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Katherine Boothe’s broad research interest is in the qualitative study of variation in health and social policies: why do jurisdictions choose different responses to similar policy problems, and what opportunities and challenges do these different policies present for reform?


Katherine’s current research programme has two related streams. Her SSHRC-funded research with Dr. Adrienne Davidson, “Evidence and legitimacy in policymaking: lessons from crisis” is driven by a need to better understand how politicians and civil servants make decisions under uncertainty. It compares instances of “normal” policy making to policy making during the COVID-19 pandemic, and asks: how do decision makers learn from different types of evidence and different groups or members of the public? How do they negotiate legitimacy in times of “normal” policymaking versus times of crisis?

Katherine’s second research stream examines public and patient involvement in health policy decision making, with a particular focus on the adoption and reform of drug assessment and reimbursement policies in Canada. This research is concerned with changing conceptions of legitimacy as they relate to rationing of public health resources. It investigates expansion of public and patient involvement in health technology assessment (HTA) in Canada since the early 2000s. Katherine is a member of the Public Engagement in Health Policy Project, which studies the past, present, and future of public engagement in Canadian health policy.

Katherine’s 2015 University of Toronto Press book, Ideas and the Pace of Change, compares the development or non-development of nation-wide pharmaceutical insurance in Canada, the UK, and Australia, in order to explain why Canada is the only mature welfare state that does not provide broad public coverage for drugs. Dr. Danielle Martin reviewed the book in the Literary Review of Canada, saying that it “addresses an issue that should concern us all. We have a drug problem in Canada: a problem of high prices, poor access and variable quality of prescribing. Change is needed.”


Katherine was an expert witness at the Parliamentary Standing Committee on Health’s 2016 hearings on national pharmacare in Canada, participated in consultations for the 2019 Advisory Committee on the Implementation of National Pharmacare, and has published a number of op-eds on pharmacare and policy learning in Canada. Read more on the news page >>




Dr. Boothe is a Co-Principal Investigator on the "Lessons From Crisis" project with Dr. Adrienne Davidson.

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The government response to COVID-19 has highlighted the importance of policy learning in the face of uncertainty; meanwhile, varying provincial government responses throughout Canada suggest that officials are responding differently to the same uncertainty frameworks.


Academics, policymakers, and the public alike need to better understand how governments understand risk, make decisions, and learn in the face of uncertainty. We do not assume that learning takes place in a broadly rational fashion. Instead, we consider the role of public and elite understandings of risk (including how risk is communicated through various media), different structures of government (especially regarding governance of public health), and trust in/reliance on science. 


Lessons from Crisis will contribute to theories of policy learning and participatory democracy, analyze the ways learning does and does not occur in crisis situations, and gain a better understanding of variation in Canadian pandemic responses, both among provinces and over time.



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Over the coming years, Canada will be faced with a range of local, provincial and pan-Canadian health policy challenges as the country responds to and recovers from the COVID-19 pandemic. At the best of times, governments and civil society organizations routinely struggle over when, how and whom to engage in their decision-making processes. The global pandemic has highlighted even further the challenges of balancing science with social values to support robust health policy decision making. 

The Public Engagement in Health Policy project aims to strengthen health policymaking in Canada by providing a platform for interdisciplinary scholarship, education and leadership in public engagement. Through the research, education and leadership opportunities provided, we seek to address current challenges such as how health policymakers can respond to calls for more inclusive and transformative public engagement processes and how public engagement can be used to improve policy responsiveness, enhance democratic legitimacy, and build trust between governments and citizens.




Canada is the only OECD country that has universal, comprehensive public hospital and medical insurance but lacks equivalent pharmaceutical coverage. In Ideas and the Pace of Change, Katherine Boothe explains the reasons for this unique situation. Using archival, interview, and polling data, Boothe compares the policy histories of Canada, the United Kingdom, and Australia in order to understand why Canada followed a different path on pharmaceutical insurance.

Boothe argues that pace matters in policy change. Quick, radical change requires centralized political institutions, an elite consensus, and an engaged, attentive electorate. Without these prerequisites, states are far more likely to take a slower, incremental approach. But while rapid policy change reinforces the new consensus, incremental progress strengthens the status quo, letting development stall and raising the bar for achieving change.

An important contribution to the study of comparative political economy, Ideas and the Pace of Change should be required reading for anyone seeking to understand why health care reforms succeed or fail.

Image by Brandi Redd





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