Alicia Yamin spoke about her work on fostering meaningful citizen participation in health priority setting during a recent CHDS seminar. Yamin is a lecturer on Law and Senior Fellow on Global Health and Rights at the Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics at Harvard Law School. She is also affiliated with the Department of Health Policy and Management at the Harvard TH Chan School of Public Health and is a Senior Affiliated Researcher at the Bergen Center for Ethics and Priority Setting.
Yamin noted that a broadly held view within health priority setting research stresses the importance of promoting legitimate decisions, based on both reasonable values and transparent and inclusive decision-making processes. Daniels and Sabin’s influential framework Accountability for Reasonableness (A4R) captures the important elements of procedural fairness. Nonetheless, A4R does not specify the conditions for its own implementation.
Yamin indicated that trust and legitimacy is important both in pandemic settings and in normal times. A key concern is the need to address the stratification of power. This may be achieved, for example, by equalizing background knowledge across participants, involving interlocuters to equalize power asymmetries, enabling participation by groups across the political spectrum and allowing them to designate their own representatives, requiring disclosure of conflicts of interest and guarantees of non-retaliation, using techniques and frameworks that challenge internalized domination, and incorporating approaches for developing and using additional information in priority setting. She ended the seminar with several open questions about the relationship between legitimacy and trust, and the role of policymakers in pursing strategies to manage power inequities while also addressing the structural sources of these inequities.
Learn More: Explore the CHDS Resource Pack: Ethics, Human Rights, Pandemics
Learn More: Read the Lancet article, Why accountability matters for universal health coverage and meeting the SDGs