Public deliberation: An ethical approach to setting public health priorities

Setting priorities for public health requires making tradeoffs among a number of competing goals and subpopulations. For example, some public health programs are likely to produce more aggregate health in a population yet exacerbate relative disparities between better and worse off groups. Other interventions may reduce health disparities but be cost-inefficient. Still other investments may target one vulnerable population, such as children, diverting investments from other vulnerable groups, such as frail elders. Each of these investments might be justifiable according to ethical principles integral to US public health, such as maximization, distributive equity, efficiency, and protection of vulnerable groups. How ought such tradeoffs be decided? What approach to setting priorities in public health is ethically defensible? This presentation defends the general thesis that “public deliberation” is an ethical approach to setting public health priorities. Public deliberation is a method of public engagement that has made significant inroads in public policy and has increasingly been used to engage citizens in bioethics and health policy issues. In the past year, the Institutes of Medicine endorsed deliberation as a method of public engagement and the Agency of Healthcare Research and Quality undertook a study to evaluate different methods of public deliberation. This presentation will identify core elements of public deliberation; differentiate public deliberation from community-based participation; and analyze the ethical merits of public deliberation as a method for setting public health priorities. These areas will be discussed using an innovative project that combines public deliberation with dynamic system modeling as a case study.