Public health policies are commonly evaluated by their financial costs and expected outcomes. However, policy decisions must also be supported by strong evidence, political feasibility, effective implementation, and public trust to achieve lasting public health benefits. Although public deliberation has been increasingly recognized as a way to involve citizens in policymaking, its role in improving policy efficiency has not been clearly defined.
In a recent analytical study, Dr. Michelle Bosché from the Harbor-UCLA Department of Emergency Medicine in Torrance, CA, and colleagues examined how public deliberation can strengthen public health policymaking by improving multiple dimensions of policy efficiency. The study was published online in the American Journal of Public Health on July 23, 2026.
"We conceptualize 5 important dimensions of efficiency: fiscal, epistemic, political, implementation, and civic," says Dr. Bosché.
The researchers explain that while fiscal efficiency focuses on achieving policy outcomes at the lowest monetary cost, the remaining dimensions evaluate whether policies are built on sound evidence, can overcome political challenges, are effectively implemented, and strengthen public trust and civic participation. Together, these dimensions provide a broader framework for evaluating public health policies.
To demonstrate how public deliberation can improve policymaking, the researchers examined three case studies. These included public engagement in pandemic influenza vaccine prioritization in the United States, Ireland's Citizens' Assembly that helped inform abortion policy reform, and Australia's deliberative forum that contributed to long-term biobanking guidelines. Across these examples, public deliberation helped incorporate community values, reduce political barriers, and support policy implementation.
Explaining the value of this approach, Dr. Bosché says, "Well-designed public deliberation broadens the range of perspectives in a policy discussion, generating options that might otherwise remain invisible. Policies that emerge from this more expansive and reflective reasoning process are better tailored to real-world constraints and local realities and are more resilient to downstream challenges. By improving the quality of decisions (epistemic efficiency) and reducing the likelihood of costly revisions (implementation efficiency), deliberation may serve as an upstream mechanism for improving policy efficiency."
The authors conclude that public deliberation should become a routine structural component of public health policymaking rather than an occasional exercise. Such an approach could improve policy quality, strengthen public trust, and create more effective and sustainable public health systems.
