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Citizens' juries: the public verdict on antibiotic resistance
Spotlight
In early July, 2016, Cardiff City Hall (Cardiff, Wales, UK) played host to an unusual experiment. For 3 days, a citizens’ jury made up of 14 members of the general public heard evidence on antimicrobial resistance from a range of experts. A representative from the Association of the British Pharmaceutical Industry outlined their perspective, and general practitioners (GPs) explained how patients’ expectations can influence prescribing habits. There were talks on microbiology and the mechanics of resistance. The jury learned about data collection and public awareness campaigns, and were presented with some radical ideas on how to combat resistance. On the 4th day, they were sequestered to discuss the issue and draw conclusions. The project was commissioned by the All Wales Medical Strategy Group (AWMSG), the Welsh counterpart to England’s National Institute for Health and Care Excellence. “The idea came out of the recognition that although there is quite a lot going on within the policy community to improve antimicrobial stewardship, and everybody realises the need to get the public involved, there seems to be very little actually happening”, explained project lead Marcus Longley (University of South Wales, UK). “So there was a decision to get the public involved, in a meaningful way, in the debate”. Jurors were drawn from a cross-section of Welsh society. One was Beth Wilson, a graduate aged 29 years who works in product design. “Going into the jury, I knew very little about resistance”, she told the Lancet Respiratory Medicine. “I had a basic awareness; I had seen things in the newspapers, but really I did not know much at all”. Wilson was astonished to discover the extent of the problem, and the seeming inability of the structures of public health to transmit messages about antimicrobial resistance to the general public. Robin Howe from Public Health Wales (which provides health-protection services to the people of Wales) gave the introductory and closing talks to the jury. “It was a very interesting and useful process”, he said. “This very astute bunch of people started off by saying they did not really understand the issues around antimicrobial resistance, and by the end of the week, their eyes had been opened and they thought it was very important that we take action”. The citizens’ jury’s findings will be sent to the AWMSG, who will consider them and report back to the government. The jury’s recommendations have yet to be finalised; however, they were particularly supportive of more sophisticated efforts to educate and engage the general public. They discussed using social marketing
www.thelancet.com/respiratory Vol 4 October 2016
to drive public awareness. Longley pointed out that it soon became apparent that vaunted initiatives such as antimicrobial champions had largely passed unnoticed by the jurors. “It was quite surprising the penetration was so low—the jury felt that we need to move beyond just health education into a way of providing education and backing people to make the right decisions”, stated Longley. Wilson believes that antimicrobial resistance is an issue that needs to be addressed on a far larger scale than at present. “We have to think bigger; we need to change our attitudes on the way we behave towards antibiotics if we want to actually make a difference— that was our main conclusion”, she stressed. To change attitudes will require much more than a few billboards, posters, and public awareness campaigns. The jury talked of incentivising patients and designing systems that encourage people to regard antibiotics as a precious and limited resource. And it all needs to be honed to the way people live; after all, a young parent with a distressed infant in the middle of the night will need more than a pamphlet on the difference between a virus and a bacterium to help them through the crisis. The jurors felt that the GP presentations were particularly illuminating. Wilson was taken aback to discover that visiting a GP has an element of consumerism to it. “GP prescribing surprised me—it sometimes seems to be about a customer-experience point-of-view and keeping patients happy by giving them antibiotics”, said Wilson. “Resistance is a lot more complex than I had originally understood”. But she, and the other jurors, had few problems in assimilating information on the subject. “Everyone who took part in the citizens’ jury got a lot out of it and felt it was a big step to actually listen to what the general public had to say”, concluded Wilson. In the aftermath of Britain’s decision to leave the European Union in the referendum earlier this year, some disappointed Remain campaigners questioned the wisdom of throwing open such an important and intricate decision to the electorate—however, the experience of the citizens’ jury is a salutary corrective. “There is a groundswell of interest in the general public in contributing to something important and worthwhile, particularly when you can demonstrate to them that they can actually make a difference”, said Longley. If people are given full and accurate information, there is no reason why they cannot participate in, and enrich, even the most complicated of debates.
iStock.com/JakeOlimb
Citizens’ juries: the public verdict on antibiotic resistance
Published Online August 22, 2016 http://dx.doi.org/10.1016/ S2213-2600(16)30264-8 For information on the citizens’ jury see http://wihsc.southwales. ac.uk/cjantimicrobialstewardship/ For the All Wales Medical Strategy Group see http://www. awmsg.org/
Talha Burki
779
In early July, 2016, Cardiff City Hall (Cardiff, Wales, UK) played host to an unusual experiment. For 3 days, a citizens’ jury made up of 14 members of the general public heard evidence on antimicrobial resistance from a range of experts. A representative from the Association of the British Pharmaceutical Industry outlined their perspective, and general practitioners (GPs) explained how patients’ expectations can influence prescribing habits. There were talks on microbiology and the mechanics of resistance. The jury learned about data collection and public awareness campaigns, and were presented with some radical ideas on how to combat resistance. On the 4th day, they were sequestered to discuss the issue and draw conclusions. The project was commissioned by the All Wales Medical Strategy Group (AWMSG), the Welsh counterpart to England’s National Institute for Health and Care Excellence. “The idea came out of the recognition that although there is quite a lot going on within the policy community to improve antimicrobial stewardship, and everybody realises the need to get the public involved, there seems to be very little actually happening”, explained project lead Marcus Longley (University of South Wales, UK). “So there was a decision to get the public involved, in a meaningful way, in the debate”. Jurors were drawn from a cross-section of Welsh society. One was Beth Wilson, a graduate aged 29 years who works in product design. “Going into the jury, I knew very little about resistance”, she told the Lancet Respiratory Medicine. “I had a basic awareness; I had seen things in the newspapers, but really I did not know much at all”. Wilson was astonished to discover the extent of the problem, and the seeming inability of the structures of public health to transmit messages about antimicrobial resistance to the general public. Robin Howe from Public Health Wales (which provides health-protection services to the people of Wales) gave the introductory and closing talks to the jury. “It was a very interesting and useful process”, he said. “This very astute bunch of people started off by saying they did not really understand the issues around antimicrobial resistance, and by the end of the week, their eyes had been opened and they thought it was very important that we take action”. The citizens’ jury’s findings will be sent to the AWMSG, who will consider them and report back to the government. The jury’s recommendations have yet to be finalised; however, they were particularly supportive of more sophisticated efforts to educate and engage the general public. They discussed using social marketing
www.thelancet.com/respiratory Vol 4 October 2016
to drive public awareness. Longley pointed out that it soon became apparent that vaunted initiatives such as antimicrobial champions had largely passed unnoticed by the jurors. “It was quite surprising the penetration was so low—the jury felt that we need to move beyond just health education into a way of providing education and backing people to make the right decisions”, stated Longley. Wilson believes that antimicrobial resistance is an issue that needs to be addressed on a far larger scale than at present. “We have to think bigger; we need to change our attitudes on the way we behave towards antibiotics if we want to actually make a difference— that was our main conclusion”, she stressed. To change attitudes will require much more than a few billboards, posters, and public awareness campaigns. The jury talked of incentivising patients and designing systems that encourage people to regard antibiotics as a precious and limited resource. And it all needs to be honed to the way people live; after all, a young parent with a distressed infant in the middle of the night will need more than a pamphlet on the difference between a virus and a bacterium to help them through the crisis. The jurors felt that the GP presentations were particularly illuminating. Wilson was taken aback to discover that visiting a GP has an element of consumerism to it. “GP prescribing surprised me—it sometimes seems to be about a customer-experience point-of-view and keeping patients happy by giving them antibiotics”, said Wilson. “Resistance is a lot more complex than I had originally understood”. But she, and the other jurors, had few problems in assimilating information on the subject. “Everyone who took part in the citizens’ jury got a lot out of it and felt it was a big step to actually listen to what the general public had to say”, concluded Wilson. In the aftermath of Britain’s decision to leave the European Union in the referendum earlier this year, some disappointed Remain campaigners questioned the wisdom of throwing open such an important and intricate decision to the electorate—however, the experience of the citizens’ jury is a salutary corrective. “There is a groundswell of interest in the general public in contributing to something important and worthwhile, particularly when you can demonstrate to them that they can actually make a difference”, said Longley. If people are given full and accurate information, there is no reason why they cannot participate in, and enrich, even the most complicated of debates.
iStock.com/JakeOlimb
Citizens’ juries: the public verdict on antibiotic resistance
Published Online August 22, 2016 http://dx.doi.org/10.1016/ S2213-2600(16)30264-8 For information on the citizens’ jury see http://wihsc.southwales. ac.uk/cjantimicrobialstewardship/ For the All Wales Medical Strategy Group see http://www. awmsg.org/
Talha Burki
779