Resounding through our national health reform process, is the international recognition that we have reached a pivotal turning point in our thinking about health and that health systems need to change.  Engaging citizens in the health reform process is recommended as critical; with reciprocal benefits espoused.  And yet, this ethically compelling recommendation can meet with many obstacles.  Not the least of these obstacles, claim some writers, is the realisation that the engagement of citizens in healthcare decisions will, by necessity, require explicit identification and negotiation of the profoundly complex cultural issues at play within the health sector.  Similar challenges can be found in the reality that governments and other decision-making bodies are grappling to find the right balance between obtaining the public’s opinion on relevant matters and the public’s cynicism towards the consultative tools of the past, which were perceived to have predetermined outcomes.  It is within the sensitivities of this highly contentious arena that my research emerges.

This work-in-progress PhD research is part of an Australian Research Council (ARC) Linkage Project[1] which will apply and evaluate deliberative processes for their effectiveness as tools in health policy development and as a means for collecting information on citizens’ views on health policy issues.  Deliberative processes offer a new paradigm of participation; one that holds great promise as a more democratic form of engagement, that values and respects the rational judgments of the participants.  Indeed, critical to participant satisfaction and the effectiveness of deliberative processes, is the value given to the community’s expertise. 

It is possible to conceive of deliberation as both an individual and collective activity, although most deliberative exponents focus their attention on the collective, participatory aspect of deliberative processes.  My research, however, will refocus this attention; thereby, rendering visible the interface between the collective and individual levels of this participatory approach.  It is within this interface that I will critique a particular phenomenon that can arise within the transference of knowledge – an epistemic injustice – which can influence who is perceived as credible and subsequently valued for their capacity to give and receive knowledge.  I will do this, within this qualitative piece of research, with the aid of metaphor analysis.

Metaphor analysis has proven efficacy working with complex issues of organisational culture change through the facilitation of shared understanding of thoughts, feelings, experiences and values – creating a shared perception for matters that may not be openly discussed.  I am drawing upon a particular branch of metaphor analysis, critical metaphor analysis, which complements cognitive semantics with pragmatic factors, to help explore the socially-situated context of my research.  In doing this, my research will create a space for dialogue, critical thinking, and reflection on the ethics of power, knowledge and injustice when citizens are engaged within the health policy process.  

[1] This ARC Linkage Project No: 0989429 titled: Citizen Engagement: Listening to citizen’s views about Australia’s health system and prevention is part of a multi-university/ state and territory health department collaborative project, developed by the Australian Institute of Health Policy Studies.