Deliberative public engagement
This paper explores the value of deliberative pubic engagement as a means of gauging public opinion to inform food policy. Since the 1990s, authors [
1‐
3] have identified a growing interest in methods which promote deliberative public engagement in policy making. Deliberative public engagement is a distinctive approach to involving people in discussions about policies and other value-laden issues [
4], including ethical matters [
5], which has its roots in deliberative democratic theory [
6‐
9]. It is described as a “talk-centric democratic theory” in which the legitimacy of government is associated with policy and public accountability to citizens [
2] (p. 317). This approach aims to give participants from diverse backgrounds and with a range of values and attitudes ample time and adequate information (without privileging the views of so-called ‘experts’) to enable them to consider and discuss an issue in depth before forming their views, and to carefully weigh reasons for and against a particular proposal. It emphasizes that outputs need not be simple answers about which policy would be preferred, for instance, but may well take the form of questions that remain open for participants and which would need to be resolved before they can endorse (or reject) a particular option. As such, it is a research method that can provide greater depth of knowledge than can be provided by alternative research methods such as survey research or focus groups, because the goal is to allow citizens to weigh evidence, discuss and debate potential policy options, and arrive at a mutually-agreed decision. Complete consensus may not be possible but the aim is to generate a decision that members of the collective can ‘live with’.
These methods have gained popularity given that the public is better educated, more sophisticated and less deferential to authority than in the past [
10]. The methods are also claimed to be an antidote to political participation for individual purposes, and they endeavour to foster citizen participation as members of a broader collective, dovetailing with ideals of active citizenship [
11,
12]. In a review of literature on the use of deliberative techniques in health, Mitton et al. [
3] note that they are most commonly reported in relation to public health issues. These methods are pertinent to public health because they have potential to empower participants through participation in and knowledge of health policy making processes [
13]; involve community members in decision making about resource allocation [
3] and priority setting [
14]; manage community expectations [
1]; and increase public commitment to policy decisions [
15] and understanding community attitudes to perceived roles in self-management of health [
16].
This paper explores the efficacy of a particular method of deliberative public engagement, the citizens’ jury, through a case study of a jury in Adelaide, South Australia, in December 2011. The main purpose of the jury was to gauge public views on the regulation of food and drink marketing and advertising at children’s sporting events. The jury also was used to trial methods and to determine the most effective means of conducting citizens’ juries in relation to public perceptions of food regulation, with reference to the key criteria for judging efficacy: representativeness, procedures and processes, quality of information, and outcomes. These 4 criteria have been recommended by Abelson et al. [
4]. Representativeness is important to ensure that citizen participation is widespread and that issues of equity are addressed. Procedures and processes ensure that the jury’s deliberations are fair and responsive, and thus give rise to legitimacy. The quality of information used in the jury process is crucial, and needs to endure a breadth as well as depth of knowledge on the part of the witnesses. Finally, outcomes refers to the extent to which public input results in policy output; in other words, the extent to which the jury’s finding are incorporated into public policy considerations. Although there have been several studies of citizens’ juries with regard to public health policy, this mechanism has not yet been widely utilized in conjunction with food regulation. As this domain raises quite different issues particularly because of its intersection with people’s everyday lives as well as with issues associated with parenting and family decision-making, this study represents an important pilot in this domain.
What is a citizens jury?
A citizens’ jury is a process in which a broadly representative group of citizens are brought together to discuss an issue that is of interest to the general community [
17]. This model was developed in the United States (US) and Germany. In the United Kingdom the Institute for Public Policy Research (IPPR) has used it for a range of regional and national policy health issues [
18]. The IPPR use 12–16 jurors while the Jefferson Center in the US recommends 18–24 members. Other citizens’ juries in the UK have also used 16 members [
14,
16]. Citizens’ juries are based on the premise that, if equipped with information and time, members of the public should be able to reach a decision on issues that they may have previously known little about [
19]. Specialists with knowledge of the issue under discussion (witnesses) are selected to present information to citizens, generate discussion and answer any questions jurors may have [
20]. The jury is given time to deliberate on the issue and it is assisted by facilitators who encourage debate and guide discussion [
18]. The jury then forms recommendations on the issue that can be taken to policy makers for consideration in the policy-making process [
19].
Citizens’ juries offer a unique opportunity for members of the population to engage in discussion and make recommendations for future policy making [
14,
19]. The advantages of the method include the involvement of members of the public, and the opportunity to gauge public reaction and opinion to policy during the policy-making process [
21]. Specifically, jurors drawn from the general population are presented with evidence from specialists on an issue of policy, deliberate with fellow jury members and make their informed recommendations on the issue [
22]. Potential considerations with the method include costs associated with venue hire, catering, staff wages and participant reimbursement [
3,
23], while a considerable amount of time is required to develop the jury, including identification and recruitment of jurors and specialist speakers. Despite these possible limitations, citizens’ juries are a unique public democracy mechanism that can yield rich data on public perceptions and recommendations on an issue of policy.
Considerations in establishing a citizens’ jury
While deliberative democratic approaches are designed to encourage two-way interaction between policy makers and the public there are a number of factors that can inhibit this interaction. The first is related to sampling, recruitment and the representativeness of the jury. Gooberman-Hill et al. [
23] argue that citizens’ juries generally should be composed of people from diverse backgrounds to ensure a range of opinions. Mitton et al. [
3] identify three recruitment strategies: purposive sampling, self-selection and random sampling. Purposive sampling ensures that underrepresented voices are included in the jury, leading to greater equity, but this potentially ignores the impact of power relations based on symbolic power within the jury [
23]. Recruitment through self-selection of participants is easier and more cost effective; however it can lead to homogeneity of participants and lack of diversity of views [
12]. The relatively small size of juries means that random sampling may lead to panels that are inclusive but not representative [
12]. This can be overcome through stratified random sampling and attention to the demographic characteristics of participants [
24].
A second set of issues relates to the deliberation process. Procedural factors that need to be considered include structuring opportunities for participation; provision of adequate time for discussion [
4]; pre- and post-testing to discern attitude change; effective facilitation [
12]; and selection of witnesses who can represent opposing viewpoints [
24]. Leadership style is particularly pertinent, with Ryfe [
12] suggesting that the leader should establish group norms by outlining rules for equality, inclusiveness and civility at commencement and providing cues about how to act within the group throughout the process. In addition, Lenaghan et al. [
14] argue that the definition of the question for the jury is crucial to its success.
A third consideration is the outcome of the deliberation process. Citizens’ juries can be understood as a consultative process that provides public input for policy makers [
12]. Lenaghan et al. [
14] argue that there are two models of citizens’ juries: a ‘deliberative model’ which involves broad ranging questions which may guide policy makers; and a ‘decision making model’ whereby the jury has a clear set of options from which to choose. The authors argue that both processes improve democratic deliberative processes, but the latter may improve the legitimacy of policy decisions. A number of authors [
3,
12,
23] note there can be tension between lay perspectives and the realities of policy making. While citizens’ juries have the capacity to alert the public to these realities, they can also create an expectation that the consultation process will inform policy [
12]. The reality of policy making is that public views are only one source of data among many. In making decisions, policy makers draw on research findings, experience, habits and tradition together with their own personal and political judgements [
3]. As such, Mitton et al. [
3] found that few studies formally evaluate the effectiveness of the deliberative public engagement process. However, Abelson et al. [
4] suggest that evaluation can be addressed through the extension of data analysis beyond description of policy recommendations to a critical evaluation of the processes of deliberation. Lenaghan et al. [
14] provided an evaluation of how their citizens’ jury operated, which was built into the development and operationalization of the citizens’ jury within this paper.
Adelaide jury: background and topic
A research team from Flinders University, with associates from the University of Adelaide and the University of Kent who were experienced with citizens’ juries, developed and facilitated a citizens’ jury. The team was interested in pilot testing this model of citizen involvement using a current public health issue.
The chosen topic was the recent debate about food marketing to children and its influence on childhood overweight and obesity. In Australia it has been documented that 25% of children aged 5 to 14 years are overweight or obese. Contributing to these rates are environments which promote obesity (also known as ‘obesogenic’ environments) [
25], one example of which is the sponsorship and advertising of unhealthy foods and beverages at children’s sport, through which children are exposed to the marketing of unhealthy food and drinks [
26].
Investigations into the effects of sponsorship on children suggest that sponsorship has an impact on children’s recall and their product attitudes and food preferences [
27]. This is problematic because the peak state organizations for children’s sport in South Australia rely on sponsorship from food and beverage companies and it is estimated that 92% of this promotion involves unhealthy products [
26]. The significance of this issue has been identified by the World Health Organization which has recommendations on the marketing of foods and non-alcoholic beverages to children, including restricting the promotion of unhealthy food and beverages at sites where children gather, such as sporting activities [
28]. Currently in Australia there are no regulations that restrict the promotion of food products to children through sponsorship [
29].
In Australia there are calls for government intervention and policy to regulate food marketing to children, including pressure from key organizations and interest groups such as the Coalition on Food Advertising to Children and the Australian Council on Children and the Media. The views of the general public regarding policy development and reform, however, are under-represented. Therefore the specific question addressed by this citizens’ jury was “Should food and drink sponsorship of, and advertising at, children’s sporting events be banned?”. The project was given approval from the Social and Behavioural Ethics Committee at Flinders University, South Australia.