We’ve been trying to make the HEDIR page more user-friendly and in that effort we’ve ignored the blog.  So starting today I’ll start making a concerted effort to contribute.  If you’ve been following the HEDIR, there has been a major discussion on the role of CHES and its importance/relevance, licensure of health educators and this has eventually led into a conversation about the role of health educators and RNs who deliver health education.

A few questions…

1)  Should health education move into the licensure stage?  If so, how much would you be willing to ‘pay’ for such license?  If no, why not?

2)  Although they may not be academically trained as health educators, are there other professions capable of providing effective health education?  If so, who and why?

More to come.

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For those of us in health education and public health this has been a fascinating time. Removing the human side of the issues (deaths, illness, etc.) and looking at this from strictly a public health issue this has been a wonderful case study on how to deal with an emergency. For those in educational settings this is well worth time talking about this situation. A few things that I’ve noted:

• Despite a lackluster effort in the last few years of his administration, the Bush’s Administration appears to have done exceptional preparation (based on the Avian Flu) for dealing with this sort of problem. Let’s give credit where credit is due. A few years ago we were concerned about the Bird Flu (which didn’t really pan out). Yet, efforts were made to provide a framework to prepare for this. We’re seeing the results of this plan and it appears to be working well.
• We’re seeing the importance that public health is playing in this situation. It’s so refreshing to see public health officials who are acknowledged for their expertise and knowledge rather than demonized (as we have seen in the past). Most people don’t want to pay taxes, but if they do they want to see the benefits resulting from such. I think the fact that the U.S. has the best established public health routine in the world is pretty evident with an event such as this, and most people that I have talked to feel that the money we’ve invested in the CDC is well worth it.
• We’re seeing the continuing emergence of the county public health department as the leader in emergency preparedness. I’m not sure how it is in the other states, but after 9-11 we realized that our emergency preparedness was in a real disarray. In a study that Dale Ritzel (former colleague of mine) and I did in the early 90s we found that everybody in our community (probably true with most places throughout the U.S.) had their own unique emergency preparedness plan but nobody was talking to the other players in the community. For example, here in Carbondale, SIU had a plan; the local hospital had a plan; the emergency personnel had a plan; the city had a plan, but nobody coordinated all such parties (or if they did nobody knew about it). After 9-11, here in Illinois, the county health departments stepped up to the plate and took over that control. Here in Jackson County (home county of SIU), the emergency preparedness coordinator at the health department is an MPH health educator. It makes perfect sense for this type of person to take over the lead. They have great planning and organizing skills, know how to work with various groups. What a great opportunity to show our students what health educators actually do.

I’m also privy to a very special situation. My wife, also an MPH trained health educator also works at the local health department (Division Director of HIV Services) who is also a key person in the emergency preparedness scenario. In addition to her regular work expectations, she also has key roles in emergencies. I can’t go into detail because of security (and probably because I don’t know them myself), but she has played a key role in receiving medical supplies to deal with the H1N1 outbreak. Last week she was awakened at 2:00 am to receive the drop of supplies. Besides carrying a cool badge she also gets to boss people around (she’s had plenty of practice with me—the difference is that most of these other people listen to her).

Earlier on the HEDIR blog there was a discussion on the terms community health public health. I think this recent event further supports the term that the health education profession needs to affiliate themselves much more with the term public health more and to identify themselves not as community health educators but rather public health educators. Public health has received great attention and it’s becoming a much more revered and respected term.

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How about a president calling for a serious investment in preventive care and appearing to know something about what he is proposing? I had often wondered whether I would hear the words spoken by Mr. Obama coming from a seated president in my lifetime.  Public health professionals and health educators employed in all settings should be thrilled with the commitment of President Obama to improve the health of American citizens and gain control of the escalating costs of healthcare insurance. Based on an opinion piece published in The Wall Street Journal on September 16, 2008, David J, Cutler, J. Bradford DeLong, and Ms. Marciarille state that health insurance premiums doubled during the period of 2000-2007.

No wonder the support for Mr. Obama’s performance jumped from 63% approval to 80% approval following his speech on Tuesady evening. He plans to take action in areas that have been greatly neglected for far too long. I suspect that approval of Mr. Obama’s performance among professional health educators is even higher.

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It seems like daily I have 2-3 action alerts in my email box at work and perhaps as many with my home email account. I am one of those cause-based folks supporting environmental issues, peace and justice issues, health issues and human rights issues. Unfortunately Internet technology makes it so easy to create an online action alert that EVERYTHING becomes an “act now or else” issue.

The net effect of this inundation of actions is the creation of a cacophony of noise which fragments our message in a million directions. The causality of the this noise is the attention of political leaders, the opposite of what we hope to do. I have been told by political staffers that email advocacy, especially that which appears to be generated by commercial software, is treated as spam.

So, the question is, what does real advocacy look like? For example, I received an action alert on the HEDIR Listserv.

Tell President Obama: No More Money for Ineffective Abstinence-Only-Until-Marriage Programs;  Fund Comprehensive Sex Education

My first question was, is there anything that would suggest that Obama or his team will continue to perpetuate the myth of abstinence only sex ed?  Likely not, considering that during the campaign we heard “Obama’s one accomplishment in the realm of education was legislation to teach ‘comprehensive sex education’ to kindergartners.” Despite how this was a distortion, the underlying reality is that President Obama supports age-appropriate, comprehensive sex education.  So the question is, “why this action alert?”  Is spamming President Obama is the right method for advocating on this issue?

Anyone who has worked on policy change or, better yet, shifting federal or local funding through policy, likely knows that the process is a tad more complicated than having 10,000 people spam a legislator.   Advocacy is not about creating spam but is the work of creating an intentional plan to build a coalition of support for an idea and then strategically working the very complex political process to push through the bureaucratic inertia until change happens.  I hate to see us fall for the illusion of advocacy, thinking that we are making a difference because of a click of a mouse because often when we click the mouse we aren’t advocating but merely creating noise.

On the same day, that I received the invitation to spam the president I received from the American Public Health Association the following update

“Representative Louise Slaughter (D-N.Y.) and Senate Majority Leader Harry Reid (D-Nev.) introduced H.R. 463/S. 21, the Prevention First Act, to promote pregnancy prevention and reproductive health. The bill includes a measure to fund age-appropriate, medically accurate comprehensive sexuality education programs, including information on contraception and abstinence. Currently, federal funding only exists for abstinence-only programs and totals about $176 million per year. Critics of abstinence-only programs claim that the programs do not deter adolescents from having sex. Moreover, they fail to prepare adolescents to become sexually active or protect themselves from unintended pregnancy, sexually transmitted infections and HIV/AIDS and, in some cases, include false or misleading information. Last year, APHA Executive Director Georges Benjamin testified before the House Committee on Oversight and Government Reform in support of funding for comprehensive sexuality education programs. You can read APHA’s testimony at: http://www.apha.org/NR/rdonlyres/11DDC21C-1AFB-4167-80D0-F365E3AEE0FA/0/AbstinenceOnlyTestimony.pdf.”

So, I would suggest that a better advocacy strategy would be not to tell Obama to stop funding abstinence-only sex education but to positively work to advance this bill. With a bill number you have the power to direct your representative to take positive action. In this case, we should be working with our local Representatives and Senators and be asking them to sign on to this bill as co-sponsors.  That allows you to make a direct positive contribution to real legislation rather than a non-descriptive, “please don’t fund abstinence only education” blast email. This takes more than a click of a mouse. It means making a local call to your representatives offices, writing and mailing a handwritten letter and, if feasible, meeting with your legislators’ staffers if your legislator could influence the process, for example if they sit on influential committees like:

House Science Committee
House Education and Labor
House Appropriations health subcommittee
Senate Health, Education and Labor
Senate Appropriations Labor, Health Subcommittee

Please understand that this post is about advocacy and is only secondarily related to comprehensive sex ed. Comprehensive sex ed was just a low hanging piece of fruit that I could hang this post on.

For more resources on Health Advocacy see:

National Association of County and City Health Officials: http://www.naccho.org/advocacy/

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a) Make a million dollars, b) Attain a power position in government

And now I have a clear understanding of how to achieve that ideal… Just 3 simple things I need to do.

1) Change my party affiliation to Democrat

2) Make it known that I would like to have a powerful position in Washington and ask my friends to tell people I am the best person for the job.

3) Quit paying taxes!

From the heart of the rockies

TDub

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I wonder if 150 years ago, the first American President from Illinois would have predicted the second American President from Illinois would be a black man.  I wonder if 150 years ago when Lincoln uttered the words “I do order and declare that all persons held as slaves within said designated States, and parts of States, are, and henceforward shall be free” he foresaw a Nation so energized about a freed man becoming THEIR president.  I wonder if 150 years ago, Lincoln would have predicted that the country would be as unified as it is… all behind a fellow Illinoisan.

Today marks a time in American politics that many have awaited and never thought possible.  An African American sits at the helm of the greatest Nation on earth… and the color of his skin could matter less.  When his signature is applied to a piece of paper, it becomes binding law of this land… and the color of his skin could matter less.  We are a great country.  And I see today as a great unifying day.  A day when we follow a leader that 150 years ago would not have been able to be president because the color of his skin mattered more than his wisdom, knowledge, or capacity.

President Obama inspired us yesterday.  “Today I say to you that the challenges we face are real. They are serious and they are many. They will not be met easily or in a short span of time. But know this, America – they will be met”.

Yes, Barack Obama is my president.  Yes, I pray for his success and achievement.  Yes, I will follow his orders when duly given.  No, I do not agree with some of his policy proposals.  No, I will not sit ideally by and accept his decisions as gospel.  No, I will not hold to my political party more than my interest in a better America.

I believe in a participatory government.  One in which my voice is just as important as Bill Gates.  One in which my vote is equal to my peers.  One in which my ideals are represented by servants of this country.  We can make a difference in America, even… especially when we disagree.  Let us discuss issues that matter, for we frequently want the same end… and we can find compromise on the means.

On this first full day (now second because of my incompetence) in office of a new president I say:  God Bless Barack Obama and God bless the United States of America.

From the Heart of the Rockies

TDub

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Will this benefit the health of our population?  Will it improve public perception of professionals, like health educators, who tend to work at relatively low incomes to help people prevent illness and unintended injuries and promote the wellbeing of themselves and others? Or, will other critical issues, such as rebuilding the national and international economies and dealing with wars, distract President Obama’s administration from addressing the health and wellbeing of the American population? What can professional health educators do to assure that the infrastructure for preventing illness and unintended injuries and promoting health and wellbeing get attention at a high level of the new administration?

Maybe this is what the SOPHE State Health Policy Institute is all about.   Maybe checking on this institute at http://www.sophe.org/ would be beneficial for those not yet retired.  It seems that February 2 is the deadline for applying for the SOPHE State Health Policy Institute.

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Today, there are lots of smoke free environments, including hospitals, AMA convention halls,APHA convention halls, medical school clinics, many restaurants, most homes and even some taverns and saloons.  Fewer than 25% of adult, white males smoke.  While the percentage of adult white women who smoke is greater today, the overall rate is markedly down.  Most ashtrays are gone and spittons appear only among antique collections.  For many of us, we see this progress and view the glass as at least half full.  For others, this is not the case.

Yesterday, January 13, 2009, I saw a HealthDay News headline that reads:  U.S. Flunks on Tobacco Control Report Card.  This report states:  According to the American Lung Association’s State of Tobacco Control 2008, the federal government as well as most states failed to enact critical policy measures, such as higher taxes on cigarettes and to adequately regulate tobacco products.   Upon reading the article, it seems to me that standards for passing the grade are quite high.  I like smoke free environments and want to see more done to cause them to happen, but it seems we are moving the markers of success pretty fast.

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The other comments seemed to agree that politics is important “public health is the body politic”.  So, since we tend to agree on this point lets take it further.

What would we say about a pharmacist having very little understanding of organic chemistry?  Or a Social worker lacking the basic understanding of say Skinner or Prochaska?

Just like Pharmacy, social work or health education… the political world is based in theory!

If public health folks enter the politic world expecting that logic, epidemiology and sound judgement will win over policy maker… we are doomed to fail. 

There was a theory in political science called “Rational Choice” that attempted to explain how policy makers decide what ideas become laws.  It goes like this:  Option A has 6 benefits and 2 shortfalls… Option B has 6 shortfalls and 2 benefits… Option C has 4 benefits and 4 shortfalls.  Therefore, Option A should be the correct option ans should become policy.   OHHHH how failed.  First this theory requires accurate and COMPLETE information for the policy maker.  Second… Even with accurate and complete information, some people will not make Option A their Choice because they have friends that think Option C is better.  (anyone say smoking ordinance?)

The rational choice principle of policy making has gone by the wayside… Yet Public Health practice regarding policy making (in administration class and so forth) rely on rational choice as the basis of their actions (remember all of our actions should be based on theory… we just didn’t realize that we were using a theory).  We exect that if we show policy makers enough “evidence” ans statistical analysis, they will form policies favorable to our agenda.

Community organizing discussions are based on a different policy theory… And this is where I find hope in advancing the policy process in our profession… It is called the Advocacy Coalition Framework.  This theory is one in which coalitions form to promote their policy ideas… even when they are unlikely bedfellows.

Take for instance an effort to address teenage drug use in the community… Community organizing says that we should marshal all the community resources that are willing to participate and address the issue with good education and community involvement… Evidence based practice shows this works… but the policy process would ask us… Who else wants the same thing we do.  The advocacy coalition framework tells us that we will be more successful in getting our ordinace (or law) passed if we team with other powerful organizations that have the same core beliefs. 

Our core beliefs are health, empowerment, and equality.  Who else shares these beliefs?  Is there any group in your community that we would normally NOT expect to help us that has the same CORE beliefs?

The Key is to base our policy efforts on theory… not wishful thinking…

From the Heart of the Rockies.

TDUB

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