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Title: Advocating for Public Health: How Can We Make a Difference


1
Advocating for Public Health How Can We Make a
Difference?
  • Linda C. Degutis, DrPH, MSN
  • Immediate Past President
  • APHA

2
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3
  • Partnerships
  • Policy and Politics
  • Advocacy

4
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5
Link Between APHA and Affiliates
  • Part of a unified voice that promotes public
    health nationwide. APHA's 30,000
    membership assures an effective voice in
    Washington and across the nation on issues of
    concern to public health professionals and
    consumers of service. Affiliates have an
    opportunity to contribute their expertise
    and help shape national, state, and local health
    policies that solve contemporary world health
    problems.

6
Volunteer Leadership
  • Participation in the APHA policy development
    process through representation on the Governing
    Council.
  • Representation on the Action Board. (3 affiliate
    reps)
  • Representation on the Committee on Membership. (1
    rep from each affiliate)
  • Representation on the Committee on Affiliates
    (CoA). Ten regional representatives serve as
    liaisons between APHA and their geographic region
    and represent the interests or APHA's affiliated
    associations. The Chair of the CoA has an
    ex-officio seat on the Executive Board.

7
There is strength in numbers
8
Partnerships
  • Add to our strength
  • Teach us about what others think and believe
  • Provide opportunities to increase our influence,
    and help others understand the importance of
    public health
  • Open doors
  • Help us grow

9
Partnerships challenge us to
  • Create a unified agenda
  • Share our turf
  • Lead by example
  • Learn different languages
  • Learn that it is no so important who gets credit
    for making a change, but that the change gets made

10
APHA and Advocacy
11
APHA Policy Priorities
  • Access to care
  • Eliminating Health Disparities
  • Rebuilding the Public Health Infrastructure

12
APHA Policy Priorities
  • In addition to the 3 overarching priorities, APHA
    is poised to respond to other issues that emerge.

13
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14
Access to Care
  • All Americans deserve comprehensive health
    coverage.
  • 47 million Americans under 65 years of age
    (15.8) were uninsured during 2006, up from 44.8
    million uninsured American adults in 2005.
  • In 2006, the number of children under age 18
    without health insurance increased to 8.7 million
    (11.7) of children nationwide.
  • The federal government provides health coverage
    to some Americans through the Medicare and
    Medicaid programs and to some low-income children
    through the Childrens Health Insurance Program,
    which is threatened by funding cuts.
  • Goal - to expand access to affordable, quality
    health care.

15
Farm Bill
  • The Farm Bill is an expansive federal legislative
    initiative that guides the federal governments
    involvement in the nations food system and farm
    policies.
  • Addresses critical public health issues
    including food and nutrition assistance,
    sustainable agricultural production, rural
    development, renewable energy, equity, and
    conservation policies.
  • APHA and public health community have been
    actively advocating to improve key elements of
    the Farm Bill. 

16
Farm Bill Provisions
  • School Nutrition Standards
  • Nutrition Research
  • Food Stamp Nutrition Education (FSNE)
  • WIC Program
  • Promote Childrens Fruit and Vegetable Intake
  • Access to Healthy Foods
  • Conservation
  • Food Safety
  • Antibiotic Resistance
  • Climate Change and Resource Use

17
SCHIP
  • 91 of SCHIP beneficiaries had a usual source of
    medical care
  • Parents of 81 of children in the program were
    confident they could meet their childrens health
    needs.
  • Established SCHIP beneficiaries were 21 more
    likely than recent enrollees to have a usual
    source for medical care.
  • Established SCHIP enrollees were 31 more likely
    to have a usual source for dental care compared
    to recent enrollees who were uninsured for the 6
    months before they enrolled.
  • SCHIP enrollees were 13 less likely than recent
    enrollees to have unmet needs for prescription
    drugs as well as care provided by a hospital,
    specialist, physician or dental professional.

18
SCHIP
  • APHA supports including at least 35 billion in
    new funds over 5 years for SCHIP reauthorization
    in the FY 2008 budget.
  • This would be enough to cover the 6 million
    children currently enrolled and an additional 4
    million children.
  • Supports strengthening federal standard for SCHIP
    benefits packages to make it comparable to the
    Medicaid benefits package, which includes
    coverage of EPSDT services
  • Supports making revisions to federal law to give
    states the flexibility to deem children eligible
    for and enroll them in SCHIP or Medicaid based on
    information from such programs as WIC and the
    National School Lunch Program.
  • Supports giving states the option to cover
    pregnant women, and legal immigrant pregnant
    women and children, in their SCHIP programs.

19
Mental Health Parity
  • Legislation passed by both houses of Congress
    different provisions
  • Final bill included in the bailout bill

20
Public Health Infrastructure
  • Over the past several years, Federal funding for
    important public health programs and agencies has
    be threatened and even cut -- dramatically
    underscoring the need to educate the
    Administration, members of Congress, and the
    public about the vital role of public health
    programs in the United States.
  • APHA continues lead the advocacy efforts on
    Capitol Hill to inform members of Congress about
    the success of adequately funded public health
    programs in an effort to restore and increase
    funding in this critical area.

21
Public Health Infrastructure
  • Workforce initiatives
  • Support for education of public health workforce

22
Health Disparities
  • Despite dramatic achievements in health and
    healthcare over the past century, racial/ethnic
    and rural/urban health disparities continue to
    exist. 
  • APHA Government Relations Staff is working with
    key allies on Capitol Hill to move forward with
    comprehensive legislation to address the
    underlying causes of disparities in health status
    and health care access.
  • At the same time, policy analysts in the APHA
    Center for Public Health Policy are dedicated
    to developing innovative policy
    recommendations to reduce and ultimately
    eliminate health disparities.

23
Health Disparities
  • Support of CDC efforts to develop multi-agency
    focus on disparities, and multi-agency funding of
    programs and research to eliminate health
    disparities

24
APHA Advocacy letters to Congress
  • September 2008
  • Coalition letter in support of the highest
    funding level for public health agencies and
    programs in the FY 2009 appropriations measures
    (September 8, 2008)
  • Coalition letter to the House Committee on Energy
    and Commerce in support of the HEART for Women
    Act (September 8, 2008)
  • July 2008
  • Coalition letter to the House of Representatives
    urging support for the Indian Health Care
    Improvement Act (IHCIA) Amendments of 2008, H.R.
    1328 (July 31, 2008)
  • Letter in support of the Improved Nutrition and
    Physical Activity (IMPACT) Act to reduce obesity
    in America (July 31, 2008)
  • Letter urging President Bush to call on the
    Sudanese government to end the violence in Darfur
    (July 29, 2008)
  • Coalition letter in opposition to the Department
    of Health and Human Services' draft regulations
    that could significantly limit women's access to
    basic reproductive health services, including
    birth control (July 22, 2008)
  • Coalition document The NGO Code of Conduct for
    Health Systems Strengthening (July 2008)
  • Coalition letter in support of the Nurses' Higher
    Education and Loan Repayment Act of 2008 that
    seeks to alleviate the nurse faculty shortage
    (July 10, 2008)

25
  • Letter to te Permanent Mission of the Union of
    Myanmar to the United Nations expressing concern
    about the humanitarian and public health
    catastrophe brought on by Cyclone Nargis (July 7,
    2008)
  • June 2008
  • Coalition letter to the Senate Appropriations
    Subcommittee on Labor, Health and Human Services
    and Education in support of at least 500 million
    for Title VII and VIII health professions and
    nursing education programs in FY2009 (June 23,
    2008)
  • Coalition letter to the House and Senate in
    support of increased funding for global health
    research at CDC and NIH (June 16, 2008)
  • Coalition letter in support of retaining in the
    supplemental appropriation bill a moratoria on
    seven Medicaid regulations proposed by the
    Centers for Medicare and Medicaid Services (June
    10, 2008) 
  • Letter urging inclusion of public health
    provisions in climate change legislation (June 4,
    2008)

26
  • Letter in support of the FY2009 Budget Resolution
    conference agreement which includes 59.7 billion
    for health discretionary programs (June 3, 2008)
  • Letter in support of legislation to ban
    asbestos-containing products and to support
    research into treatment of individuals with
    asbestos-related diseases (June 3, 2008)
  • May 2008
  • Coalition letter to the House Appropriations
    Subcommittee on Labor, Health and Human Services
    and Education in support of 11.1 million for CDC
    activities to address global climate change in
    FY2009 (May 29, 2008)
  • Coalition letter to the House and Senate
    Appropriations Subcommittees on Labor, Health and
    Human Services and Education in support of 7.9
    billion for HRSA in FY2009 (May 29, 2008)
  • Coalition letter in support of the Public Health
    Preparedness Workforce Development Act (May 28,
    2008)
  • Coalition letter to the House and
    Senate Appropriations Subcommittees on Labor,
    Health and Human Services, and Education in
    support of at least 500 million for health
    professions education programs for FY2009 (May
    21, 2008)
  • Coalition letter thanking the House and Senate
    Budget Committees for including in the FY2009
    Budget Resolution 59.7 billion for health
    discretionary programs (May 20, 2008)
  • Coalition letter to the Senate in support of the
    highest allocation possible for the Interior
    Appropriations Committee for FY2009 to improve
    funding for the Indian Health Service (May 19,
    2008)
  • Coalition letter in support of an allocation
    level for the Appropriation Subcommittee on
    Labor, Health and Human Services, and Education
    in FY2009 of at least 15 billion more than the
    FY2008 funding level (May 16, 2008)
  • Coalition letter to the House in support of the
    highest allocation possible for the
    Interior Appropriations Committee for FY2009 to
    improve funding for the Indian Health Service
    (May 15, 2008)
  • Coalition letter to House and Senate leadership
    expressing concern over the CMS directive
    on August 17 regarding SCHIP (May 15, 2008)

27
  • CDC Coalition letter to the Appropriations
    Subcommittee on Labor, Health and Human
    Services, and Education in support of 7.4
    billion for CDC for FY2009 (May 15, 2008)
  • Letter urging Representatives to support the farm
    bill (May 13, 2008)
  • Letter to the United Nations and African Union
    expressing concern over the humanitarian and
    health crisis in Zimbabwe (May 9, 2008)
  • Coalition letter in support of moratoria on seven
    Medicaid regulations proposed by the
    Administration (May 6, 2008)
  • Coalition letter to Senators urging that the
    Medicare bill include provisions that would help
    identify and eliminate disparities in the quality
    of health services that minorities and women
    receive (May 1, 2008)
  • Coalition letter urging Senators to support the
    Vaccines for Children Access Act (May 1, 2008)
  • Coalition letter to U.S. Treasury Department in
    support of requiring alcoholic beverages to
    include a label with "Serving Facts" (May 2008)
  • April 2008
  • Coalition letter in support of a provision in the
    Federal Trade Commission Reauthorization Act that
    would require the FTC to track and report on
    alcohol advertising practices (April 28, 2008)
  • Coalition letter urging the House Energy and
    Commerce Committee to pass the Health Equity and
    Accountability Act (April 25, 2008)
  • Letter to Rep. Honda in support of his
    legislation, the Office of Correctional Public
    Health Act (April 16, 2008)
  • Coalition letter to the House and Senate Budget
    Committees in support of funding for the Indian
    Health Service (April 15, 2008)
  • Letter in support of the Genetic Information
    Nondiscrimination Act (GINA) (April 14, 2008)
  • Coalition letter to the House and Senate
    leadership in support of passing a moratoria on
    recent Medicaid regulations and increasing
    federal funding for states facingbudget
    shortfalls (April 10, 2008)

28
  • Letter to Senators in support of the Economic
    Recovery in Health Care Act (April 8, 2008)
  • Coalition letter to the House and Senate
    Committee leadership expressing concern over the
    directive CMS issued in August regarding SCHIP
    (April 7, 2008)
  • Coalition letter to the House and Senate in
    support of the Medicare Fracture Prevention
    Osteoporosis Testing Act (April 7, 2008)
  • Coalition letter asking the House and Senate
    Labor-HHS Appropriation Subcommittees to fund the
    Lifespan Respite Care Act (April 4, 2008)
  • Coalition letter asking the House and Senate
    Labor-HHS Appropriations Subcommittees to
    increase funding for the CDC's National Center
    for Injury Prevention and Control to establish
    the Health Child Abuse Research, Education and
    Services (CARES) Network (April 2, 2008)
  • Coalition letter on funding for bilateral
    maternal and child health programs and UNICEF for
    FY 2009 (April 2, 2008)
  • Letter asking Representatives to support global
    TB control by passing the Global AIDS bill (April
    1, 2008)
  • March 2008
  • Coalition letter to Reps. Berman and Slaughter 
    recommending improvements to the Global AIDS bill
    to strengthen the health care workforce in donor
    countries (March 28, 2008)
  • Coalition letter to Sens. Biden and Lugar
    recommending improvements to the Global AIDS bill
    to strengthen the health care workforce in donor
    countries (March 28, 2008)
  • Coalition letter to the Food and Drug
    Administration supporting Congress' request for a
    moratorium on qualified health claims for
    conventional foods (March 27, 2008)

29
  • Coalition letter in support of the Healthy
    Families Act to ensure sick pay days for all
    workers (March 26, 2008)
  • Coalition letter thanking Gov. Culver of Iowa for
    rejecting abstinence-only-until-marriage funding
    (March 21, 2008)
  • Coalition letter on the FY 2009 pandemic
    influenza preparedness appropriation (March 20,
    2008)
  • Coalition letter urging support for the CDC's
    Environmental Health Laboratory and National
    Environmental Public Health Tracking Program
    (March 19, 2008)
  • Coalition letter in support of the Strategies to
    Address Antimicrobial Resistance Act (March 18,
    2008)
  • Letter in support of the Protecting the Medicaid
    Safety Net Act of 2008 (March 13, 2008)
  • Letter in support of a provision in the Senate
    Budget Resolution regarding reimbursement for
    school-based administrative and transportation
    services under SCHIP and Medicaid (March 13,
    2008)
  • Letter opposing an amendment to the budget
    resolution regarding SCHIP coverage of an embryo
    or fetus, but not a pregnant mother (March 13,
    2008)
  • Friends of Indian Health coalition letter
    requesting a Senate hearing on the President's
    proposed FY 2009 budget for the Indian Health
    Service (March 8, 2008)
  • Coalition letter in support of inclusion of the
    new Loan Forgiveness for Services in Areas of
    National Need in the reauthorization of the
    Higher Education Act (March 4, 2008)
  • Coalition letter in support of FY09 funding for
    the National Center for Health Statistics (NCHS)
    (March 4, 2008)

30
  • February 2008
  • Letter to Representatives Kennedy and Ramstad in
    support of their legislation, the Paul Wellstone
    Mental Health and Addiction Equity Act (February
    28, 2008)
  • Coalition letter in support of the Global AIDS
    Bill and inclusion of an amendment that would
    support TB vaccine research and development
    (February 26, 2008)
  • Coalition letter in support of the Health Equity
    and Accountability Act and requesting a hearing
    (February 25, 2008)
  • Nursing community consensus document on Title
    VIII reauthorization priorities (February 22,
    2008)
  • Letter to Sen. Kerry in support of the HIV
    Nondiscrimination in Travel and Immigration Act
    (February 21, 2008)
  • Letter to Members of Congress on APHA's
    Legislative Priorities (February 20, 2008)
  • Coalition letter on the public health
    discretionary budget allocation in fiscal year
    2009 (February 19, 2008)
  • Coalition letter thanking Gov. Janet Napolitano
    of Arizona for rejecting abstinence-only-until-mar
    riage funding (February 15, 2008)
  • Coalition letter in support of the Fitness
    Integrated with Teaching (FIT) Kids Act of 2007
    (February 12, 2008)
  • Coalition letter in support of legislation that
    would eliminate Medicare patient costs for
    preventative services (February 11, 2008)
  • Coalition letter in support of legislation that
    would require Medicare to cover testing for HPV
    (February 7, 2008)

31
  • Coalition letter commending the FDA for holding a
    hearing on sodium in the American diet and
    making  recommendations (February 1, 2008)
  • January 2008
  • Letter reiterating support for the Minority
    Health Improvement and Health Disparity
    Elimination Act (January 25, 2008)
  • Coalition letter to Mayor Fenty urging that the
    District of Columbia's participation in the Title
    V abstinence-only-until-marriage grant program
    end immediately (January 23, 2008)
  • Letter to the Chairman of the Appropriations
    Subcommittee on Labor, Health and Human Services,
    and Education requesting the opportunity to
    testify during the subcommittee's public hearings
    on the FY2009 bill (January 22, 2008)
  • Letter to Congresswoman Schakowsky in support of
    the Microbicide Development Act (January 22,
    2008)
  • Coalition letter urging senators to pass the
    Indian Health Care Improvement Act Amendments of
    2007 (January 17, 2008)
  • Letter opposing the CMS policy that restricts
    states' ability to offer SCHIP or Medicaid to
    children in households with incomes above 250 of
    the federal poverty level (January 16, 2008)
  • Coalition letter thanking Gov. Freudenthal of
    Wyoming for rejecting federal abstinence-only-unti
    l-marriage funding (January 14, 2008)
  • Coalition letter in support of expanding the
    national Fresh Fruit and Vegetable Program as
    part of the Senate's farm bill (January 2008)

32
APHA Advocacy Testimony and Briefs
  • Testimony of Dr. Benjamin before the House
    Oversight Committee on Abstinence-Only Programs
    (April 23, 2008) 
  • Testimony of Dr. Benjamin before the House Select
    Committee on Energy Independence and Global
    Warming on Global Warming and Public Health
    (April 9, 2008)
  • Friends of HRSA testimony to the House on the FY
    2009 appropriation for the Health Resources and
    Services Administration (March 31, 2008)
  • CDC Coalition testimony to the House on the FY
    2009 appropriation for the Centers of Disease
    Control and Prevention (March 13, 2008)
  • Friends of Indian Health coalition testimony on
    the FY 2009 appropriation for the Indian Health
    Service (March 2008)
  • Coalition Testimony to the House Committee on
    Foreign Affairs, Subcommittee on Africa and
    Global Health before the Hearing on Multidrug
    Resistant Tuberculosis (February 27, 2008)
  • APHA Testimony to the House Committee on Foreign
    Affairs, Subcommittee on Africa and Global Health
    before the Hearing on Multidrug Resistant
    Tuberculosis (February 27, 2008)

33
  • APHA Testimony to the Maryland House of
    Delegates, Health and Government Operations
    Committee before the Hearing on the Uniform
    Emergency Volunteer Health Practitioners Act
    (February 26, 2008)
  • APHA Testimony to the House Committee on Foreign
    Affairs, Subcommittee on Africa and Global Health
    before the Hearing on Global Child Survival
    (February 14, 2008)
  • APHA Testimony to the Senate Health, Education,
    Labor, and Pensions Committee on Addressing
    Healthcare Workforce Issues for the Future
    (February 12, 2008)
  • APHA Testimony to the Maryland Health and
    Government Operations on brominated flame
    retardants (January 30, 2008)
  • Comments
  • Comments on EPA's proposed rule for National
    Ambient Air Quality Standards for Lead (January
    16, 2008)
  • Briefs
  • Amicus brief in the case of Stormans Inc.
    (plaintiff) v. Washington State Department of
    Health and Judith Billings (defendant) on
    pharmacists refusal to dispense
    medications (March 7, 2008)
  • Amicus brief in the case of the New York State
    Restaurant Association (plaintiff) v. New York
    City Board of health, New York City Department of
    Health and Mental Hygiene and Thomas R. Frieden
    (defendant) on nutrition labeling requirements
    (February 11, 2008)

34
Advocacy Action Board
  • Charged with the facilitation and implementation
    of Association policies and positions
  • Takes action on APHA priorities, action alerts
    and other advocacy activities as needed
  • Appoints subcommittees, collaborates with other
    units of the Association and its Affiliates, and
    encourages relationships with other organizations
    interested in collaborative action and building
    coalitions

35
Advocacy Strategies
  • Grass-tops effort to mobilize members
  • SCHIP Mental Health Parity
  • Involvement of Section, SPIGs, Caucuses,
    Affiliates
  • Use of internet-based web tools (Capwiz)
  • Monthly Legislative updates via e-mail
  • Action alerts at critical times

36
Advocacy Strategies
  • Hill visits by members either as part of a group
    (Section, Committee, etc.) or as individuals
  • Contact of key members on specific issues
  • Talking points and fact sheets available

37
National vs. State Policy
  • While much of the funding for public health
    programs comes from the federal budget, most
    programs come under state or local authority

38
All Policy has Local Roots
  • Local stories, local needs
  • Everyone wants to bring something back to his/her
    state
  • Sometimes these efforts focus on what are
    perceived to be more visible projects
    (highways, bridges, etc.) whereas public health
    programs do not receive priority

39
How do we make public health a priority?
40
Opportunities
  • Major election year
  • Inform newly elected and re-elected officials
    that public health is a major priority
  • Educate them about public health and why it is
    critical
  • Help them understand what happens when public
    health is not a priority

41
Questions for Candidates and Elected Officials
  • The following questions were designed to
    help start conversations about public health with
    candidates running for local, state and national
    office. They can be tailored to highlight local
    issues by providing local examples and concerns.
    One of our goals is to expand thinking about
    health from health care to public health, and to
    generate interest in prevention and support for
    public health infrastructure. The lists provided
    in questions 1, 2 and 3 are not meant to be
    exhaustive. You are encouraged to pick examples
    that are relevant to you and that you are
    comfortable with.

42
  • I am concerned about the public health
    infrastructure. That includes (fill in with
    relevant examples see list below for some
    options). What are you going to do to make our
    public health system better able to prevent
    chronic and communicable disease and injuries?
  • Disease and injury prevention activities
  • Public health workers
  • Public health labs
  • Personnel at state and local health departments
  • Safety net for uninsured/assuring access to care
  • Cancer screening
  • Vaccine delivery programs
  • Tobacco prevention programs
  • Protecting the public from environmental toxins
    and other exposures
  • Food safety

43
  • Its been said that an ounce of prevention is
    worth a pound of cure. How would you redirect the
    funding emphasis on treatment to preventing
    diseases and conditions such as (fill in with
    relevant examples see list below for some
    options)
  • heart disease and stroke
  • diabetes
  • lung disease
  • cancer
  • obesity
  • injuries from motor vehicle crashes, falls, etc
  • suicide and violence prevention
  • illness and injury due to environmental exposure

44
  • Much of the funding for public health programs at
    the state and local levels comes from federal
    agencies like (fill in with relevant examples
    see list below for some options). Unfortunately,
    several of these agencies--like the CDC and
    HRSA--have seen budget cuts since 2005 and have
    been slated for additional budget cuts in 2009.
    How would you prioritize funding for these
    agencies?
  • community health centers
  • health professions training and education
  • improving the built environment
  • emergency preparedness and response
  • health education and outreach

45
  • While in the last 30 years, we have improved the
    aggregated U.S. populations life expectancy the
    difference in life expectancy between whites and
    nonwhites has increased. What will you do to
    eliminate this gap?

46
Find a Champion
  • Lets find champions for public health

47
Challenges
  • Educating legislators about public health
  • How do you explain what you do?

48
Explaining Public Health
  • Use the Aunt Mildred test
  • Does your Aunt understand what you do?
  • Could she explain it to her friends?

49
How the Community Perceives Public Health
  • Dependent upon
  • Access to health care
  • Education
  • Economics
  • Media reports
  • Popular media
  • Geography

50
Example
  • Poll re trauma center access

51
The Policy Process
  • Policy is not necessarily data-driven
  • Its usually possible to find data to support any
    position
  • Personal stories/anecdotes supported by data can
    make strong arguments
  • It can take a long time for a policy to be
    brought forward
  • Timing is everything

52
Policy inevitably involves politics
  • - on all levels

53
Advocacy is critical
  • Advocates can have a major impact

54
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55
WARNING Advocacy work can be hazardous
56
What are the hazards?
  • 10. Your neighbors walk away when you start
    talking about how we really need to improve the
    child booster seat law
  • 9. People who dont wear their motorcycle
    helmets when riding are always testifying against
    you
  • 8. You dont have room on your car bumper for
    all of the bumper stickers that you need to
    express your views
  • 7. Your children are now wearing their helmets
    to bed because they figure that they better get
    used to it before a new law passes
  • 6. Your sons teenage friends call you the
    safety NERD
  • 5. Your significant other rolls his/her eyes
    when you say I cant believe theyre still using
    the term accident….
  • 4. Your mother wont know how to describe what
    you are doing
  • 3. You might find that you enjoy it
  • 2. It usually doesnt get you promoted

57
1. Well-behaved advocates rarely make history
58
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59
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60
What Drives Policy Change?
  • Shifting priorities
  • Social change
  • Events
  • Money
  • Data?
  • Policy is usually reactive, not proactive

61
Policy
  • Federal
  • Congress
  • Committees
  • Professional Associations
  • Advocacy organizations
  • State/local
  • Legislature, local government
  • Community organizations
  • Coalitions

62
Role of U.S. Congress
  • Not to pass laws,
  • BUT
  • To keep bad laws from passing

63
Congressional Staff
  • Every member can vote on every issue
  • Too much work, too little time
  • Workdays scheduled in 15 minute increments
  • Requests require quick response on multiple
    issues
  • Work long hours at low pay
  • Young
  • House average is 24 years
  • Senate average is 27 years
  • Limited expertise (content and life)
  • High turnover maybe only 1-2 years in an office
  • Rely (with good reason) on those with expertise
    in specific issues/topics

64
The Policy Process
  • Identification of an issue
  • Important to member
  • Constituents
  • Personal experience
  • Not necessarily data driven
  • Identification of need for legislation
  • Development of legislation
  • Development of support from others
  • Introduction of bill

65
The Policy Process
  • Timing can be critical
  • Can take time for a particular issue to rise to
    the top of the primordial soup
  • Policy inevitably involves politics
  • Compromise may be necessary, but dont compromise
    your values

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What makes a good advocate?
  • Knowledgeable about the issue
  • Keeps it simple (single issue per
    visit/conversation)
  • Knows what s/he is asking for (introduction of
    legislation, sponsorship, etc.)
  • Provides local data/information on importance of
    issue
  • Can be trusted to provided accurate information

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What makes a good advocate?
  • Respects staff
  • Agenda does not appear geared towards personal
    gain
  • Knows
  • where the opposition stands
  • risks/benefits to the Member who supports what
    advocate is asking for
  • Passionate about issue, but not a zealot

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What makes info…
  • Most useful
  • Timely 68
  • Concise 20
  • Readable 13
  • Credible 12
  • Least useful
  • Too long 28
  • Biased 19
  • Irrelevant 19
  • Not timely 17

Source Richard Sorian Center for Studying
Health System Change, 2003
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To Keep in Mind
  • Timing
  • Know your audience
  • Viewpoint
  • Objectives
  • Level of knowledge of topic
  • Potential opposition
  • Make it local
  • Local data
  • Local stories

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If You Want to be Effective
  • Develop relationships
  • Keep in touch
  • Personal visits (face to face)
  • The Ask know what you are asking for and why

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If You Want to be Effective
  • Local media placements
  • Timing
  • Join with others strength in numbers
  • Leave a bulleted one pager with main points
  • Describe the issue concisely
  • Identify what needs to be done
  • Provide your contact information

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Summary
  • Policymakers cannot know every constituent and
    issue
  • To be called upon as a resource, get to know your
    legislator and their staff
  • Grassroots advocacy is powerful
  • Individual action
  • Groups of constituents
  • Commitment
  • Use local data and local stories

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VOTE!!!
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