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

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Advocating for Public HealthHow Can We Make a
Difference?

• Linda C. Degutis, DrPH, MSN
• APHA President
• Presentation to the California Public Health
  Association North
• March 14, 2008

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From Connecticut to California
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APHA Founded on April 18, 1872

• The APHA is the oldest, largest and most diverse
  organization of public health professionals in
  the world
• 501C(3)
• Nonpartisan
• Vision A healthy global society

Stephen Smith at age 98 APHAs 50th Anniversary
1921
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APHA

• The oldest, largest and most diverse organization
  of public health professionals in the world has
  been working to improve public health since 1872.
  
• APHA aims to protect all Americans and their
  communities from preventable, serious health
  threats and strives to assure community-based
  health promotion and disease prevention
  activities and preventive health services are
  universally accessible in the United States.
• APHA builds a collective voice for public health,
  working to ensure access to health care, protect
  funding for core public health services and
  eliminate health disparities.

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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.

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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.

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National Public Health Week

• April 7 13
• Focus Climate Change

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What Do We Need to Advocate for Public Health?
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• The perception of health as healthcare limits
  the reach of health disparities work and gears
  projects toward addressing disparities in the
  distribution of a given disease outcome rather
  than preventing disparities through a focus on
  communities.

The Prevention Institute, 2007
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Leadership
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Members of the Future Public Health Practitioners
of America meet for a reunion at APHA
headquarters in November 2007
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Theres a difference between interest and
commitment. When youre interested in doing
something, you do it only when circumstances
permit. When youre committed to something, you
accept no excuses, only results.

• Art Turock

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Imagination is more important than knowledge
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A Healthy Community Requires Partnerships Beyond
Health

• Education
• Environment
• Housing
• Behavioral change
• Education
• Economic development
• Transportation
• Criminal justice
• Social welfare

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• Without health there is no happiness.
• An attention to health then,
• should take the place of every other object.
• Thomas Jefferson 1787

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APHA and Advocacy
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Building a Public Health Movement

• Consumers
• Health Providers
• Academic Community
• Purchasers
• Advocacy Groups
• Business
• Public Agencies
• Consumers Families
• The Public

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APHA Policy Priorities

• Access to care
• Eliminating Health Disparities
• Rebuilding the Public Health Infrastructure

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APHA Policy Priorities

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

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Issues Addressed

• SCHIP
• Farm Bill
• Support of increased appropriations for CDC, HRSA
• Need for increased support for workforce
  development
• Support of CDC efforts to develop multi-agency
  focus on disparities, and multi-agency funding of
  programs and research to eliminate health
  disparities

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Methods

• Letters to Congress
• Testimony
• Media coverage
• Engagement and activation of members
• Grass-tops efforts
• Internet-based tools
• Hill visits
• Action Board

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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

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Grass-Tops Efforts

• This years focus
• Mental health parity legislation

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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

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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

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How do we make public health a priority?
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Opportunities

• Major election year
• Inform candidates 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

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Challenges

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

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Explaining Public Health

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

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Questions for Candidates

• 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.

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• 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

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• 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

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• 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

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• 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?

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WARNING Advocacy work can be hazardous
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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

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1. Well-behaved advocates rarely make history
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Be Creative
Well, lemme think. You stumped me son, Most
folks only want to know how to go the other way.
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There is a balance between knowledge and wisdom.
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Its important to recognize the difference
between vision and hallucination
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If all you have is a hammer, everything looks
like a nail.

• We see what we look for, and we look for what we
  know.

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If you keep the blinders off and your heart and
mind open, you will become skilled at looking at
things from many different perspectives.
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Know What Others are Thinking
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Work as a Team
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Sometimes the Little Fish Triumph
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And so you just threw everything together?
Matthews, I thought I told you to organize a
posse.
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Be Passionate About Public Health
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president_at_apha.org or linda.degutis_at_yale.edu