Tuesday, 9 April 2013
Interview conducted by Alison Swain via phone at 5:30PM on Wednesday, 3 April 2013
Q: Can you tell me a little about the Michigan Association of Local Public Health? What are some of your goals?
A: Well the Michigan Association of Local Public Health is a statewide association representing the 45 local public health departments in Michigan. Our Mission is to support local public health departments in their role protecting and serving the local communities but also serving their governing boards as well. Some health departments are governed by county commissioners, single county health departments but then we have multiple county health departments where there are still commissioners that represent certain counties but come together as what's described as a board of health.
A: I have worked there just under three years. I'll be celebrating my three year anniversary there next month and my background includes thirteen years of working in associations. My first eight years was with the Michigan Nurses Association and then I worked briefly with the Michigan Head Start association and then moved over to the Michigan Association of Local Public Health.
Q: Could you briefly walk me through typical day of work?
A: Well, because we are a small nonprofit, it's just me and my assistant who works part time so my days do get pretty hairy. In theory on a daily basis I monitor legislation that is introduced into either the House or the Senate and I monitor legislation that we may take a position on either one way or another in support or in opposition to see if it's going to come up for committee testimony, watching if it's going to go for a House or Senate vote, those types of things. So I monitor legislation that way. Also, Tuesdays, Wednesdays, Thursdays are when the legislature is in session during the week, during their legislative cycle, keep in mind that they do have summers off, spring break, Christmas break and hunting season, but on Tuesdays, Wednesdays and Thursdays there are certain committee meetings that are held, not necessarily something that we take a position on but that's how you keep in touch with your other colleagues who may have interests in those other areas and certainly catching up with legislators and establishing that relationship with them. Finally it's just doing work with the associated state departments, not all associations have to have relationships with the state departments but what's unique with the Michigan Association of Local Public Health is that we're tied to the department of community health, the department of environmental quality, the department of agriculture, a little bit of the department of human services, the department of education and the department of licensing and regulations.
Q: What have been some of your recent successes? Was there something that you personally were proud to achieve?
A: Well, for me personally, when I came on board there's a line item in the budget called Essential Local Public Health Services, but when I came on board it was called Local Public Health Operations, so it kind of had more of an administrative feel and one thing a conservative legislature doesn't want to pay for is administration. So, we were able to successfully get permission from appropriate folks to actually change Local Public Health Operations to Essential Local Public Health Services which are eight mandated services by the state of Michigan that local public health departments are charged with doing and contract compliance, accreditation review of those eight essential services which we do on behalf of the entire population.
Q: When you're working on your legislation do you have any specific tactics or strategies to bringing about change to influence public policy?
A: Well yeah, and every lobbyist pretty much knows this. If you take for example Michigan's legislative set up, you have a governor who's republican, but he's kind of considered a bit of a moderate, versus like a tea party-type republican or libertarian type republican, the House has a republican majority with a tea party component, so if you're going to go after something that requires funding for some social issue, for instance family planning, they are going to be against those types of things and you're never going to be able to sway their vote or anything like that. And then over in the Senate, again, you have a Republican majority, but they seem to be a more of a reasonable body of leaders, because they've been around the block, they've been in the House, they're reasonable to work with. You have to understand what the political environment is, you have to target accordingly. So if I wanted to get policy implemented I would have to reach out to a republican who is well respected by the party but who is also well respected by their chamber and if I can get their support, then you let them do a little bit of the work themselves and then eventually you have to get it up to the governor, so you have to then make sure the governor is on board.
Q: What are some of the specific challenges you face and who are your typical opponents?
A: The challenges are that local public health, if I'm talking about essential local public health services, that requires state dollars. They're not going to tax to get more revenue to support these types of programs. So you kind of get stuck with a revenue stream that's very fluid and based on sales, based on income tax, payroll tax, all of these certain things that are tied to the general funding and these dollars are not designated in any way. So the general fund fluctuates and we fluctuate as well. So the challenge is really demonstrating what the value is of public health to the local community but then the broader 9.9 million folks that are here in Michigan, because a lot of people think that public health is health care for the poor, we don't do healthcare, we do supplementary complementary services like immunizations, family planning, we do the maternal infant health plan program, we do food safety, we do water safety, we also monitor sewage. And so one of the challenges is convincing people that these are necessary. One legislature member said to me last year during testimony, "We cannot bankrupt the state, trying to keep people safe". In other words it's "eat at your own risk, swim at your own risk, live at your own risk, you're on your own." You kind of have to get the public behind your initiative and that's a little bit difficult, because I could always say, ‘Hey, I don't get birth control, I don't do immunizations at the health department, I eat at restaurants, yeah, sure, but the food is safe, right? Or I swim in a pool, or I drink the water, is that really public health?" So it's hard to get John Q public or John Q Taxpayer to kind of buy into the public health because they just don't see what the value is. Now, I think if you ask the people on the Carnival Cruise Ship the value of fresh water and not having sewage running around, I think those 4,000 people would tell you, "yeah, public health is pretty important".
Q: Do you guys try to reach out to the public to get a backing, and if so how do you do it?
A: You know, we haven't pursued that as of yet. Keep in mind, I have some health departments that are very politically active, and know who their representatives and senators are, they basically have them on speed dial and are well respected for the role that they play in the local community. And then I have health departments that are not active, because it's not drawing attention to what they do at a local level. One thing that most of the local health departments do is customer satisfaction surveys, and when they compile the information a lot of them will forward those to their legislators so it's demonstrating that if there are positive customer surveys, you want to share them, even if they're negative, to be able to demonstrate and say, "Yes we got this negative feedback, and we've reviewed it, we're making changes to correct that, so we don't get negative feedback again."
Q: How have your opinions of state politics of policy changed as you've become more involved in government?
A: [Laughs] Well you know it's interesting after the Right to Work thing and everything going on with the federal government, every time I meet up with a colleague since kind of all that has happened, I kind of just ask, "like are you burned out? Is this getting difficult?" and you know there's not one person that says, "God, I love my job" and you used to be able to say that. Kind of before term limits came into play, before the whole tea party movement, it's been very challenging, you do get a little jaded over the process. You see that winners or losers are picked. You see that the winners are those that make political action campaign contributions, that's a difficult pill to swallow. We're a nonprofit, public health does not engage in political activity like that. You know that being said, the interesting thing is, one of the top ten PACS in Michigan is even burned out. And when you have those kind of PAC dollars that, in theory, can influence all sorts of stuff, and they're burned out on it? It just goes to show that this is a very difficult environment, and you get to a point where you get a little bit snarky and a little bit snappy and when we get told "we just don't have the dollars" I said "no, you just don't have the prioritization to protect the state." I used to say that there were three levels of lobbying, or that a lobbyist goes through. They start off with passion, end up cynical and then they just end up numb. I think there are a lot of people that have been doing this long enough that are kind of just in the numb stage. I'm still balancing between passionate and cynical. I typically use the reasonable person standard, and I think others do too, but those that go out and vote, are not reasonable and that's difficult.
Q: We've been asked to pick an issue to follow throughout the semester, and mine has been Birth Control availability and use. I was looking at the resolutions MALPH has worked on and in 2004 the Sex Education Legislation was passed. Can you tell me a little bit about it or is Birth Control an Issue you deal with at all?
A: We do advocate for family planning, because those services are typically provided in local public health departments. That is something that they know that there is a need at the local level. When it comes to family planning they just want to call it abortion, and contraception and that's that. Family planning really is a broad overreach. We want to address if you are not ready to be pregnant whether you're single or married or whatever, then access to preventative services are key to that endeavor. And certainly, if you can't afford them, then there is an opportunity through federal funding with a little bit of state dollars that come to the state to offer birth control to folks that cannot or should not or do not want to be pregnant. Once you have an unintended pregnancy that child is at risk. There are two questions a gynecologist should ask. One, do you want to be pregnant in the next six months? If so, they can immediately get them going on a path towards preconception health, you know, don't drink, don't do drugs, let's get you going on prenatal pills. And if you don't want to be pregnant, then let's figure out a way for you to prevent it, because then there are serious problems associated with that. Family planning also looks at women who are pregnant, and asks how to give a positive birth outcome. Family planning focuses on positive outcomes all the way through for mom and baby. When it comes to contraception, you really have to reframe the message, and that's what anyone who is tied to contraception in any way. And we certainly don't get involved in very hot topic areas. You just simply reframe the message and you talk about preconception health, mom and baby, getting the services that they need, so we have a positive birth outcome. It just has to be framed differently, don't talk about contraception, talk about the planning aspects.