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Abstract

This paper examines the meanings of and distinctions between public deliberation and a tradition of participation in health committed to community empowerment, collective action, and social justice and their implications for health equity. Although participation (as empowerment) and public deliberation share fundamental democratic ideals, these democratic practices differ in basic respects. Whereas participation in health typically seeks to engage marginalized and minority groups in planning, research, and action on the social determinants of health and wellbeing, deliberative processes seek to create the conditions for reasoned and respectful public dialogue that can lead to well considered collective judgments about important social issues. Whereas the ultimate aim of participation in health is a redistribution of resources and power that will advance health equity and social justice, the ultimate aim of deliberation is a fair process that yields public decisions all will view as legitimate. Proponents of public deliberation often contend that decision-making subject to democratic deliberation will result in (more) just outcomes; yet, public deliberation has been criticized precisely for its inability to include marginalized perspectives and to challenge status quo institutional arrangements and power relations. This analysis concludes that the use of public deliberation to advance health equity and social justice in the U.S. context holds promise despite serious challenges.

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