Excellence in State Public Health Law
Feb 15, 2013, 2:56 PM
The Aspen Institute’s Justice and Society Program, with funding from the Robert Wood Johnson Foundation, is accepting applications for a new project, the Excellence in State Public Health Law program.
The one-year program will bring together and provide resources to teams in eight states to work together to address their respective public health priorities, such as tobacco control and disaster preparedness. At the program’s conclusion, each team member will be recognized as a Fellow in the Excellence in State Public Health Law Program.
As the application process begins, NewPublicHealth spoke with Meryl Chertoff, JD, Director of The Aspen Institute’s Justice and Society Program, and program director of the Excellence in State Public Health Law Program, and Leah Devlin, DDS, MPH, former health official of North Carolina and a past president of the Association of State and Territorial Health Officials, who is a consultant to this program.
NewPublicHealth: Tell us about the program.
Meryl Chertoff: The post-Affordable Care Act period is an excellent opportunity to focus on public health innovation through state legislative and regulatory activities. The goal of the program is to provide key people working in public health law with additional tools, networks and opportunities to share best practices and innovations in their state. Especially in a time of economic shortfalls, we have to do more with less. We have to support legislators, advisors to governors and relevant agency officials in their ongoing efforts to use public funds in the smartest way and to build the partnerships that they need in order to effectively leverage the assets that are available to them. We are very much hoping that the initiatives that are undertaken will utilize evidenced-based research in order to improve public health
Leah Devlin: And it’s about building partnerships, which is important in this environment because there are so many new governors, new legislators, and new state health officials. We have our biggest health gains when we develop a sound health policy. So bringing together these high level leaders within a state who may be working together on a public health issue for the first time will be a very powerful approach. It is important to note that the teams can also include local health directors who are also critical players for successful health policy development in states.
NPH: Who will be part of the teams?
Meryl Chertoff: We’re going to be selecting up to eight teams with eight individuals per team. The project director in each state will be the state health official or the territorial health official. In addition, teams will include a representative from the governor’s health policy staff, legislative policy makers, a senior staff member of the state legislative services or bill drafting office and the legislative liaison. The reason that the criteria are so specific is that we want to be sure that we have representation of the key stakeholders. We want to break down the siloing that can sometimes occur when people may not be working across sectors as much as we would hope to see, and as much as would be most constructive for the creation of best practices.
NPH: What’s the critical knowledge base you hope the program will give to the state teams, and how can that improve public health and population health in their states?
Leah Devlin: I mentioned earlier that we have our greatest health impacts when we are able to affect policy change, whether that’s statute or regulation or an administrative act of a governor. And we’re talking about “prevention policies.” If you can identify systems changes implemented through policy that affect the entire population or the environment around the population, that’s when you’re going to have your best impact – rather than trying to serve individual people one at a time. Good examples could include changes in schools around school lunches or focusing on physical activity time in schools, requiring graduated driver’s licenses, creating smoke-free communities or regulating petting zoos to prevent e. Coli transmission.
Meryl Chertoff: Coming myself out of a legislative staffing background, I understand that the time horizon on policy change is relatively short. One of the things that we hope to do is to show how comparative savings, which may be achievable over the medium or longer term, are worthwhile to take into account in pursuing policy change.
NPH: The program asks applicants to focus on public health law and policy rather than on specific health care delivery. Why?
Meryl Chertoff: Both are extremely important. There is a lot of work and a lot of thinking being done about delivery. This program is aimed at population-based measures and attempting to bolster the public health sector specifically. That’s a factor that is occasionally neglected.
Leah Devlin: There’s a lot of evidence around policy interventions that work, like the tobacco tax, like having a quit line that is adequately funded and coupled with a strong social marketing approach. You can’t be effective without doing these things one at a time. Health problems are so complicated you have to address a variety of issues, and have a package of strategies that come together to make a difference. And you can do that best with effective policy.
NPH: How will having very high-level attendees help achieve population goals in each state?
Meryl Chertoff: I’m particularly excited at the opportunity to bring people from the governor’s health policy staff together with the state health officer and with the people in the legislative sector, in order to build teams that we hope will last beyond this particular project. And one of the strengths in having the Aspen Institute as the lead on this is that we are accustomed to working with high-level people both in government and in non-governmental organizations (NGOs). Our educational and seminar work is well known for bringing such groups together. We create sturdy relationships that outlast the particular interaction.
Leah Devlin: It is important to emphasize that while health officials make recommendations for policy development based on sound science, many times at the end of the day it is the elected officials that make the final decisions.
So this is an incredible opportunity to bridge between the governor’s office, the legislators and their staff with other state agency directors who may be key to successfully implementing a specific health improvement policy for the state. Most teams I’m sure will want to have bipartisan representation, and elected officials often look to their staff on critical issues, because they have responsibility for so many things. Including these policy staff is really important.
NPH: Leah, what in your own work in North Carolina, and with ASTHO, indicate that this kind of bringing together of high level teams will lead to the success you’re aiming at?
Leah Devlin: After the anthrax attacks of 2001 we began in public health and in other sectors of government building up a preparedness and response approach together, to all hazards. After those attacks we had a steady march of new, emerging infectious diseases such as West Nile Virus and monkey pox, SARS and pandemic flu. It was obvious that we had to strengthen our relationships with other first responders. We’ve always been on the front line, but our partners didn’t always recognize us that way.
One important strategy in preparedness has been to participate in a number of opportunities led by the federal government and with resources from the federal government to put together teams, usually through the governor’s office, and they would say, okay, bring your Governor’s Health Policy Director, your State Health Director, your Homeland Security Director, your legislators and we would all go to Washington to share what we were doing in our states to build the prevention and response capabilities around all hazards. It was a very dynamic and effective process.
One of the things that’s exciting about this initiative is that each state will have access to $10,000 of technical assistance and other resources. . Partnerships are strengthened the most when there are opportunities to share resources. For example, we used some preparedness funding in our state back in 2001-2002 to strengthen the work we were doing with the Department of Agriculture to take advantage of their GIS mapping that they had developed a little earlier.
Meryl Chertoff: Another thing that I hope that we will be able to assist on is how to tell their story in a compelling way. Because the language of science and the language of politics are very different we want to enable the people who are working in the scientific sector to tell their story in a way that it will make sense to people who are legislative and executive policymakers.
I think it’s very exciting for groups to come together when they are thinking about their own particular problems and to hear how others are approaching the same problems or about past successes that others have had—learning lessons from their peers.
NPH: Is forming relationships among the program participants also an important goal?
Meryl Chertoff: We’re definitely hoping that that is going to be an important part of the outcome, and we are hoping that this will be the beginning of the network. In the best of all possible worlds I hope that a legislator who is from one party will be able to call a legislator up from another state and another party six months or a year down the road and to have them serve as each other’s sounding board or “board of advisors” to be able to think through these problems, maybe even before they approach people in their own states so that they are ready for potential pushback when they take their proposals live. We hope that a robust network and sense of safety and trust will develop over the course of the entire year.
Leah Devlin: If these leaders are comfortable with each other and know each other then there will be other good things that come from this besides the project that they take on this year. They can also expand the model to include different partners back home as the issues they are addressing will change. Some legislators might be interested in particular issues; others will be interested in something else, the same for the different administrative heads of different departments. This is a model that can be transferable.
This commentary originally appeared on the RWJF New Public Health blog.