In Brief:
The politics around COVID-19 were supercharged by the explosive nature of the disease, and its unnerving real-time spikes of illness and death. The fact that public health officials were obliged to act even before they fully understood which measures would be most effective added to the turmoil.
The political dimension of public health is always there. Seat belts, sugar taxes, gun laws, warnings on cigarette packages, water quality standards, food safety laws, coverage for pre-existing conditions, workplace safety standards and countless other legislative and regulatory actions integral to public health are the result of political processes. Even if they represent progress, the policies that are enacted may or may not reflect the best public health science.
Shelley Hearne is the director of the Center for Public Health Advocacy at the Johns Hopkins Bloomberg School of Public Health and the school’s Deans Sommer and Klag Professor of the Practice in Public Health. Her decades of public health leadership have included roles as executive director of the Big Cities Health Coalition, managing director of the Pew Health Group and founder of the Trust for America’s Health.
Hearne is one of the authors of Policy Engagement, the second book in a series devoted to strategic skills for public health practice published by the American Public Health Association. The first, Community Engagement, was published in December.
The series will address nine “indispensable, high-performance skills applicable to the entire public health workforce regardless of specialty or discipline,” identified by a National Consortium for Public Workforce Development established a decade ago by the de Beaumont Foundation and supported by the Centers for Disease Control and Prevention (CDC) and the U.S. Department of Health and Human Services.
Public health officials may need better political strategies to achieve their goals but, Hearne says, “How the hell are they going to get a political strategy if they're terrified of engaging in the policymaking process?”
Policy Engagement is intended as a 101 guide to such engagement. In a conversation with Governing, Hearne talks about what the book has to offer.
Governing: Who is the intended audience for this book?
(Johns Hopkins)
Shelley Hearne: It's for all walks of life in public health. If you're a front-line worker in clinics or doing community work, you have firsthand knowledge that absolutely must shape how policies are made.
It’s for the CEOs of businesses, the leaders of clinical operations, the heads of hospitals, even NGOs that are doing advocacy work. There are basics in here that can provide insights, from novice to expert, on how to engage in the policymaking process.
Governing: Why is it important for public health stakeholders to get this information?
Shelley Hearne: Every issue that we work on in public health is debated, decided and driven by policy. You may have the science on what would work, but if it's not understood and owned and championed by policymakers, it's not going to happen.
That’s why we have to have the skills not only to do the research and to be out in the field helping, but to combine that knowledge with the ability to work with the people who make the policy decisions that can help create a healthier nation.
We are the sickest nation of the wealthy world. We know that if we had better policies in place — policies that have already been tested, that are tried and true — we could have significant improvements in hitting our health goals.
If we're not the ones that are making sure that science and facts are driving policy, who's going to do it? It truly is in our hands. Whatever your issue is, whatever your passion is, whatever your career is, you could be part of informing and influencing whether or not those policies are put on the books.
Governing: You have long and varied experience in the public health field. What’s your sense of this moment for public health in America?
Shelley Hearne: This is going to sound odd, but I am incredibly excited despite all the bad news we have in terms of health outcomes, disparities in diseases by race and a demoralized and ebbing public health workforce.
This is the first time in my career that I have seen top leadership, and the next generation that is coming in, realizing that we must equip the public health workforce to get re-engaged in championing science, championing evidence and working hand in glove with policymakers.
In the past, advocacy was a dirty word and there was a divorce from [the act of] engaging. So many of the readers of Governing — legislators, staffers and policy officers — have never met someone from public health. They haven't met their local health official. That’s going to change.
There's a recognition that you've got to engage, but you can't engage with confidence unless you learn the skills somewhere. That’s what drove putting this book together.
We’re trying to fill that gap, and this is a first step. I’m excited.
Public health is a public work. It’s a public duty and it's public resources.
Shelley Hearne
Governing: What would you say to someone in public health whose first reaction is that this kind of advocacy isn’t really their job, or doesn’t fit their personality?
Shelley Hearne: That's part of why we wrote it. There's a chapter that says, “Stay true to who you are.” Being a good advocate is knowing what you're comfortable with and what you know.
The book covers basic, intermediate and advanced levels of policy engagement. It will walk you through. You may be a shy person who thinks you can't talk. Well, that's fine. Here's some things you could do and ways to engage. Here are some basic steps you could take that are not going to put you at risk for your job.
You never know when you might be informing and influencing a policymaker, whether you're in an elevator or you get an unexpected chance to talk to your governor or the state legislator sitting next to you at your kid's soccer game.
It’s important to realize all the different ways that public health can get its word out. That's what's needed now. We need to be visible, engaged and part of the problem solving.
Governing: You introduce one chapter with an African proverb: “If you want to go fast, go alone, if you want to go forward, go together.” Is it important for people to realize that advocacy isn’t a one-person job?
Shelley Hearne: People sometimes get daunted about engaging in the policymaking process because they think they have to put the whole campaign together and it's all on their shoulders. That's the worst way to go. One-person crusades are not solutions.
One of the things that we talk about as a beginning step is to just go offer to be a resource to policymakers at the local, federal or state level, wherever your interactions are. If you're a state health official, have your legislators come and do a tour of the facilities and go out and see what is happening on a daily basis in the health department.
It can be as simple as that to start developing trust, understanding and partnerships. It may be 18 years or 18 months or 18 days later, but if something comes up and they need an interpretation, they know who to call.
You can build relationships with other groups out there that have been long toiling on this but don’t have a full picture. Participating with them can bring in more of the science and public health perspective, and add balance.
Governing: Couldn’t this just look like more work to departments already short staffed or overburdened?
Shelley Hearne: It's not more work, and it's probably going to pay off pretty quickly.
Public health is a public work. It’s a public duty and it's public resources. They should know the public policy officials who are making decisions about their agency. Ideally, you're working in partnership to improve the ability of your community to thrive.
Is a phone call, showing up at a meeting, developing a relationship “more work”? I think that's actually common sense and good operating practice for the health of that agency.
I used to spend a lot of time on bioterrorism and preparedness work. In the early days when we were doing tabletop exercises, one of the stunning discoveries was that the different agencies involved had never met each other. If you're meeting someone when a wildfire is coming into the city, or you think you have anthrax or a pandemic event rolling in, that's a formula for a poor response.
One of the secondary things that happens is that you start to realize that others outside public health are dealing with the same issues. It gets back to that community of decision-making. Public health's going to do better when the public safety, the education, the transportation folks understand how public health helps them and vice versa.
That's going to make an agency work better. Your budget's going to be less at risk. You're going to have other allies and your job will probably get easier down the road because the places you're trying to influence and change already know and trust you.
Governing: The book talks about the importance of storytelling in communicating public health issues. Are there any guiding concepts for that?
Shelley Hearne: Storytelling is almost a test of, “Is it real, these numbers you are giving me?” We have great science, great facts, but the reveal that happens in a story is the authenticity of the teller.
My counsel to people, whether students or public health leaders, is tell the truth and be as authentic as hell. Don't be cute. Don't embellish. Your credibility is all that you have.
A real story told succinctly is like giving color commentary in the play-by-play call of a game. It has to fit in there and be tight.
Credibility is the most important asset of a story.
Governing: On a personal level, anyone would agree that good health is an essential ingredient for a happy life. Why is it hard to build agreement around policies that we know could improve good health for all?
Shelley Hearne: I came out of the environmental field. Everyone wanted to engage on environmental issues, from polar bears to backyard issues. The reticence on the health side is befuddling.
That’s where we need to calibrate. Public health leaders in all walks of life, in all areas, need to engage with evidence and passion and be part of the problem solving.
We’ve got to open up the doors. The policymakers, your audience, need partners that understand these issues. Not people screaming and yelling and thinking that if they yell louder, somehow that's the answer.
Public health professionals need to be partners in making sure that good, healthy policy is what is being put in place. They need to step up their game.
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