Every couple of decades governments decide that they need to involve citizens more in public decision-making processes. The significant changes that have occurred over the past decade, including a growing loss of faith in the traditional institutions of government, have once again prompted political decision-makers to explore options for enhanced citizen participation. In the health care sector, reforms occurring during the 1990s were couched in terms such as "enhanced responsiveness," "improved accountability," and "increased citizen participation." In the new millennium, governments and regional health authorities have been relatively silent on this issue. As has been the case in the past, a wide range of opinions exist about what citizen participation is and how governments should proceed. Without either conceptual clarity or practical direction, governments have been slow to articulate what they hope to achieve or how they intend to get there. The purpose of this paper is to examine the concept of citizen participation within the context of a series of basic questions from which decision-makers might draw some policy relevance. Rather than taking a particular disciplinary perspective (i.e. health promotion), the authors have chosen to review a broad spectrum of existing literature to provide a better understanding of what is known about citizen participation, both good and bad. As such, the paper is meant to be a point of departure for an informed discussion of the possibilities for improved citizen participation in health (care) decision-making.

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Alberta's Primary Care Networks (PCNs) bring together family physicians and other health professionals to provide local, comprehensive, and readily accessible primary care services to patients. The Edmonton North PCN, one of the largest in the province, piloted the Resource in Clinic (RIC) Program with objectives to increase efficiencies in the use of physician time, increase physician workplace satisfaction, increase unattached/orphan patient access, and decrease patient wait times. An evaluation of the RIC Program employed surveys (completed by physicians with RICs, RIC staff, and patients), log chart recording, and physician billing data and cost analysis. The findings indicated high satisfaction with the model, increased physician visits, and improved access for patient with comorbidities. The study did not demonstrate increased number of patients or new patients, nor could conclusions be drawn related to patient wait times.

Fiscal concerns have provided the impetus for wide-ranging attempts to reform the delivery of health care in Canada. Health reform has in turn stimulated great interest and activity in health service research. For health service research to be of maximum use in addressing current and future challenges to the health care system, closer liaison is needed between researchers and decision makers--the users of research. The purpose of this paper is to promote greater interaction between decision makers and researchers by proposing a framework for health predicated on types of information needed for decision-making rather than on study methodologies. We distinguish between decision makers at the societal, health system, program and service levels. Types of studies are classified by their purpose and by the phase of the management cycle for which they provide information for decision-making.

As population health programs, environmental health services differ fundamentally from other forms of health service delivery. At a time when the health sector is striving for integration, the incorporation of these unique services into the delivery system presents a unique challenge to policy makers and administrators across the country. The University of Alberta recently completed a comprehensive review and redesign of locally governed and delivered environmental health protection services in Alberta. This paper outlines the key issues and unique features surrounding the delivery of environmental health services and presents the study team's suggested approach to addressing these issues.