Reframing Efficiency: How Public Deliberation Strengthens Public Health Policy

With the efforts to downsize US public health infrastructure, a national conversation has emerged about how to use government resources efficiently while maintaining a robust public health system. Drawing on ethical frameworks, we describe 5 types of efficiency important for public health policy. We argue that well-designed public deliberation can enhance these dimensions of efficiency by improving the quality and contextual fit of policies, rebuilding shared factual baselines in a polarized environment, and increasing trust and adherence to policy outcomes. Through case studies from US influenza pandemic planning, Australia's biobank research, and Ireland's abortion policy, we illustrate how deliberative processes can improve epistemic, political, implementation, and civic efficiency. We also examine practical challenges, including scaling participation and ensuring institutional uptake. Finally, we discuss emerging innovations that make large-scale, representative engagement feasible. We conclude that embedding public deliberation as a structural component of policymaking, rather than an ad hoc supplement, is essential for creating trusted, efficient public health policy. (Am J Public Health. 2026;116(9): 1331-1338. https://doi.org/10.2105/AJPH.2026.308637).