Citizen participation in healthcare: a field perspective

Abstract Background Many nations are faced with challenges regarding the sustainability of their healthcare systems. Rising costs and limited financial and human resources mean that difficult decisions regarding the provision of healthcare are imminent. Which care should be provided, when and where? These decisions will affect all current and future users of healthcare. This has given rise to calls from policy makers and others to include citizens in the decision making process. The question is how this can be done. What are viable ways of citizen participation in healthcare? What are critical issues to take into account? And how do citizens themselves want to participate? Methods We use results from a literature review, six interviews with organizations in the field and the results of two citizen platforms to map the challenges and opportunities for citizen participation in healthcare. We study the case of the Netherlands, a country with a long and singular tradition of participatory policies. Results Preliminary findings indicate there are six key decision variables that are instrumental in shaping citizen participation in the field of healthcare. Among those are the kinds of knowledge that participants possess and the valuation of these kinds of knowledge by agents in the field of healthcare. Conclusions We interpret the results using a Bourdieusian conceptual framework, which emphasizes the contextual framing of participation. Citizen participation can be understood as an intervention in the field of healthcare. Participation is structured by the different forms of knowledge of participants as capitals. This highlights power differences that must be understood in order to design fruitful participatory processes. Key messages • Citizen participation in healthcare understood as an intervention in the field of healthcare. • Understanding power differences is crucial for designing and implementing this intervention.


Background:
The corporate political activities of harmful industries, including the use of agnogenic (ignorance or doubt producing) practices and the construction of dystopian narratives, directed at influencing policymaking are well documented. However, the use of agnogenic practices by industry-funded organisations who deliver industry-favoured education-based measures remains unexplored. This study aims to build understanding of this by analysing three UK gambling industry-funded youth education programmes that represent key policy responses to gambling harms. Methods: Using a published typology of corporate agnogenic practices the ways that evidence is used within the programmes' resources to legitimise their content and implementation were analysed. Programme evaluations and claims about the programmes' evidence base and effectiveness were also analysed.

Results:
Agnogenic practices, including confounding referencing, misleading summaries and evidential landscaping, that resemble those adopted by harmful industries are used within gambling industry-funded youth education programmes and by the charities that oversee their delivery. These practices serve corporate interests, distort the limited evidence in support of youth gambling education measures, and legitimise industry favoured policies.

Conclusions:
This novel study demonstrates that agnogenic practices are used to construct utopian narratives that claim that gambling industry-favoured youth education programmes are evidencebased and evaluation-led. These practices misrepresent the literature and evaluation findings and may undermine effective policymaking to protect children and young people from gambling harms. Key messages: Gambling industry-funded education programmes warrant greater scrutiny and conflicts of interest need to be addressed.
The methods and findings of this study are of relevance to other contexts and areas in the field of the commercial determinants of health given other harmful industries adopt similar approaches.

Background:
Many nations are faced with challenges regarding the sustainability of their healthcare systems. Rising costs and limited financial and human resources mean that difficult decisions regarding the provision of healthcare are imminent. Which care should be provided, when and where? These decisions will affect all current and future users of healthcare. This has given rise to calls from policy makers and others to include citizens in the decision making process. The question is how this can be done. What are viable ways of citizen participation in healthcare? What are critical issues to take into account? And how do citizens themselves want to participate? Methods: We use results from a literature review, six interviews with organizations in the field and the results of two citizen platforms to map the challenges and opportunities for citizen participation in healthcare. We study the case of the Netherlands, a country with a long and singular tradition of participatory policies.

Results:
Preliminary findings indicate there are six key decision variables that are instrumental in shaping citizen participation in the field of healthcare. Among those are the kinds of knowledge that participants possess and the valuation of these kinds of knowledge by agents in the field of healthcare.

Conclusions:
We interpret the results using a Bourdieusian conceptual framework, which emphasizes the contextual framing of participation. Citizen participation can be understood as an intervention in the field of healthcare. Participation is structured by the different forms of knowledge of participants as capitals. This highlights power differences that must be understood in order to design fruitful participatory processes.

Key messages:
Citizen participation in healthcare understood as an intervention in the field of healthcare. Understanding power differences is crucial for designing and implementing this intervention.
iii630 European Journal of Public Health, Volume 32 Supplement 3, 2022