Lynn McIntyre, MD MHSc FRCPC1 and Catherine L. Mah, MD FRCPC PhD2

1 Professor and Associate Scientific Director, Institute for Public Health, University of Calgary, lmcintyr@ucalgary.ca2 Scientist, Centre for Addiction and Mental Health and Assistant Professor, Dalla Lana School of Public Health, University of Toronto, catherine.mah@utoronto.ca

With thanks to Ryan Lukic, Krista Rondeau, Patrick Patterson, and Laura Anderson

Rapid simulation of a deliberative dialogue process: A food insecurity policy workshop

P U B L I C H E A LT H 2 0 1 4 – C P H A c o n f e r e n c e M a y 2 8

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Why are you here today?

You are a citizen of a major municipality, CPHA Metro. You have been invited to participate in a citizens’ dialogue on income support policy options to address food insecurity.

Please bring a ‘whole life perspective’ to this discussion, including your persona’s expected professional and personal roles, knowledge, values, and beliefs.

Chatham House Rule: You are completely free to use any of the information from today in your work and future deliberation, but neither the identity nor the affiliation of the speaker/participant should be revealed.

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Exploration of issue and policy options (15 min)Conflict identification (20 min)Action formulation (20 min)

Dialogue AgendaPart 1: Rapid deliberative dialogue simulation

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Marginal

Moderate

Severe

How many households are affected by food insecurity?

Source: Canadian Community Health Survey, 2012, in Tarasuk et al. 2012 PROOF report on Household Food Insecurity in Canada, 2012

Who is more likely to be food insecure?• Lone mothers• Aboriginal groups• People who do not

own a home12.6% of Canadian households

(1 in 8) were food insecure in 2012

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Low income: evidence on food insecurity risk

< 10k 10k to 19k

20k to 29k

30k to 39k

40k to 49k

50k to 59k

60k to 69k

70k to 79k

80k to 89k

90k to 99k

100k to

109k

110k to

119k

120k to

129k

130k to

139k

140k to

149k

0

5

10

15

20

25

Food SecureFood Insecure

Pe

rce

nt

of

Po

pu

lati

on

It’s about income, most of the time CCHS 4.1

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Evidence on food insecurity

Drivers of food insecurity

Low income, but also income shocks

Workforce participation and education partially protect against food insecurity, but labour market practices can perpetuate food insecurity

Structural determinants that make particular population groups vulnerable

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Many policy options for addressing income insecurity

Income supportTargeted income support (e.g., for food)

EmploymentTraining, capacity building, labour protectionCost of living

Macro-economic policy

Social protection, benefits

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Evidence on income

Key example of this policy instrument: Guaranteed annual income for seniors through pension

Logic model:Addresses 1) income floor but also 2) budget shocks

Evidence on effectiveness:Reduces food insecurity rates by more than half for age >65y

Implementation possibility:Universal guaranteed basic income (general tax revenues)

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Source: Canadian Community Health Survey 5.1 (2009/2010) in Emery, Flesich and McIntyre 2013 How a Guaranteed Annual Income Could Put Food Banks Out of Business, University of Calgary School of Public Policy Research Papers 6(37)

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Evidence on income-for-food

Key example of this policy instrument: Supplemental nutrition assistance program (SNAP in US)

Logic model:Allows people to spend more on food relative to other goods than they would otherwise

Evidence on effectiveness:Reduces food insecurity (particularly households with children)

Implementation possibility:Targeted social assistance program (general tax revenues)

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SNAP Reduces Food Insecurity

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Deliberation part 1:Conflict identification

Which is the fairest approach, and why?

Guideline: your group does not need to come to a consensus, but you can if you wish

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Income

• E.g., seniors’ pension• Increases income floor

and evens out income shocks

• Reduces food insecurity• Funded through general

revenue

Income-for-food

• E.g., SNAP (US)• Increases ability to

spend more on food relative to other goods

• Reduces food insecurity• Funded through general

revenue

Review of policy options

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Deliberation part 2:Formulate action plan

Which policy option would you recommend and why?

Guideline: your group does not need to come to a consensus, but you can if you wish

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Dialogue AgendaPart 2: Reflective evaluation; review of dialogue method and use in public health practice

Reflective evaluation of dialogue Report back and evaluation (15 min)Overview of deliberative dialogue methods and application to public health policy and practice (15

min)

Take home messages (5 min)

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Reflective evaluation

1. How well did the dialogue process support discussion of a high-priority issue in order to inform action?

2. What features of the dialogue process worked best? What could be added or changed?

3. How did your role and background influence your participation?

Reflection

SUPPORT tools #14 (Lavis et al) http://www.health-policy-systems.com/supplements/7/s1

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Review: Deliberativedialogue methods

Purpose: a transformative discussion

• A forum for transforming ideas, opinions, or action strategies though group deliberation

• For decision-makers: public engagement• For KTE: exchanging evidence on polarized issues• Representing public/community interests and values

Boyko et al. 2012; SUPPORT tools; Brown 2006; Davies and Burgess 2004

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Review: Deliberativedialogue methods

Key elements:

• Appropriate venue/environment• Transparent process and rules of engagement• Timeliness of the issue

• Appropriate mix/representativeness of participation (different ways to achieve this)

• No ‘magic number’ of participants (often 8-15 for a citizens’ panel)

Boyko et al. 2012; SUPPORT tools; Brown 2006; Davies and Burgess 2004

19SUPPORT tools #14 (Lavis et al) http://www.health-policy-systems.com/supplements/7/s1

20Health Canada 2000

Reflection

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Reflection

National Coalition for Dialogue & Deliberation http://ncdd.org/

Goals for the outcomes but also the process

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ReflectionAlso a part of reflective practice (civic professionalism)

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Reflection

Ottawa Charter 1986

How can this process be used in public health practice?

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Reviewing our objectives

Following this workshop, participants will be able to:

1. Identify key elements of a deliberative dialogue2. Formulate, with other citizens, a workable policy option

to act in a mutually acceptable way (but not necessarily consensus)

3. Describe at least two examples of public health practice scenarios in which deliberative dialogue methods could be applied

Reflection

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Thank you!

PI: Valerie Tarasuk, Craig GundersenCo-Investigators: Lynn McIntyre, Catherine L. Mah, Herbert Emery, Jurgen Rehm, Paul Kurdyak