Gayblack Canadian Man

Foreign Policy Analysis
Developing and Influencing Policy for the Public’s Health

Developing and Influencing Policy for the Public’s Health

Good afternoon I’m Colleen Huebner
associate professor of Health Services and director of the Maternal and Child
Health training program for the School of Public Health today it’s my pleasure
to introduce you to Michael Fraser CEO of the association of maternal and child
health programs or as we fondly know it am chip am chip is a national resource a
partner and advocate for the public health community for others as well
working to improve the lives and health of all women children and families in
the US this includes the membership includes professionals advocates
academics it could include you certainly family members as well there’s a role
for each of us in protecting the health and well-being of vulnerable groups
infants disabled veterans disabled children native peoples or new
immigrants just to name a few this afternoon Dr. Fraser will talk about how
to lend our voices to those who can’t speak as powerfully for themselves. Why
it’s necessary to do this to assure a healthy and vital future and when and
where to act to be most effective. and with that welcome Michael (Michael Fraser) Good afternoon I’ve been really
looking forward to this trip for a number of different reasons both
personal and professional but we’ve been planning this one for a while so it’s
nice that it finally arrived I’m gonna be really nice on you and make let you
stay up there but honest to god really you couldn’t just come down a little bit
all right we are going to spend about an hour talking about policy and I’m gonna
try engage you although you’re miles away in the conversation and there’s a
couple different ways to do that so work with me here what I’d like you to do is
consider this question real briefly it’s a true/false so you have a 50% chance of
being right okay text your answer to policy development is a core function of
public health so one person answered that’s okay one person answered true
we’re gonna get a few more here a core function of public health so I’m gonna
wait for the votes to tally we’re getting a pretty good bar here these are
your students excellent great so it’s sense of the group so far policy
development is a core function of public health okay so part of what I’m trying
to do in my talk this afternoon is build your capacity to carry out that core
function of public health policy development and especially when I go to
University’s policy development of different things to people okay
so we’re gonna talk a little about the kind of policy that I’m interested in
and the kinds of things that we do in Washington on behalf of States it’s a
very specific led to federal legislative policy related to maternal and child
health and we’ll talk a little bit about that okay so let me just do one more
question then we’ll get into the into the meat of it so you got the part that
policy development is a core function of public health well done and that’s good
to see honestly it’s not all groups have that
confidence but let’s see where we feel we are in terms of our competency in
this area okay as both student and faculty partners staff how confident are
you now just coming into this conversation that you have the
competency needed to public policy related to public health
in our country okay how competent do you feel yourself to be and I realized that
you know this is a group that’s done probably various work in this area so
well that’s that’s good because by the end we’re gonna see that change
hopefully unless a lot more people vote it’s everybody that wanted to vote feel
like they had the chance to send their text okay so strongly disagree disagree
a few folks in the strongly agree part but basically the goal today then is to
familiarize you more with some of the activities that you can undertake as a
public health advocate all right and my main takeaway today is that although you
may be in an academic environment may be plotting out research questions and
techniques and doing analysis policy development and supporting the work of
public policy and public health is absolutely essential to your work as if
as a future public health professional and those of us who are in public health
now and that while the scientific endeavor and the research behind the
work that we do is obviously paramount here the work that that we can also do
that’s complementary to that not separate is part of our work as public
health professionals so we’re gonna have some fun I hope you’re relaxed this is
not a serious lecture I gave that up many many years ago and I just want to
share with you some of the stuff I think is interesting important and relevant to
the to the topic at hand so we’re gonna we did those questions and here’s
another slide that I hope you all have received in your training but when we
look at what public health is all about and some of us in the room were actually
part of the creation of this and dr. Allen but you know it was important many
years ago probably about 10 or 15 even longer that it be real clear what it is
that public health is all about and so the ten essential services of public
health were developed this news new to anybody this is a good diagram of the
enterprise of public health and you can see how policy development is a core
function in fact there’s a lot of different ways that we do that you might
not be able to see it very well because the resolution on this graphic is a
little fuzzy but the the point here being that just like epidemiology
surveillance health promotion activities are essential to the work that of a
public health department or the public health enterprise so too is policy
development and the work that we do at amp chip is policy development specific
to moms kids father’s and Families okay and even more specifically to that we
are charged through our board and our membership to advocate primarily for the
federal program that funds state maternal and child health programs that
I refer to as title 5 its the MCH services Block Grant and it’s a federal
investment that’s shared by the states that’s programmed based on state needs
to meet the needs of that state’s vulnerable populations especially moms
and kids ok so I hope you’re fluent in that if those of you who are taking an
MCH policy course that should be a refresher but that’s really what I’m
talking about when I’m talking about federal legislation but when we look at
sort of the the lay of the land when it comes to public health more generally
but also to maternal and child health there’s a great aphorism for this it was
the best of times and it was the worst of times any English majors in the room
you know who this gentleman is yes who they don’t want it they don’t worry it’s
not hog miss whoever that was it’s Charles Dickens right so the best
of times worst of times beginning of Tale of Two Cities I thought it was
apropos tale of two states washed into Washington DC is not a state but
whatever another way of saying the same thing is when it comes to Public Health
Policy and the challenge that we have in front of us you really can see the glass
is half-full or half-empty okay and it’s all of us see if both ways
depending on exactly what we’re what we’re doing but I think it’s important
to know we are living in what is probably one of the most exciting times
in public health at least governmental public health but also one of the most
challenging times when it comes to public health and for those of you who
have worked in governmental public health either through your internships
or other projects you will now you will have felt just how challenging these
times are and for those of you who are considering that I hope that this
invigorates you a little bit but also go in with your eyes wide open because
there are a lot of challenges right now in the States and here’s just some
numbers to set the stage okay so the first number think it has enough
zeros right it’s 1.5 billion they get that one right okay does that ring a
bell to anybody here in terms of maternal and child health or might be
too esoteric so that is the amount 1.5 billion new dollars that have been
appropriated through the Affordable Care Act for maternal infant and early
childhood home visiting programs in the States okay
so have you heard about home visitation yes okay evidence-based home visitation
okay excellent excellent you’re on your way so that’s the dollars
to support that work in this those are the dollars to support that work in the
States those dollars are new dollars through the Affordable Care Act that we
lobbied for with other partners to be part of the Affordable Care Act okay 1.5
billion dollars that’s significant new investment ternal in child health
probably the biggest we’re ever going to see in any time soon probably in my
lifetime I don’t know about y’all’s okay 13 billion another maybe esoteric number
that’s a total of propriate over ten years for the public health and
Prevention fund in the Affordable Care Act which funds programs in the
community level but also in the states and academic settings to basically put
prevention to work to implement prevention health promotion strategies
child obesity prevention other chronic disease prevention in the state’s
thirteen billion dollars in the public health and prevention fund okay mostly
to CDC for Public Health Service Act fund programs okay
that’s incredible that’s incredible these are big big numbers but
simultaneously so that’s the best at times simultaneously for almost ten
years we’ve seen pretty drastic reductions just in our program the
maternal and child health Block Grant over 10 years totaling 641 million I
need to add some zeroes here as someone pointed out to me this morning in
Olympia well done so we’re seeing a constriction in the core Tata 5 Block
Grant but we’re seeing these new resources for categorical programs okay
17800 any guesses on what that is the number of public health jobs lost in
state health department’s since 2008 across the country okay it was the best
of times it was the worst of times now no one’s gonna go work in state public
health and that was not my intent just to let you know but what’s going on
again is this incredible new resource and excitement while there’s contraction
in the core systems that that provide those services in the states okay and
the federal funding for those so you can see here some work that was done by one
of our other national associations the state territorial health officials
Association is basically saying you know times are not good in the States for the
state health workforce and you you may be hearing some of that in the
background of what you’re doing almost 91 percent almost all state health
departments have eliminated service as a result of budget reductions okay and and
that doesn’t mean the needs were met so they don’t have to do them anymore okay
as as you’ve probably deduced so best of times worst of times what’s really going
on this incredible contraction of resource okay and federal
budget cuts that are currently in play are only compounding what states have
been dealing with since 2008 if not before with the recession and all those
kinds of things you probably see that here at a state institution as well okay
so it’s not just happening to public health but you feel that crunch in all
states now and that’s having an impact on policy because policy is really
theirs it’s not a complicated definition it’s about rules decisions and budgets
that impact big groups of people really I mean that’s a simple way of saying it
but where we choose to invest our dollars is policy decision okay
and is shaped by a lot of different influences so what I want to do is give
you a little bit of a sense of some of those influences today here’s the glide
path of the maternal and child health services Block Grant since 2003 I
started at AM chip in 2007 that’s why we’ve leveled off knows K but you know
we’re unless you’re a skier this is not the glide path that you want to see when
you’re looking at services to States to improve the health of moms and kids the
fathers and families okay and so we’ve had an incredible fight an incredible
fight in maternal and child health particularly there are some glaring
exceptions that like home visitation but to get a little more complicated now I
know it’s getting late but to get a little more complicated now that same
glide path in purple is course state Block Grant funding okay and then the
yellow piece is abstinence only teen pregnancy prevention I’m not even talk
about that that’s they’ll get me all riled up and we’ll be here for a long
long time but that core funding has been stable for a lot of different reasons
but the increase as I mentioned that blue bar there is the new home
visitation dollars okay in the little bit on top is prep which is personal
responsibility teen pregnancy prevention by another name that is not abstinence
only programmed so you can see new resource here okay and if the teeny top
is a small grant that’s title five funded for
connecting families to services through a family family information the point I
want to make here is that Congress is colorblind when it comes to looking at
this chart okay so when we go to advocate for maternal and child health
there look at me in the face like what the hell are you doing in here we have
given you one point two billion dollars in title five how could you possibly ask
for more okay and what we haven’t done is to be
able to clearly articulate the difference in those programs and
basically say well you really can’t do your birth defect screening with your
home visitation money or your breastfeeding promotion with your home
visitation money or now it’s your lead screening program with your home
visitation dollars so the new resource is very categorical very specific while
we’re seeing declines in our overall Block Grant
it’s a policy problem that we have so I mean that that we are working on we can
talk some more about okay compounding this problem I hate to even say this
because it’s very well you’ll make up your own mind this just came out last
week in The Washington Post DC and this is an example DC’s infant mortality rate
is at a historic low is a historic low and that and let me tell you it’s bad
okay why are we not dancing in the streets on that one hmm it’s still pretty high okay yeah so all
things told but things like this completely undermine one of our core
messages which is their babies are gonna die if you don’t increase funding for
this program and yet we’re seeing these successes coming out at the same time
okay so we’re even the the message is even
more complicated the policy argument that we have to make is even more
complicated by the fact that that we’re actually doing well in some areas and
therefore it makes the store we have to tell a lot more complicated now folks
will say well those data were three years old which is the most recent
infant mortality data you can get okay and those are the result of in big
investments that were made earlier on and probably in five to ten years we’re
going to see those rates going down as a result of cuts we’re making now that
explanation that I just told you is way too long to share with someone with this
much attention making a decision on a budget okay so we are dancing in the
streets this is although it’s still high there is definitely opportunities to
celebrate but at the same time it’s complicating the policy message even
more which is when you cut there’s going to be hurt and we haven’t been able to
clearly articulate that hurt right now because of the way our data are
collected and the stories that we need to tell aren’t collected so just
complicating the the policy environment even more and we have this incredible
opportunity and health reform now to actually address some of the core
maternal and child health needs across the country amazing opportunity to
support public health and prevention to expand access to invest in the public
health workforce to to really think through what a core comprehensive
benefits package would be for private market and then you know Medicaid in the
states it’s an incredible opportunity and all of that too is you know as you
as you well know and I’ll talk about a little bit more in a very delicate
balance right now so I you know I don’t know what the current rate of ativan use
and DC is now but pretty much everybody’s got some major anxiety
disorder just waiting for this Supreme Court decision what we’ll talk a little
bit more about that in a sec so all of this sort of brings me to why is
maternal and child health such a tough sell okay so you know here
we have just this is last week USA Today that dropped off in front of my hotel
room on the front page you know two really big MCH issues and in the
spotlight two really big title five maternal and child health issues in this
spotlight autism which is an emerging area that
we’re all very concerned about and trying to do a lot more work in and teen
pregnancy on the front page of the USA Today so you’d think that advocacy for
maternal and child health populations would be really easy so I just want to
ask you off the top of your head and we’ll do this poll poll everywhere right
now you know how easy do you think it is to advocate for for MCH issues because
you know after all everybody loves kids and motherhood as American as apple pie
let’s you’d think it would be an easy work it would be easy work to advocate
for maternal and child health and frankly it is in terms of getting the
messages out the receipt of those is more often than not falling on deaf ears
which to me was a big eye-opener so you got here about I’m not going to 80
percent of you realizing that thinking this is hard or really hard and quite
frankly I was shocked at how hard it is to advocate for a maternal and child
health or more specifically for the maternal child health Block Grant and
here’s one reason why okay so this is a congressman from Michigan’s first
District and you know he was very proud of displaying the sign his office said
if you were here to ask for more money you’re in the wrong office okay there’s
incredible you know ideological divide that you all are probably well aware of
now in DC where there’s a tremendous push for shrinking the size of
government that’s that’s the the line they use okay and the incredible push to
you know control the deficit and control you know the the federal spending etc
etc and that’s true I mean I think if you look at the numbers that that’s true
but honestly you know if you if we honestly look at our federal budgeting
process it’s a statement of our priorities where are we really putting
priorities where are we really doing our spend
okay and I would pause it to you just individually as Mike Fraser or not as
CEO of amp ship because we don’t have an official position on this but I would
posit to you that it’s not a money problem
that we have in this country it’s a priorities problem that we have in this
country in the richest country in the world I mean let’s just say that okay
that’s my friend a lot of other people have just you know disagree with that
and that’s part of what makes this such a difficult endeavor for something you
would think would be relatively straightforward the states are hurting
how this is all playing out in the States is also very difficult so we have
this new home visiting investment States they’re saying well we don’t want it so
here you have States cutting their budgets reducing services elevated me
because the recession turning away federal dollars because it’s either
related to the Affordable Care Act or they don’t think it’s important enough
to receive those to manage them okay this case is just an example of a case
in Florida where they didn’t want any of the new home visiting money they changed
their mind fairly soon after this headline came out okay because they were
shamed basically into into taking that but you have half the states suing the
federal government over the Affordable Care Act right now okay and that’s the
policy context in which people are trying to do to public health work the
need for MCH advocates for maternal child health advocates and by extension
public health advocates is not a new need okay the the activism of the early
1900s in maternal and child health was firmly
rooted in what I would say we’re public health professionals they may not call
themselves that at the time but in their realization that to improve health we
had to address issues of equity inequity and and make the link between improving
living conditions working conditions education conditions and health okay
that so here’s an early chart that I love this you know epidemiology from
1923 which is correlating father’s income with infant mortality which you
know obviously higher father’s income lower infant mortality okay and that
being used to craft public health programs to address him from
eyetality the maternal child health Block Grant has been around 76 years it
was the first federal public health program that really initiated the
creation of state health department’s and those early programs were about
child labor they were about cleaning up housing they were not about necessarily
doing the kinds of work that we do today but that thrust is still there I love I
love this sort of early March you know and kind of tying in the the active as
the MCH active isn’t the path to what we wear we kind of need to get back to it’s
like Back to the Future here in terms of where we need to be as public health
advocates that’s why I’m so excited to be to be talking to you because I think
you’re that next group okay so is it clear now how this policy development
piece fits into the work that you do as public health professionals that’s kind
of tying tying that back up okay so so what do we do with all of this so you’re
sitting here thinking well I got papers to write I got you know whatever it is
do people take tests anymore I’m not familiar with that but you know I got
stuff to do I got researched I got grants that’s
Mike’s job he’s got it covered in Washington I don’t have to worry about
that that ain’t the case at all and I want to
talk to you a little bit about that okay because we all have a privilege and a
right to be lobbyists guaranteed in the First Amendment of the Constitution we
have the right to petition the government for a redress of grievances
especially you okay because the folks I work with in the states are very
constrained in their ability to lobby they work for the executive branch of
the state government and the governor wants to control the message does want
as MCH director out there asking for more money if he or she doesn’t want
that for their state but you all have a lot more degrees of freedom in this
conversation which is again part of the reason why I want to share with you so
the opportunities to educate inform and then ultimately Lobby if that’s
something you can do really are tremendous but part of it is getting to
figure out how can I do that and how can I do that effectively as an advocate all
right but now more than ever we need we need folks advocating I mean the the
whole perception of the system is that it’s completely broken and we can have a
whole conversation about that in the future but you can see here that
congressional approval ratings you know over the past year or two are
just in the tank I mean 10% of people approved of the way Congress was
handling its job in March of this year I’d like to know who they are they
probably you know all work for members of Congress or something like that so
you know the majority opinion is something’s not working we don’t
understand the system and you know I think that’s true but it is the system
we have at some level and it’s important that we understand how to work within
that if we really do want to see change realistic change okay so let me ask you
this do you agree or disagree or is this true or false for you if you knew that
how laws were made you’d be more likely to participate in the policy-making
process let me let me ask you that in a poll bond so not so sure so the
predominant the predominant group saying here not so sure why is that do you
think anybody seen the the movie mr. Smith goes to Washington okay so do you
want to do like a tenth 15-second recap on that for me anybody it’s a what’s it
all about a novice senator gets elected goes to
Washington changed the world right and yes so is an idealist who’s confronted
when he goes to Washington with cynicism and graft and corruption and all this
stuff that we have to deal with yes indeed so here’s here’s how he sort of
approaches the lawmaking process the policy-making process is a novice okay
and I think it’s a little bit instructive so he wants to introduce a
bill to fund a boy’s camp okay so that’s that’s the the bottom eye so we’re gonna
watch this for a couple minutes and then talk about the process yes was his idea
of course I should have been the one tell you the faintest idea what no
you’re gonna help if I were triplets that’s when I met Sean or senator Paine
said that you’re going to help me not what do we have to have what books do we
have to happen how do we write your mind if I give you a rough idea of what
you’re up against so well our senator has a bill in mind like you a camp right
right fine now what does he do he has to sit down first and write it up the why
when where how and everything else and that takes time well but this one is so
simple oh I see this one’s simple yeah and with your help
oh I’m helping yeah simple and I’m helping so we knock it off in
record-breaking town of let’s say three four days Oh a day a day yes just a mine
tonight I don’t seem to be complaining senator but in all civilized countries
there’s an institution called dinner Oh longer myself well I couldn’t we sort of
have some stuff brought in on trays you know like big executives oh sure
well dinner comes in on trays where big executives will light into this and we
finish the bill before morning yeah it’s dawn your bill is ready you take it over
there and introduce the top you get to your feet in the Senate take a long
breath and start spouting but not too loud because a couple of the Senators
might want to sleep then a curly-headed pageboy takes it up to the desk where a
long-faced clerk reads it refers it to the right committee
why look committees as small groups of senators have to sift a bill down look
into its study and report to the whole Senate
you can’t take a bill nobody ever heard about and discuss it among ninety-six
men where would you get yeah I see that good
now we rally some committees got it yeah nowadays are going by Senator days weeks
finally they think it’s quite a bill it goes over to the House of
Representatives for debate and a vote but it has the wait is turn on the
calendar counter huh yeah that’s the order of business your bill has to stand
way back there in line unless the steering committee thinks it’s important
what steering committee do you really think we’re getting anywhere oh yes miss
Saunders now tell me what’s the steering committee Committee of the majority
party leaders they decide when a bill is important enough to be moved up toward
the head of the list well this is pardon me this is well we now go over the house
oh yeah house more amendments more changes and the bill goes back to the
Senate the Senate doesn’t like what the house did to the bill they make more
changes the house doesn’t like those changes it’s tiny so so they appointment
from each house to go into a huddle called a conference and they battle it
out finally if your bill is still alive after all this devastation it comes to a
vote yes sir the big day finally arrives and Congress
the change okay so it’s a little cynical let’s let’s let’s be realistic here but
you know the process of rule of legislation obviously is complicated but
I love the way this just sort of lays it all out but let me go back here and
there’s another way of saying the same thing if I can get to it
yeah so we’re just going to talk about this for a little while No
so I mean what I want to share with you is obviously I’m talking about
influencing alleged policy making happens at all of these steps it’s a
complicated process one that’s very involved all right and there are rules
to influence what the priorities are going to be and what’s not what’s good
to know about maternal child health Block Grant but
particular is we don’t go through that process every year the maternal child
health Block Grant is part of the Social Security Act which is permanently
authorized which means that all that happens at an annual basis for maternal
and child health is appropriations putting dollars to legislation that’s
already been enacted because seventy-six years ago they decided let’s not have
this debate every year every three years or every five years to reauthorize
Social Security so what I what I want to get to you is it may be something you’re
interested in to go back and look at your civics 101 if you had it and if you
didn’t to think a little bit more about that process so you can see where you as
advocates can insert yourselves but when I’m really talking about MCH advocacy
from AM chips perspective we are really talking about influencing the
appropriations process for maternal and child health because we don’t have the
need for a lot of new legislation we have the need for resources to
appropriate to the legislation that we already have in process so that just a
little caveat there but also important for you to know okay so this gets back
to your comment earlier about the factors involved in policymaking and I
want to pull you again get you a little get some feedback here on what you see
as the most important factor or what factor has the most influence let me say
it that way which factor has the most impact on policy making is it the
experience and expertise of the the legislature or their staff is it that
legislators judgment is that the resources that they have available to
them is it their habits and tradition is it lobbyists and pressure groups that
are pushing them to make certain decisions okay is it pragmatics and
contingencies is it evidence is it is it the facts or is it the the values that
that legislature legislature either has or shares interesting can y’all see this room back
there it’s a good good sense of the group here okay so here we are about 23
of you answer here we are in an academic setting true okay and the hopefully the
results of the research you’re doing in the work that you’re doing is leading to
an evidence base to inform something other than your CV okay
that is going to lead to change and it does I’m not I’m not being facetious or
disparaging but you’re also savvy enough to know that something else is going to
influence the decisions that are made related to maternal child health policy
and public health policy more generally how do you feel about that none of you
put evidence down there huh how do you feel about that being realistic huh
I don’t want to discount the value of evidence honestly but there is a real
need to realize that even the best and most sophisticated data and analysis
that you present is not necessarily what’s going to drive policymaking okay
and that’s a really interesting conversation that we could have but what
that means to me then is as an advocate where we can have the most impact in the
strategies that we’re going to use are not going to necessarily be as reliant
on sharing a bunch of data and hoping for change right
yes lobbying in pressure groups just to be real about it frankly their values
are also pretty influential these days I will give you that but in terms of the
most impact lobbying and pressure groups now how many of you saw thank you for
smoking than the movie okay actually I should show clip from that in a future
presentation there’s good lobbyists and bad lobbyists okay as I mentioned you
all too are part of that advocacy endeavor okay so I’m not talking
necessarily about all the bad guy lobbyists I’m talking to me we have
lobbyists for maternal and child health we need your help in that endeavor so
interesting thank you for for responding to that let’s keep going here in terms
of the so here’s you know I’ve got the chance to testify before Congress a
couple weeks ago absolutely incredible opportunity you can see how full the
committee members were but no they were all coming and going they said this was
like a staged picture but the the opportunity then for someone like me to
have to really take the the work that you’ve done and translate that into a
very specific ask which is what lobbying is is really what we have to talk about
because I need the stories and the data to do my job and you’re the ones that
are producing that for for us so not I don’t want to disparage and leave you
with the fact that you know evidence is meaningless that’s not true at all it
influences the work that we do but how we share that in the ways that we do
that are very strategic so imagine having five minutes before congressional
committee to make the case for level funding for the maternal and child
health Block Grant what would you what would your talking points be you can’t
bring in the you know the state needs assessment and say let’s do this you
know you have to be very very crisp in in what you’re doing so that’s one
strategy the the direct lobbying that we do on the hill but we also do a lot of
communication with our partners in the states to get the message out that
stuff’s going on in DC and we need help asking for level funding for the
maternal child health Block Grant educating informing about what cuts to
the Block Grant might do cuts to other public health programs might do so this
is just an example of one of our legislative alerts asking folks to
participate in in this process the sort of grass stops process of contacting
their representatives and amplifying messages that we’re sharing in
Washington and what’s really to me the best compliment then is so here’s our
alert that we send out partner groups then take those messages and send them
out to there so you probably can’t read this but this is a piece that we did
that was repurposed by the National Family Planning and reproductive health
Association pushed out to their members so it’s sort of this
you know snowball impact that we can have so while we have 17,000 people in
our database my guess is our reach is much deeper
than that because people forward it they incorporate it into their messages and
that’s something that you can do if you’re getting our messages or you want
to get our messages take them and then share them with coalition’s you work
with folks you work with and really it doesn’t take that much effort so those
of you who are asking about the time commitment to this this can be you know
five or ten minutes especially in the in the the links that we provide but those
those five or ten minutes when we go visit Congress and they’ve heard from
even five or ten constituents they’re gonna pay attention to the issue we’re
not talking about millions and millions of people needing to call they want to
hear from five or ten people I mean more is better but even that much for the
work that we’re doing is high-impact because what more that what’s more the
cases we get the message we haven’t heard anything about this issue and so
how important can it really be and you’re paid to do this work but if the
folks that are actually at home voting aren’t doing this work we’re not going
to pay attention to it so very crucial part of the work that we do is
amplifying through our partners and and folks that we contact with at a very
grass grass tops level so part of what I want to do is show you that impact okay
so I hope nobody tries to friend me or something a minute little lists but this
is my Facebook and how we get it to large screen I’m not going to worry
about right now but this is congresswoman roybal-allard from
California and this is a floor speech that she gave last year in February of
2011 when there was a proposed 210 million dollar cut to the maternal child
health Block Grant okay and what we did then was mobilize
art groups to share the message that that cut would be detrimental and then
provide her office and her staffers with the reasons why
okay and so I just want to I want to share this because this is a very good
example and we can talk about at the end of how you two can influence policy a
policy makers action okay so you ready position to this continuing
resolution because it ignores the needs of America’s families and does nothing
to create jobs strengthen the middle class or effectively lower the deficit
the 1.3 billion dollar cut to community health centers is astounding in my
district alone if these cuts are enacted over 112,000 individuals will suffer a
significant loss in primary health services and they will be forced to use
costly hospital emergency care nationally these cuts mean health
centers will be unable to serve 11 million patients over the next year it
means 127 new health centers in underserved districts will lose their
funds and it means the loss of thousands of health care jobs also on the chopping
block is the title 10 program which provides over 8,000 men and women in my
district with reproductive health care and cancer screenings nationally the 317
million dollar cut to title 10 will force many clinics to close eliminating
another primary care safety net for 5 million men and women also unbelievable
is the 210 million dollars in proposed cuts to the maternal and child health
Block Grant program this cut will devastate primary and preventive health
services in California for an estimated 2.6 million pregnant women infants and
special needs children the cuts also endanger other critical programs such as
California’s newborn screening program which last year tested almost 550,000
newborns for treatable genetic and metabolic diseases which if
undetected could have become painful and life-threatening on the national level
these cuts and MCH grants will reduce or eliminate prenatal health services for
two million women and primary health care for more than 17 million children
in a country that ranks far behind almost all other developed nations in
maternal and infant outcomes we can ill afford to slash funding for the only
federal program that focuses solely on improving the health of mothers and
their babies makes you kind of want to move to California doesn’t it but let’s
talk about that for a second I mean what what talk to me about your response to
that well what did she have to say okay and part of part of what I think she was
trying to do was show impacts of cuts but absolutely you know that might be
too much okay but how do you think she got those data there were a lot of data
from Russia from you he says yeah I mean yeah there’s there it’s not like the
staffers are sitting around saying let’s get some good data that we can give for
her floor speech I mean part of what we do and you you ranked lobbyists and
pressure groups is the most impactful policy factor there you know that’s what
we do is provide those data okay so if we didn’t engage with their staff for
about the Block Grant and kind of have that conversation she never probably
would have even included it on here so so while you’re right getting more savvy
on our message and probably being a little more appealing to bigger values
and kind of a core message it’s gonna really make a big difference and that’s
something that we we really need to talk about it for the public health
enterprise overall that very simple act of contacting your member or your
representative with some pretty key information about what impact is does
actually get translated into things like this which eventually become part of the
record and actually may influence policymaking so it’s both the pro-ana
Khan I think is what I’d like like to take away
from that but there’s other ways you can do that I mean here we have the an op ed
which is another strategy that we rely on that that talks about the value of
the Block Grant that we try and place in newspapers and this time of year
Mother’s Day we use very strategically to send across the country to all our
press contacts op eds about why the Block Grant is an essential investment
now it didn’t make the Wall Street Journal it didn’t make the front page of
USA Today but it did make the Des Moines Register and the Lexington Herald
Tribune Lexington Kentucky why should we care why is that a is that a big deal
those whoever reads those any ideas well some Kentucky but the the Senator Harkin
chair of the committee that appropriates for the health funding in the Senate and
who’s the Senate leader Minority Leader now where’s he from Mitch McConnell
Kentucky okay so they read those papers first and then if they have time they
get to the Washington Post’s okay so you may come from a place with the senator
or representative on a key committee and I can tell you that or you can look it
up online and there’s really only twenty or thirty of those folks that you really
could get to and say as a constituent as a public health student as someone who
is interested in this and following what you’re doing in Washington I urge you to
make this choice this is uh this is my ask that goes a really long way so it’s
not like you have to get to all you know five hundred members of Congress 435
members of Congress it’s a it’s a much smaller set than that and that hopefully
gives you a little relief – what could seem like a very big task makes my job a
little bit easier – okay so that’s that’s another strategy that you could
use or you can go visit okay so we have number
that come in for annual conference and while they’re there take time to go up
on the hill and visit with their elected leadership if they’re if they’re allowed
to talk about what they do at the Block Grant to educate and inform them about
the work of that federal program in their state okay so there’s a lot you
can do we don’t have to create a lot of new legislation we don’t have to create
a lot of necessarily new technique here but we have to be very strategic with
what we have and we can influence the policy development process so these are
my present one of my president-elect and another member that we’re going to visit
their congressperson Max Baucus from Montana whose committee has oversight
over the maternal child health Block Grant in the Senate Finance Committee
okay so it actually can be quite fun and it’s something that I recommend you all
do okay so here’s where we’re at and we’ll sort of conclude with a little bit
of conversation to maybe talk some more here’s where we’re at with regards to
some of the the policy work that we’re doing right now we’re at a point in
American politics as I mentioned when I started which is historic okay and we
have this is many video recorded so I’m trying to be very conscientious we we
have seceded or seated what would normally be a political process to
really to people maybe even one okay one Supreme Court justice will decide the
fate of the Affordable Care Act okay it it’s interesting isn’t that why we had
the American Revolution to begin with I mean the the the whole notion that a lot
of what we care about a lot of what’s exciting right now in public health is
tied into the decision around the health reform in the Affordable Care Act to me
it’s pretty intense when you think about it so there’s a tremendous amount of
uncertainty right now in Washington when it comes to public hope policy because
our biggest and most exciting pieces of that are tied into the Affordable Care
Act for many reasons and the fate of that bill rests not in the fact that the
Supreme Court thinks home-visiting is a bad idea or teen pregnancy prevention is
a bad idea or public health prevention fund is about idea
but in the notion that is it constitutional for the federal
government to tell the states that they have to provide insurance to every one
of their citizens okay and so all of what we’re talking about is wrapped up
in that interesting interesting but in some ways
unrelated constitutional question okay how this is going to resolve oh man
I I know if I knew I wouldn’t be here I’d be around the world with a crystal
ball that worked okay so I think that’s really important for us to realize you
know that that that process was so gunked-up that it led to you know to
this bumping it up to the Supreme Court the only thing that we do know is that
for the foreseeable future we will be seeing cuts
regardless of what happens with this because the super committee failed to
come up with an agreement to cut the 1.2 trillion from the federal budget 413 on
January 1st of 2013 there will be an across-the-board cut of 7 to 9 percent
of all federal discretionary programs and so again there’s an opportunity for
advocacy but that’s a pretty certain thing that’s a that’s a pretty certain
thing moving forward so what I was hoping to do was share with you some of
the work that we do share with you some of the very simple tactics that we use
share with you the urgency for this work and hopefully enlist you in being part
of that work that we all need and that that we all do ok so let me do a quick
closing poll here if you don’t mind let’s see if we if we had any change
I knew if we have more time I could really get this up but let’s see what we
got here in terms of your your the post-test here same question we asked
before how confident do you feel that you have the competency needed to
influence public policy related to public health within the United States
based on our thinking our of our our together still a fair chunk well I think
you can see from the from the numbers that we do have some more work to do but ho
fully you want to be part of this process and I’m happy to share our
newsletter with you our get on it get you on our legislative alert list if you
want to give me your email address we’ll add you to our database just so you know
what’s going on and and hopefully this is a good adjunct to some of the work
that you’re doing you know that’s more academically focused more research
focused in terms of using another part of your core competency as public health
professionals so with that I’m going to thank you for the opportunity to visit
with you this afternoon let’s you have a chance to ask questions if you want or
we’re just visiting afterwards I’m not sure what the plan is but we’ll turn it

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