Public Health Partnerships: NewPublicHealth Q&A with Marc Manley
Strategic partnerships to help extend the reach and resources needed to improve population health, was a focus of recent annual conferences, including the AcademyHealth Annual Research Meeting and the 2012 annual conference of the National Association of County and City Health Officials. Blue Cross and Blue Shield of Minnesota has played many different partnership roles on critical public health issues, including as a convener.NewPublicHealth spoke with Marc Manley, MD, MPH, Vice president and chief prevention officer of Blue Cross and Blue Shield of Minnesota, about collaborations the health plan has been a part of that are benefitting Minnesotans and can serve as models in other parts of the United States.
NewPublicHealth: Can you give us a strong example of collaboration inMinnesota among varied partners that improved population health?
Dr. Manley: In 2006, partners in Minnesota including local and county governments and Blue Cross began working together to pass local smoke-free ordinances. Once there were enough local laws, neighboring cities began advocating for statewide uniformity, so in 2007, a group of the state’s health organizations and other stakeholders determined that the legislative environment was conducive toward adopting a statewide clean indoor-air law and formed the Freedom to Breathe Coalition. Partners included Blue Cross and Blue Shield of Minnesota, hospitals, the American Cancer Society, the American Heart Association and the American Lung Association, the local public health association, the Minnesota Medical Association and the Service Employees International Union. We all shared the goal of passing a strong law that covered all workplaces in Minnesota including bars and restaurants. However, we also knew that there would be many amendments offered to change the bill as it made its way along the legislative path. Some changes would weaken the bill so much that it was easy to assume that we’d all oppose them. Other amendments could seem more reasonable to some organizations but not others. From the beginning, we were able to get on the same page and agree to operating principles that outlined what we would do if we had disagreements about amendments as the process unfolded. Agreeing to operate as a team and to trust each other was also part of those operating principles. We established an expectation of transparency and cooperation right from the start – and then dealt promptly with any departure from those expectations.
Supporting data and strategic focus were also key to our success. We couldn’t reach every legislator, so we put our energy into those who we were most likely to convince to support the bill. We learned to be nimble when priorities changed. We compiled compelling statistics on the costs of secondhand smoke, educated the public and then polled public opinion to show their majority support for the law. Grassroots support, public relations and communications were essential parts of the campaign. In the end we were successful in passing the law and I’m happy to report that this October we will celebrate five years of being smoke-free!
NPH: Beyond the critical benefit of better air quality for Minnesotans, what were other long lasting results of the campaign?
Dr. Manley: One of the best side effects of the Freedom to Breathe campaign is that it has inspired public health advocates to use public policy as a tool for creating positive change. Working on this campaign provided a training ground through which advocacy skills have been learned and strengthened.
The lessons learned in the tobacco control trenches serve as a good model for advocacy work on other health issues. For example, we see groups that were working on clean indoor air now looking around their communities and asking what it would take to make those communities easier for walking and biking, to help more people build physical activity into their everyday lives. Other groups are thinking about improving access to healthy, affordable foods. Both of these are important steps toward preventing another very serious problem facing our state and nation – obesity.
NPH: Can you share another strong example?
Dr. Manley: More recently we led the passage of another state law, Complete Streets Minnesota. That’s a law that makes it easier for communities to become walkable and bikeable. It basically asks that when transportation decisions are made they consider the needs of all users – people on foot and on bike as well as drivers, plus people of all ages and abilities. That, too, took quite a bit of work ahead of time. We joined with a number of other organizations statewide to get the state law passed in 2010. The approach was very similar to the smoke-free law, but one big difference is that a state complete streets law really applies to state roads, state highways and state transportation systems. So even though the state law is passed, we still have work to do to get similar laws passed throughout the state at the city and county level.
NPH: What’s the practical application of some of the state laws?
Dr. Manley: It basically means that – where it makes sense – more and more of our roads are getting marked for bike trails, or it means that transportation planners are more likely to put in crosswalks so that people can cross safely, even on highways in some cases. And it means that planners are more likely to consider having sidewalks where they might not have put them in the past. To date, we have 28 communities that have passed their own versions of Complete Streets laws and we’re working on more. The coalition created a website to support the Complete Streets effort. Here users can get more information on the issue and find updates on cities and counties that have passed laws.