Public health policies are more likely to be effective and sustainable when citizens are involved in their development, a new study published in the American Journal of Public Health has found.

The study, led by Dr. Michelle Bosché of the Harbor-UCLA Department of Emergency Medicine in Torrance, California, examined how public deliberation could improve different aspects of public health policymaking, including the quality of evidence, political feasibility, implementation, and public trust.

The analysis, published online on July 23, 2026, argues that assessing public health policies solely on their financial costs and expected outcomes may overlook other factors that determine whether such policies succeed.

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According to the researchers, “Policy efficiency should be considered across five dimensions: fiscal, epistemic, political, implementation, and civic efficiency.

“While fiscal efficiency measures whether policy objectives can be achieved at the lowest monetary cost, epistemic efficiency assesses whether decisions are based on sound evidence.

“Political efficiency considers the ability of policies to overcome political barriers, while implementation efficiency focuses on how effectively policies can be put into practice. Civic efficiency, meanwhile, considers public trust and participation.

“We conceptualise five important dimensions of efficiency: fiscal, epistemic, political, implementation, and civic,” Bosché said.

The researchers examined three case studies to assess the role of public deliberation in policymaking. They included public engagement in pandemic influenza vaccine prioritisation in the United States, Ireland’s Citizens’ Assembly that contributed to abortion policy reform, and an Australian deliberative forum that helped shape long-term guidelines for biobanking.

The study found that involving members of the public in these processes helped policymakers incorporate community values, reduce political obstacles and strengthen the prospects for effective implementation.

Bosché said public deliberation could also help policymakers identify options that might otherwise be overlooked.

“Well-designed public deliberation broadens the range of perspectives in a policy discussion, generating options that might otherwise remain invisible,” she said.

According to her, policies developed through broader and more reflective discussions are more likely to reflect real-world constraints and local realities, making them more resilient to challenges during implementation.

She added that deliberation could improve the quality of decisions while reducing the likelihood of costly policy revisions later.

The researchers therefore recommended that public deliberation should become a routine component of public health policymaking rather than an occasional exercise.

They said institutionalising the approach could contribute to better policy decisions, stronger public trust and more effective and sustainable health systems.

The study was funded by the Kevin Gould Family Fund and the Alan and Jane Jacober Family Fund.