The approximately 10,000 participants in the Commission's web-based consultation about Canadian public health care policy were not randomly selected.

The participants in Commission's March 2002 public opinion telephone survey consisted of a random sample of 1,600 Canadians aged 18 or over. According to the Commission's report, the survey "results were statistically weighted by age, gender and region to ensure that the findings were representative of the Canadian population." The survey had a margin of error of +/- 2.5 percentage points.

One important oversight was the inclusion of marginalised groups, particularly Indigenous Peoples who face large disparities in health services and health outcomes. Organizers did not take any extra measures to ensure marginalized populations were included and no separate participatory spaces were made for such groups. While some Indigenous Peoples participated in the dialogues, the outcomes — which stressed the importance of Indigenous care — cannot be said to fully reflect the views and experiences of those communities. 

Methods and Tools Used

The Commission worked with the Canadian Policy Research Networks (CPRN) and Viewpoint Learning to adapt their Choicework Dialogue as a methodology for this public dialogue on the future of the Canadian public health care system. Choicework Dialogue is a structured and facilitated method of face-to-face, in-person deliberation in which a representative sample of approximately 40 citizens deliberates for 8 hours about a policy issue. Surveys measure participants' attitudes about the issue at the start and end of the deliberation, comparable to Deliberative Polling. Survey results are used by the organization sponsoring the deliberation as evidence of informed public opinion about the issue.

The Choicework Dialogue method was selected because it enabled participants to work through policy tradeoffs and "to reconcile conflicting values." The Commission worked with CPRN and Viewpoint Learning to prepare materials for the dialogue, to conduct the dialogue during January through March 2002, to analyze the results of the dialogue, and to publish those results in a report issued in June 2002.

During the Citizens' Dialogues, the Commission received public opinion via two means: first, the Commission posted an abridged version of the Citizens' Dialogue workbook (described below) on the Commission's website and invited Canadian Internet users to read this abridged workbook and respond to survey questions based on its content. Approximately 10,000 self-selected users responded to this web-based consultation. When this web-based consultation began is unclear; the consultation seems to have continued through at least June 2002. In addition, after the Citizens' Dialogue had concluded, in mid-March 2002 the Commission conducted a formal public opinion telephone survey of a random, weighted sample of 1,600 Canadians respecting their attitudes about Canadian public health care policy.

What Went On: Process, Interaction, and Participation

In 2001, a project team — consisting of personnel from the Commission on the Future of Health Care in Canada (the Commission), the Canadian Policy Research Networks (CPRN), and Viewpoint Learning — prepared for the Citizens' Dialogue on the Future of Health Care in Canada. As a method for the Citizens' Dialogue they chose Viewpoint Learning's Choicework Dialogue method.

The project team wrote a workbook that provided the content of the Citizens' Dialogue on the Future of Health Care in Canada. The workbook contained factual information about three major Canadian public health care policy issues (cost, quality, and "uneven coverage"); descriptions of four Canadian public health care policy "scenarios" — or values-based policy approaches — and accounts of the advantages and disadvantages associated with each scenario. The project team developed the scenarios on the basis of a background paper by Professor Dr. Matthew Mendelsohn about "trends [since 1990] in Canadians’ attitudes, values and preferences" concerning health care; input from several health care policy experts and researchers; and published and unpublished health care policy research. The four "scenarios" described in the workbook were:

• Scenario 1: increasing public spending on the current Canadian public health care system (called the "status quo option");
• Scenario 2: requiring co-payments to increase revenues and reduce demand for health care;
• Scenario 3: "systemic reform through creation of a parallel private" health care system;
• Scenario 4: "systemic reform" through "reorganizing" the public "primary care" system.

Several health care policy experts and researchers also reviewed and commented on a draft of the workbook, which the project team then revised in light of those comments.

Each dialogue consisted of a single session lasting 8 hours, was facilitated by professional facilitators from Viewpoint Learning, and was video-recorded. 

At the start of each dialogue participants received their workbooks. Facilitators explained "the purpose of the dialogue," how the results of the dialogue would be used, and the procedure and "ground-rules" of the dialogue. for the session. The facilitators then explained the three principal health care policy issues discussed in the work book and presented facts concerning them. Next, the facilitators explained the four scenarios described in the workbook.

Then the participants completed a survey regarding their attitudes toward each of the four scenarios described in the workbook. The survey used a seven-point scale from 1 (meaning "totally unfavorable") to 7 (meaning "totally favorable"). The point "4" on the scale was interpreted as "undecided."After completing the survey, participants engaged in discussions in small groups and in plenary sessions to determine the desirable and undesirable effects of each scenario and their preferred "vision of the future" for the Canadian public health care system. In the afternoon, participants worked again in small groups and plenary sessions to discuss the trade-offs of each scenario that would be required to realize their preferred "vision of the future." At the end of the afternoon, participants completed another survey respecting their attitudes toward each of the four scenarios described in the workbook. This survey used the same seven-point scale as was used in the survey at the beginning of the dialogue. At the end of the dialogues, participants collectively ranked the four scenarios as follows:

1. Scenario 4: "systemic reform" through "reorganizing" the public "primary care" system (79% of participants supporting);
2. Scenario 1: increasing public spending on the current Canadian public health care system (61% supporting);
3. Scenario 2: requiring copayments to increase revenues and reduce demand for health care (50% supporting);
4. Scenario 3: "systemic reform through creation of a parallel private" health care system (39% supporting).

The project team summarized what they characterized as the participants' "consensus" policy preferences at the end of the dialogues in the following terms:

• Participants expressed strong support for the public health system's continuing to provide "universal coverage" and "equal access."
• Participants preferred to increase public funding for the public health system and to reorganize the primary care system, rather than creating a parallel private health care system.
• Participants were willing to pay higher taxes for the public health system, provided that the system operate with greater efficiency, transparency, and accountability. Participants supported appointment of a health system auditor and a health system ombudsperson to improve accountability and responsiveness.
• If higher taxes proved insufficient, participants were willing to accept user fees or co-payments to fund the system.
• Participants expressed a willingness to use new information technologies and to adopt preventative health and wellness measures to lower costs and increase the efficiency of the public health care system.

The March 2002 public opinion telephone survey measured respondents' attitudes towards the four health care policy scenarios using a four-point scale from 1 (meanining "strongly oppose") to 4 (meaning "strongly support"). No point on the scale was interpreted to mean "undecided." The telephone survey respondents ranked the policy scenarios in the same order as did the Citizens' Dialogue participants, but with higher levels of support: 

1. Scenario 4: "systemic reform" through "reorganizing" the public "primary care" system (81% of respondents supporting);
2. Scenario 1: increasing public spending on the current Canadian public health care system (79% supporting);
3. Scenario 2: requiring copayments to increase revenues and reduce demand for health care (63% supporting);
4. Scenario 3: "systemic reform through creation of a parallel private" health care system (49% supporting).

The telephone survey respondents' attitudes differed in one notable respect from those of the Citizens' Dialogue participants: most telephone survey respondents favored increasing public spending by reallocating existing government revenues and not raising taxes, whereas most Citizens' Dialogue participants favored raising taxes.

Influence, Outcomes, and Effects

The project team measured the results of the Citizens' Dialogue quantitatively through the participant survey and qualitatively by observing the video-recordings of the dialogues.

During the dialogues, participants' attitudes about two scenarios underwent substantial change. Regarding Scenario 1 (increasing public funding for the existing system), the percentage of participants supporting this scenario rose from 48% at the start of the dialogues to 61% at the end of the dialogues. Respecting Scenario 4 (overhauling the primary care system), the share of participants supporting this scenario rose from 56% at the start to 79% at the end of the dialogues.

Summary of the reported quantitative results:

Scenario 1: increasing public spending on the current Canadian public health care system:

• % of Participants designating this favorable before the dialogue: 48%; after the dialogue: 61%; % change: +13%
• Mean Score (on scale of 1 [totally unfavorable] to 7 [totally favorable]): before dialogue: 4.33; after dialogue: 4.8; % change: +10.8%

Scenario 2: requiring co-payments to increase revenues and reduce demand for health care:

• % of Participants designating this favorable before the dialogue: 45%; after the dialogue: 50%; % change: +5%
• Mean Score (on scale of 1 [totally unfavorable] to 7 [totally favorable]): before dialogue: 4.07; after dialogue: 4.36; % change: +7.1%

Scenario 3: "systemic reform through creation of a parallel private" health care system:

• % of Participants designating this favorable before the dialogue: 34%; after the dialogue: 39%; % change: +5%
• Mean Score (on scale of 1 [totally unfavorable] to 7 [totally favorable]): before dialogue: 3.52; after dialogue: 3.73; % change: +6.0%

Scenario 4: "systemic reform" through "reorganizing" the public "primary care" system:

• % of Participants designating this favorable before the dialogue: 56%; after the dialogue: 79%; % change: +23%
• Mean Score (on scale of 1 [totally unfavorable] to 7 [totally favorable]): before dialogue: 4.58; after dialogue: 5.64; % change: +23.1%

Quantitative results respecting the evaluation of the Citizens' Dialogue process were not reported.

The report of results of the Citizens' Dialogue does not formally describe qualitative findings. The report states that at least one participant said that they had been treated with respect. According to the report, some participants stated that they had enjoyed their experience during the dialogues and felt a sense of "solidarity with their fellow citizens." Many participants stated that their views had changed during the dialogues. "Many" participants reported that the dialogue had a "transformative effect." Some participants expressed respect for the views of the other participants.

According to Maxwell, Rosell, and Forest (2003) the Citizens' Dialogue influenced the final report of the Commission on the Future of Health Care in Canada entitled Building on Values: The Future of Health Care in Canada (also known as The Romanow Report) in two respects. First, the Romanow Report characterized Canadian citizens as playing an active role in the Canadian public health care system — through such efforts as prevention and wellness — and in the health care policy reform process. Second, the Romanow Report incorporated the Citizens' Dialogue participants' recommendations on increased transparency and accountability for the Canadian public health care system. In addition, the Romanow Report incorporated the Citizens' Dialogue participants' recommendations regarding increased public funding for the Canadian public health system and the use of new information technologies in health care delivery.

Some aspects of the 2003 First Ministers' Accord on Health Care Renewal are consistent with the Citizens' Dialogue participants' consensus policy preferences, including increased funding for Canada's public health system through a Health Reform Fund, increased accountability and transparency, an emphasis on prevention and wellness, and the use of new information technologies in the health system. 

Respecting the March 2002 telephone survey about Canadian public health care policy, the project team interpreted the congruence of the telephone survey respondents' scenario rankings with those of the Citizens' Dialogue participants as indicating that the Citizens' Dialogue results generally reflected the the attitudes of the Canadian population. The project team interpreted the differences in results regarding how to increase public spending on health care as evidence of the influence of the Choicework Dialogue process on the Citizens' Dialogue participants. The project team observed that the dialogue participants' survey results at the beginning of the dialogue — like the telephone survey results — showed a preference for reallocating existing government revenues rather than raising taxes. Nonetheless, during the dialogues, most Citizens' Dialogue participants came to reject the trade-offs that would have been required in order to reallocate existing government revenues and accordingly came to favour tax increases as a means to increase public spending on health care.

Analysis and Lessons Learned

The Citizens' Dialogue influenced the content of the final report of the Commission on the Future of Health Care in Canada (the Romanow Report). Sheedy (2008) characterizes the Citizens' Dialogue as successful on the grounds that the Romanow Report depicted citizens as playing an active role in Canadian public health care, called for ongoing public involvement in Canada's public health policy process, and included a recommendation for a "Canadian Health Covenant" expressing "a consensual vision of the health care system." MacKinnon et al. (2007) state that the Citizens' Dialogue also influenced the Commission's decision to recommend the formation of a "Health Council of Canada" and to recommend amending the Canadia Health Act to incorporate the value of "accountability" in the Canadian public health system. According to MacKinnon et al. (2007), through the Romanow Report, the dialogue may have had some influence on the 2003 First Ministers' Accord on Health Care Renewal regarding provisions for increased funding for Canada's public health system, increased accountability and transparency, an emphasis on prevention and wellness, and the use of new information technologies in health care delivery, as well as on the 2004 First Ministers' Health Accord. Woodford and Preston (2011) and Walkom (2008) note that the government implemented the "Health Council of Canada," apparently upon the recommendation of the Romanow Report. MacKinnon et al. (2007) credit the Citizens' Dialogue with some influence on the creation of the Health Council of Canada in 2003.

In contrast, Chafe et al. (2011) argue that the Romanow Report was "mothballed"; this suggests that the Citizens' Dialogue had little effect on Canadian health care policy. According to Woodford and Preston (2011), the Canadian "government provided no feedback about the degree to which the recommendations" contained in the Romanow Report "were considered in policy-making." Both Woodford and Preston and Walkom further state that most of the Romanow Report's recommendations "were not accepted by the government." Woodford and Preston (2011), Walkom (2008), and MacKinnon et al. (2007) state that the recommendations of the Romanow Report that were implemented by the government "were not implemented as originally envisioned" and were implemented at a "very slow rate." Woodford and Preston (2011) and MacKinnon et al. (2007) contend that the Canadian government's relative neglect of the recommendations of the Romanow Report indicates that the government is unwilling to be influenced by citizens' expressed views.

The use of random sampling to select the participants of the Citizens' Dialogue lends persuasive authority to the participants' consensus policy preferences. The congruence of the scenario rankings of the telephone survey respondents with those of the Citizens' Dialogue participants indicates that the dialogue results were consistent in some respects with the preferences of the Canadian population. 

The report of results of the Citizens' Dialogue indicates that participants' attitudes respecting two policy scenarios — Scenario 1 concerning increasing public funding for the public health system and Scenario 4 concerning overhauling Canada's primary care system — underwent substantial change during the dialogues.

In addition, the difference in preference regarding the means of funding increased public spending between the telephone survey respondents and the Citizens' Dialogue participants furnishes further evidence that the Citizens' Dialogue process substantially influenced the dialogue participants' attitudes.

Because the report of results of the Citizens' Dialogue does not formally describe results of participants' or third-parties' evaluations of the Citizens' Dialogue process, assessments of the quality of deliberation during the Citizens' Dialogue cannot be made.

Von Lieres and Kahane (2007) and Woodford and Preston (2011) criticize the methodology of the Citzens' Dialogue as being "top-down," to the extent that the project team, influenced by experts and government officials, created the workbook and set the agenda. Woodford and Preston (2011) state that important Canadian public health care policy issues — including "the Canadian Health and Social Transfer" policy as well as other "fiscal and jurisdictional issues" — were excluded from the Citizens' Dialogue agenda.

MacKinnon et al. (2007) argue that the Citizens' Dialogue has encouraged other governmental entities to include the public in policy making. They state that the results of the Citizens' Dialogue encouraged the Canadian Nuclear Waste Management Organization to use Viewpoint Learning's Choicework Dialogue method in their public deliberation about Canadian long-term nuclear waste management policy, called the Citizens' Dialogue on the Long-term Management of Used Nuclear Fuel in Canada.

According to MacKinnon et al. (2007) the Citizens' Dialogue influenced the discussion methods used in the following Canadian public deliberations:

• Citizens' Dialogue on Canada’s Future (2002)
• Citizens' Dialogue on Sharing Public Funds for a Better Canada (2005-2006)
• Citizens’ Dialogue on Public Health Goals in Canada (2005)
• House of Commons Sub-Committee on Persons with Disabilities Public Consultations (2002-2003)
• Senate Committee on Social Affairs, Science and Technology, Public Consultations on Mental Health, Mental Illness and Addiction Services in Canada (2003-2005)
• British Columbia Citizens' Assembly on Electoral Reform (2004)
• Ontario Citizens' Assembly on Electoral Reform (2006-2007) 

Lack of Indigenous Representation

Some have argued that Indigenous Peoples were insufficiently represented among Citizens' Dialogue participants and that, because Indigenous Peoples have unique health care issues, their specific circumstances and concerns were not addressed during the Citizens' Dialogue. 

The complex legacies of colonisation have left Indigenous Peoples — First Nations, Metis and Inuit — at the bottom in a range of indicators such as well-being, economic status, education, housing quality, and health outcomes. Complicating matters, many Indigenous people claim self-government rights, often based in centuries-old treaties. There are conflicting views of which political units are involved on the territory called ‘Canada’ and whether Aboriginal people are subject to the rule of the Canadian state.

While the 12 Citizens' Dialogues made up the explicitly deliberative element of the Commission’s work, the Commission used a ‘ChoiceWorks’ methodology based on the principle that participants are individuals and speak for themselves and not as representatives of special interests. Some Indigenous people were included in the dialogues, but neither the design nor the outcomes of the dialogues adequately reflected Indigenous voices. Though there were Indigenous representatives present at all 12 session, organisers expressed disappointment in the degree to which the dialogue was able to engage them. Indigenous Peoples often did not turn up to sessions once recruited — many live in remote locations and no transportation was provided — and were typically were very quiet in the dialogue sessions; studies have shown that social status and contextual factors such as dialogue location have effects on participation (in)equality (Cornwell and Hans 2011). Two localised ad hoc attempts to hear more Indigenous voices — through the creation of a small separate group and the recruiting additional Indigenous people to sessions — had little effect. 

The Commission on the Future of Health Care in Canada addressed some of those criticisms in chapter 10 of the final report of the Commission entitled Building on Values: The Future of Health Care in Canada (also known as The Romanow Report).

See Also

The Royal Commission on the Future of Health Care in Canada 

Choicework Dialogue 

Public Hearing 

References

Julia Abelson, et al. (2004). Canadians Confront Health Care Reform. Health Affairs, 23, 186-193. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.23.3.186

Julia Abelson and François-Pierre Gauvin. (2004). Engaging Citizens: One Route to Health Care Accountability. Ottawa: Canadian Policy Research Networks. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.539.1539&rep=rep1&type=pdf

Julia Abelson, Mark E. Warren, and Pierre Gerlier Forest. (2012, March-April). The Future of Public Deliberation on Health Issues. Hastings Center Report, 42(2), 27-29. http://onlinelibrary.wiley.com/doi/10.1002/hast.30/abstract

Lisa Birch and François Pétry. (2009). Exit, Voice and Loyalty and the Future of Healthcare in Canada: Insights From Public Opinion Research. Paper presented at the 2009 conference of the European Consortium for Political Research, September 10-12, 2009, Potsdam, Germany. https://ecpr.eu/Filestore/PaperProposal/d2795afb-684e-4277-800f-9da54903057d.pdf

Roger Chafe, Wendy Levinson, and Paul C. Hébert. (2011). The Need for Public Engagement in Choosing Health Priorities. CMAJ, 183(2), 165. https://www.cmaj.ca/content/183/2/165

Howard Chodos and Jeffrey J. MacLeod. (2004). Examining the Public/Private Divide in Healthcare: Demystifying the Debate. HealthCarePapers, 4 (3), 10-25. http://www.cpsa-acsp.ca/papers-2005/MacLeod.pdf

Erin York Cornwell and Valerie P. Hans. (2011). Representation through Participation: A Multilevel Analysis of Jury Deliberations. Law and Society Review, 43(5). https://scholarship.law.cornell.edu/cgi/viewcontent.cgi?article=2547&context=facpub

Commission on the Future of Health Care in Canada. (2002). Report on Citizens' Dialogue on the Future of Health Care in Canada. http://publications.gc.ca/collections/Collection/CP32-77-2002E.pdf

Commission on the Future of Health Care in Canada and Roy J. Romanow. (2002). Building on Values: The Future of Health Care in Canada. [also known as: The Romanow Report; The Romanow Commission Report .] Saskatoon. Retrieved from https://qspace.library.queensu.ca/bitstream/handle/1974/6882/BuildingOnValues.pdf?sequence=5

Raisa Berlin Deber. (2003). Health care reform: Lessons from Canada. American Journal of Public Health, 93(1), 20-24. Retrieved from http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.93.1.20

EKOS Research Associates. (2005). Citizens’ Dialogue on Public Health Goals in Canada: Final Findings Report. Ottawa: EKOS Research Associates. http://www.ekospolitics.com/articles/cd-phg_e.pdf

Michael J. L. Kirby and Wilbert Joseph Keon. (2006). Out of the Shadows at Last: Transforming Mental Health, Mental Illness and Addiction Services in Canada. Final Report of The Standing Senate Committee on Social Affairs, Science and Technology. Ottawa: Senate Canada. http://www.parl.gc.ca/Content/SEN/Committee/391/soci/rep/pdf/rep02may06p... [Part 1] http://www.parl.gc.ca/Content/SEN/Committee/391/soci/rep/pdf/rep02may06p... [Part 2]

von Lieres, B., and D. Kahane. (2007). "Inclusion and Representation in Democratic Deliberations: Lessons from Canada's Romanow Commission, in Spaces for Change? The Politics of Participation in New Democratic Arenas, edited by A. Cornwall and V. Schattan. London: Zed Books. http://r4d.dfid.gov.uk/PDF/Outputs/CentreOnCitizenship/Romanowpaper.pdf

von Lieres, B., and Kahane, D. "Canada's Designs for Aboriginal Participation." Citizenship DRC Case Study Series.

Judi Longfield and Carolyn Bennett. (2003). Listening to Canadians: A First View of the Future of the Canada Pension Plan (Disability) Program: Report of the Standing Committee on Human Resources Development and the Status of Persons with Disabilities. Ottawa: House of Commons Canada. http://www.parl.gc.ca/content/hoc/Committee/372/HUMA/Reports/RP1032289/h...

Mary Pat MacKinnon et al. (2003). Citizens' Dialogue on Canada's Future: A 21st Century Social Contract. Ottawa: Canadian Policy Research Network. http://www.cprn.org/doc.cfm?l=en&doc=359 [DEAD LINK] Update:https://web.archive.org/web/20091203165934/http://www.cprn.org/documents/19075_en.pdf

Mary Pat MacKinnon, Sonia Pitre, and Judy Watling. (2007). Matching Methods with Policy Purpose: Two Case Examples of Public Engagement. Ottawa: Canadian Policy Research Network. https://web.archive.org/web/20081231101541/http://www.cprn.org/doc.cfm?doc=1631&l=en

Judith Maxwell, Steven Rosell, and Pierre-Gerlier Forest. (2003, May 10). Giving Citizens a Voice in Healthcare Policy in Canada. BMJ, 326(7397): 1031–1033. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1125934/

Judith Maxwell et al. (2004). Responsible Action - Citizens' Dialogue on the Long-term Management of Used Nuclear Fuel. Ottawa: Canadian Policy Research Network. https://web.archive.org/web/20081229123913/http://www.cprn.org/doc.cfm?doc=1050&l=en

Tom McIntosh and Pierre-Gerlier Forest. (2010). Talking to and with Canadians: Citizen Engagement and the Politics of the Romanow Commission. Southern Journal of Canadian Studies, 3, 28-50. https://www.researchgate.net/publication/273457140_Talking_to_and_with_C...

Amanda Sheedy. (2008). Handbook on Citizen Engagement: Beyond Consultation. Ottawa: Canadian Policy Research Networks. https://web.archive.org/web/20081231084451/http://www.cprn.org/doc.cfm?doc=1857&l=en

Tom Walkom. (2008, July 7). Post Mortem on Romanow. Toronto Star. http://www.emerginghealthleaders.ca/resources/Post-mortem-on-Romanow.pdf [DEAD LINK]

Judy Watling, Judith Nolté, and Mary Pat MacKinnon. (2006). Strengthening the Federation: Citizens' Dialogue on Sharing Public Funds for a Better Canada. Ottawa: Canadian Policy Research Network. https://web.archive.org/web/20081229124122/http://www.cprn.org/doc.cfm?doc=1422&l=en

External Links

Canadian Policy Research Networks [archived site]

Canada. Prime Minister. (2000, September 11). The Health Action Plan.

Health Canada. (2003). 2003 First Ministers' Accord on Health Care Renewal.

Health Canada. (2004). [2004 Health Accord]: First Minister's Meeting on the Future of Health Care 2004: A 10-year plan to strengthen health care. 

Notes