Lynn McIntyre, MD MHSc FRCPC 1 and Catherine L. Mah, MD FRCPC PhD 2 1 Professor and Associate Scientific Director, Institute for Public Health, University of Calgary, 2 Scientist, Centre for Addiction and Mental Health and Assistant Professor, Dalla Lana School of Public Health, University of Toronto, With thanks to Ryan Lukic, Krista Rondeau, Patrick Patterson, and Laura Anderson Rapid simulation of a deliberative dialogue process: A food insecurity policy workshop PUBLIC HEALTH 2014 – CPHA conference May 28

2 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.

3 Exploration of issue and policy options (15 min) Conflict identification (20 min) Action formulation (20 min) Dialogue Agenda Part 1: Rapid deliberative dialogue simulation

Marginal Moderate Severe 4 How many households are affected by food insecurity? Source: Canadian Community Health Survey, 2012, in Tarasuk et al 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 home 12.6% of Canadian households (1 in 8) were food insecure in 2012

5 Low income: evidence on food insecurity risk It’s about income, most of the time CCHS 4.1

6 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

7 Many policy options for addressing income insecurity Income support Targeted income support (e.g., for food) Employment Training, capacity building, labour protection Cost of living Macro-economic policy Social protection, benefits

8 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)

9 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)

10 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)

SNAP Reduces Food Insecurity 11

12 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

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 13 Review of policy options

14 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

15 Dialogue Agenda Part 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)

16 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)

17 Review: Deliberative dialogue 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

18 Review: Deliberative dialogue 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

19 SUPPORT tools #14 (Lavis et al)

20 Health Canada 2000 Reflection

21 Reflection National Coalition for Dialogue & Deliberation Goals for the outcomes but also the process

22 Reflection Also a part of reflective practice (civic professionalism)

23 Reflection Ottawa Charter 1986 How can this process be used in public health practice?

24 Reviewing our objectives Following this workshop, participants will be able to: 1.Identify key elements of a deliberative dialogue 2.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

Thank you! PI: Valerie Tarasuk, Craig Gundersen Co-Investigators: Lynn McIntyre, Catherine L. Mah, Herbert Emery, Jurgen Rehm, Paul Kurdyak 25