Engaging citizens in local health policymaking. A realist explorative case-study.

BACKGROUND: Municipalities have been trying to involve citizens as citizen participation is thought to improve municipalities’ accountability, the quality of services, and to align policies and services to communities’ needs. This study examined citizens’ participation preferences in policymaking by investigating their health policy priorities, expectations of involvement, and required support. METHODS: For this case-study the realist evaluation approach was applied to focus groups with citizens and to a workshop with a local panel consisting of professionals, citizens and citizen representatives. RESULTS: This study showed that citizens want to be involved in (health) policymaking with the aim of improving their communities’ quality of life and living environment and prioritised local services and amenities (e.g. suitable housing, public transport, health and care services). Instead, professionals’ priorities were focussed on singular public health issues related to prevention and lifestyle factors. The results also show that citizens felt responsible for driving citizen participation and representing community needs to the municipality, but needed the municipality to improve their communication and accessibility in order to do so successfully. Furthermore, the professionals on the panel indicated that they needed training on how to reach out to citizens. Such training should highlight how to better align their language to citizens’ lived experiences. They also wanted their organisations to provide more space, flexibility and resources to build relationships with citizens in order to provide improved communication and accessibility to citizens. CONCLUSION: The difference in priorities between citizens and professionals highlights the importance of involving citizens in policymaking. Moreover, citizens’ involvement can act as a lever for change to bring a wider range of services and policy sectors together and has the potential to better align policies to citizens’ lived experiences and hopefully increase the democratic legitimacy of policymaking. However, to fulfil such potential municipalities will need to invest in improving their accessibility and communication with communities

Cross-Sector Collaboration for a Healthy Living Environment-Which Strategies to Implement, Why, and in Which Context?

Background: Working toward a healthy living environment requires organizations from different policy domains and nongovernment partners involved in public health and the living environment to collaborate across sectors. The aim of this study is to understand how this cross-sector collaboration for a healthy living environment can be achieved. Methods: The realist evaluation approach was used to investigate what strategies can be used in which contexts to achieve cross-sector collaboration. The “Collaborative Adaptive Health Networks” framework was used as a theoretical framework. Seventeen partners of three Dutch projects collaborating for a healthy living environment in different regions were interviewed about their experiences during the initiating phase of their projects. Results: Seven themes for achieving cross-sector collaboration were identified, namely creating a feeling of equivalence, building trust, bridging different perspectives, providing clarity regarding roles and tasks, creating commitment, creating active engagement, and understanding whom to engage and when. For each theme, the strategies that were used, and why, were specified. Conclusion: This study provides new insights in how cross-sector collaboration for a healthy living environment can be achieved in different contexts. Whether the start of a cross-sectoral collaboration is successful is largely influenced by the choice of leadership and the interorganizational relations