Over the last three years, the Public Engagement in Health Policy (PEHP) team has sought to understand and address current challenges in public engagement practice through research, education, and leadership initiatives. Some key questions guiding our work include how health policymakers can foster more inclusive and transformative public engagement processes, and how public engagement can be used to better serve communities and build trust between the public and political institutions. While these top-down government-initiated approaches to engagement are important, we heard time and again, about essential work happening within and by communities. This community organization-led engagement work has the power to make significant impacts on the health and well-being of the groups they serve.

As we reflected on the project, we wanted to find a way to amplify the incredible work currently being done in and for communities. We launched a Community Fellowship initiative to support  organizations to carry out innovative engagement-related activities that would help advance the goals of more inclusive public engagement in the health and social care sector. The team received 26 eligible applications from organizations and community leaders and were delighted to provide fellowship support to 11 teams doing front-line engagement work with a diverse range of populations and communities: the full list of fellowship recipients is available here.

Bringing Community Fellows together at McMaster Innovation Park

In addition to the fellowship, the Public Engagement in Health Policy team wanted to support fellows by providing consultations, facilitating shared learning, and amplifying fellow-led initiatives. In October 2023, we brought together the fellowship teams for a full-day event to share their progress, to exchange their learnings, and to support community building. We canvassed the community organizations, to ask what would be most helpful for them, and built an agenda around their needs and goals. Recognizing the importance of peer support, we started the day with a community exchange – each team had up to 10 minutes to introduce their organization, engagement activity, progress, and areas in which they wanted input. After every four presentations, we broke for refreshments – and, more importantly, an opportunity for the organizations to connect with one another!

Highlighting the equity-centred engagement guide

Several fellows highlighted equity-centred engagement as a topic of interest. This shared enthusiasm was not surprising – many of the fellows are committed to promoting equity within their organizations, so naturally, wanted to reflect on how they could champion equity in their engagement-related activities. To start the conversation, we presented the Supporting Equity-Centred Engagement Guide developed by members of the PEHP team. We led the fellows through the five key steps in the guide, and then shared three key questions for thinking through centring equity in engagement:

1. When planning the engagement process how do we deliberately and intentionally embed equity from the very start of the process?
2. How can we develop opportunities for meaningful engagement that is built on trust, valuing all voices and experiences, and distributing power?
3. How can we identify and learn from the challenges and successes we encountered or will encounter in our engagement work?

Supporting critical reflection about equity-centred engagement

Equity-centred engagement isn’t easy. It can look different in different organizations, it requires dedicated resources and strategic investments, and to do it well means a lot of deep thinking about the “why” and the “how”. In order to discuss these questions and encourage critical reflection, the Community Fellows and PEHP team members split into three community conversations.

Taking guidance from the equity-centred engagement guide, our afternoon community conversations spanned three broad stages of engagement: initiating and planning engagement, facilitating and conducting engagement, and taking stock and evaluating engagement. These conversations were facilitated by members of the PEHP team, who provided reflective prompts to guide conversation, but were importantly led by the Community Fellows themselves.

Each group weaved both practical suggestions for centring equity in engagement activities and nuanced conversations about the possibilities and pitfalls of this work. The Initiating Engagement group discussed the importance of investing in engagement by offering suitable compensation and ensuring adequate staff are dedicated to engagement activities. They discussed the problems associated with a lack of resources, which often leads to tokenistic engagement or engagement with those who are easiest to reach, missing those who are most vulnerable or most affected.

The Conducting Engagement group noted the importance of meeting people where they are and shaping engagement around participants’ capacity, preferences, and needs. They reflected that harms can sometimes occur during engagement, especially for communities who have negative experiences with the healthcare system, and that plans need to be in place for offering support and repairing relationships. Finally, the Evaluating Engagement group got into the nitty gritty of data and thought about the various ways we can determine whether engagement went well. A key insight was that engagement itself can guide evaluation – by asking those engaged what successful engagement looks like for them.

The 2023 Community Fellows Fall Event was a day full of sharing ideas, building connections, and thinking critically about engagement. It was inspiring to hear about the array of engagement initiatives being led by community organizations serving diverse communities across Canada. We hope the rich conversations that took place on the day will carry on as Fellows continue to plan, conduct, and evaluate their engagement activities. We wish fellows and their community organizations the best of luck with their ongoing work!

Roma Dhamanaskar is a PhD Candidate in the Health Policy program at McMaster University and a research fellow with the Public Engagement in Health Policy Project. Her research interests reside at the intersection of public engagement and health policy ethics. Roma holds a Master of Bioethics from the University of Pennsylvania and aims to apply theory from political philosophy to the field of public engagement in health policy. Roma is also a research assistant with the Public Engagement in Health Policy Project and Public & Patient Engagement Collaborative.

Joanna Massie is a PhD Candidate in Political Science at McMaster University. Her research explores deliberative democracy and themes of representation and public interest. She is a Fellow in the Digital Society Lab at McMaster University, and was an inaugural Fellow of the Public Engagement in Health Policy project. She is a Research Assistant with the Public Engagement in Health Policy team.

Moizza Ul Haq is a recent Master of Public Health graduate at McMaster University. She seeks to work towards promoting equity and justice in the communities, and is passionate about applying the principles of equity, anti-oppression, justice, and accountability to public health research and practice. She is lead author of the Supporting Equity-Centred Engagement guide. She was a Research Assistant with the Public Engagement in Health Policy team.

This essay was prepared by members of the Public Engagement in Health Policy team, which is supported by the Future of Canada Project at McMaster University. Please visit https://ppe.mcmaster.ca/research/public-engagement/ for further research outputs and resources.