Citizen engagement in health policymaking: challenges and recommended solutions

Abstract Background Involving citizens in health policymaking leads to the development of policies that are tailored to their needs and enables them to exercise their right as citizens. Citizen engagement in health policymaking in low and middle-income countries (LMICs) is rarely practiced and so understanding barriers and facilitators to engagement and the factors that impede effective participation is crucial. This study aims to understand views from policy stakeholders and citizens on citizen participation in health policy making and solicit recommendations on how to improve this process in the context of Lebanon. Methods We conducted 29 individual in-depth interviews with stakeholders who work in fields relevant to health policy and/or have had experience in engaging citizens and four focus groups (average 8 to 10 participants each) with citizens from four municipalities in different governorates across Lebanon. Participants were purposively sampled through local Primary Healthcare Centers and municipality networks. Results Barriers to engagement were seen as a manifestation of a dysfunctional and top-down political system, weak culture of participation, and lack of formal processes and platforms for engagement. Citizens’ attributed lack of participation to mistrust with the political system while on the other hand, stakeholders thought that citizens lacked the needed skills for active engagement. Recommendations for improvement focused on the importance of implementing system level changes, developing contextualized citizen engagement processes, and ensuring its adoption and implementation. Conclusions Although participants identified many challenges to engagement, they acknowledged its value and were able to propose concrete solutions and recommendations for change. Those recommendations are useful for other LMICs of similar contexts whose mandates require participation. Key messages • By identifying and understanding barriers to citizen participation in health policymaking, public health professionals can work towards improving engagement. • Strategies and methods such as implementing system level changes and developing contextualized citizen engagement processes can be applied to improve citizen participation were needed.


Background:
Involving citizens in health policymaking leads to the development of policies that are tailored to their needs and enables them to exercise their right as citizens. Citizen engagement in health policymaking in low and middleincome countries (LMICs) is rarely practiced and so understanding barriers and facilitators to engagement and the factors that impede effective participation is crucial. This study aims to understand views from policy stakeholders and citizens on citizen participation in health policy making and solicit recommendations on how to improve this process in the context of Lebanon.

Methods:
We conducted 29 individual in-depth interviews with stakeholders who work in fields relevant to health policy and/or have had experience in engaging citizens and four focus groups (average 8 to 10 participants each) with citizens from four municipalities in different governorates across Lebanon. Participants were purposively sampled through local Primary Healthcare Centers and municipality networks.

Results:
Barriers to engagement were seen as a manifestation of a dysfunctional and top-down political system, weak culture of participation, and lack of formal processes and platforms for engagement. Citizens' attributed lack of participation to mistrust with the political system while on the other hand, stakeholders thought that citizens lacked the needed skills for active engagement. Recommendations for improvement focused on the importance of implementing system level changes, developing contextualized citizen engagement processes, and ensuring its adoption and implementation.

Conclusions:
Although participants identified many challenges to engagement, they acknowledged its value and were able to propose concrete solutions and recommendations for change. Those recommendations are useful for other LMICs of similar contexts whose mandates require participation. Key messages: By identifying and understanding barriers to citizen participation in health policymaking, public health professionals can work towards improving engagement.
Strategies and methods such as implementing system level changes and developing contextualized citizen engagement processes can be applied to improve citizen participation were needed.

Background:
Even though right-wing populist parties (RWPP) are increasingly influential in Europe, their position on public health has hardly been researched. I aimed to fill this research gap by focusing on the case of the FPÖ (Freiheitliche Partei Ö sterreichs) and its opposition to Austriás smoke-free policy. Understanding RWWP positions on health policy can help to prevent detrimental influences on health policy making. Therefore, this project aimed to investigate how the FPÖ framed Austria's smoke-free policy and whether newspaper articles reflect these frames.

Methods:
Online archives of the three most-read Austrian newspapers (Standard, Kurier, Kronenzeitung) were searched for articles on the policy published in November 2019, when the policy was implemented. Furthermore, speeches by FPÖ politicians in the parliamentary debate on the policy in June 2019 were identified via the parliamentary archive. Drawing on 4 speeches by FPÖ politicians and 29 newspaper articles, I used frame analysis to answer the research question.

Results:
The analysis yielded that FPÖ politicians used authoritarian, populist, and libertarian frames to argue against the implementation of the smoke-free policy. Thus, the policy was portrayed as not being in the interest of the people, restricting personal and economic freedom, and as elitist. These frames were not reflected in newspaper reports that mainly focused on the practical aspects of the policy implementation. However, in contrast to politicians supporting the policy, FPÖ politicians were overrepresented in newspaper reports representing 47% of political actors cited in newspaper articles.

Conclusions:
Authoritarian, populist, and libertarian frames were used by the FPÖ in opposition to the smoke-free policy. While these frames were not replicated by Austrian newspapers, RWP politicians were overrepresented in articles on the policy. These findings illustrate the importance of effective counter-framing by health advocates. Key messages: RWPP used authoritarian, populist, and libertarian frames to oppose Austria's smoke-free policy. Even though RWPP frames were not replicated in newspaper articles, RWPP politicians were overrepresented in reports on the policy.
iii628 European Journal of Public Health, Volume 32 Supplement 3, 2022