Abstract
Closing the health inequity gap can be seen as an issue of justice, however what concretely best serves the interest of justice is in dispute. It is argued that standard policy-making mechanisms are inadequate to address this issue, and therefore more and better public dialogue is required. Drawing on deliberative democratic theory and practice, three public organizing considerations are offered: organizing within the state sphere, organizing within the public sphere, and using cross strategies. It is recommended that public resources be provided to involve the public in deliberations about population health promotion issues related to the wicked problem of health inequities.
Key words: Deliberative democracy, population health, health promotion, health inequity, advocacy, civil society
Résumé
On peut considérer la réduction des inégalités en santé comme une question de justice, mais on ne s’entend pas sur les mécanismes qui, concrètement, servent le mieux les intérêts de la justice. Nous faisons valoir que les mécanismes habituels de formulation des politiques sont insuffisants dans ce cas, et qu’il faut tenir des discussions publiques plus nombreuses et plus éclairées. Nous proposons trois mécanismes possibles d’organisation du public, fondés sur la théorie et la pratique de la démocratie délibérative: l’organisation dans la sphère étatique, l’organisation dans la sphère publique et l’utilisation de stratégies transversales. Il est recommandé que l’État fournisse des ressources pour faire participer le public aux délibérations sur les questions de promotion de la santé des populations liées au problème épineux des inégalités en santé.
Mots clés: démocratie délibérative, santé des populations, promotion de la santé, inégalités en santé, revendication, société civile
Footnotes
Acknowledgements: B. Evoy is a recipient of the Canadian Institutes of Health Research Doctoral Research Award, as well as the Institute of Population and Public Health, Canadian Public Health Association, Canadian Public Health Initiative and Public Health Agency of Canada Population and Public Health Doctoral Student Award 2007.
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