Interest finding more effective methodes for public involvement in decision-making about heath-system is more widespread than ever in Canada since significant aspects of health care decision-making were devolved from provincial govnernments to regional health authorities are often assessed against the nature and degree of interaction that occurs with the public. Consequently, decision-makes in a variety of policy domains routinely struggle with questions about when it is a appropriate to invole the public what the most effective means are for doing this, and how to measure their success. The authors analysed these issues by documenting the experiences of health systems decision makes in two Canada provinces (Ontario and Quebec) with public consultation and participation over the past decade. Their findings illustrate that despite decisions to consult wit their communities are driven by the same basic set of objetictives: to obtain form and to provide information to the community to ensure fair, transparent and legitimate decision making processes and to garnes suport for their outcomes. Decision makes also acknouledged the need to rethingk approacges for infolving the public in decision making processes in response to the perceived failure of past public participation and consultation processes. While these experiences have clearly left some participation practitioners feeling beleaguered, many are approaching futre community consutltation processes optimistically with plans for more focused, propuseful consultation that hae clear objectives and more formal evaluation tinged with a healthy dose of pragmatism