Trends in Government-Initiated Public Engagement in Canadian Health Policy From 2000 to 2021.

Introduction: Canada has a rich history of public engagement in health policy; however, shifts in engagement practices over time have not been critically examined. Methodology: We searched for cases of government-initiated public engagement in Canadian health policy from 2000 to 2021 at the federal, provincial (Ontario, British Columbia, Nova Scotia) and pan-Canadian levels. Government databases, portals and platforms for engagement were searched, followed by academic and grey literature using relevant search terms. A coding scheme was iteratively developed to categorize cases by target population, recruitment method and type of engagement. Results: We identified 132 cases of government-initiated public engagement. We found a predominance of feedback and consultation engagement types and self-selection recruitment, especially at the federal level from 2016 onward. Engagements that targeted multiple populations (patients, public and other stakeholders) were favoured overall and over time. Just over 10% of cases in our survey mentioned efforts to engage with equity-deserving groups. Conclusion: Overall, our results identify a heavy reliance over time on more passive, indirect engagement approaches, which limit opportunities for collaborative problem solving and fail to include equity-deserving populations. Those overseeing the design and implementation of government-initiated public engagement will draw valuable lessons from this review to inform the design of engagement initatives.