American Public Health Association (APHA) President Melvin Shipp, OD, MPH, DrPH, held a special, president-elect session at this year's APHA annual meeting on the critical importance of mastering the policy-making process to advance public health. At the well-attended October 31, 2011 session—"An Inside View of Federal Health Policy Making: The Robert Wood Johnson Foundation Health Policy Fellows"—five alumni of the Robert Wood Johnson Foundation (RWJF) Health Policy Fellows program, including the program's director, Marie Michnich, DrPH, talked about how to get things done at the policy level and make good use of the career opportunities the program offers.
Enriching the Policy-Maker Pipeline
"We have a pressing need for people with public health backgrounds to work at the policy level," said Michnich, who discussed policy-making on the front lines during the session. "Currently, about 10 percent of our fellows work in public health. We want to encourage more people to participate in the program because it's important to have people with a population focus engaged in policy-making."
Michnich also spoke about the professional benefits of completing the fellowship. The 38-year-old RWJF Health Policy Fellows program includes, "a three-month orientation during which fellows meet with more than 200 people who make policy at the federal level, including commissioners and key committee members," Michnich said. "Recently, fellows have worked in the office of First Lady, Michelle Obama, the offices of the Speaker of the House, the Secretary of Health and Human Services, as well as on major congressional committees with health jurisdictions." Fellows receive a $165,000 grant and spend a year working in Washington, D.C.
A Life-Changing Journey
"The fellowship is a transformative experience," said Art Kellerman, MD, MPH, a 2006-2007 Health Policy Fellow who is currently a vice president and director of Rand Health at the Rand Corporation. "This is the best fellowship in the country for health policy. It gives you an opportunity to serve, to contribute to a mission and learn while you are there. During my term, I tackled tough issues, while learning things about how Congress worked that could never be learned in a classroom or from a book."
Kellerman's fellowship experience included working alongside Rep. Henry Waxman, D-Calif., when he was chairman of the Oversight and Government Reform Committee and getting an inside look at how politics affected Health and Human Services (HHS) initiatives. But Kellerman, who was also a 1983-1985 RWJF Clinical Scholar, really put his fellowship skills to work after taking on a new job in Atlanta.
"I was part of a group of people who worked to keep Atlanta's Grady Health System—one of the largest public hospitals in the country—from closing in a very tough political year," Kellerman said. "It meant working with community leaders, state legislators, county commissioners, student groups and others. My policy experience was invaluable and my time in D.C. gave me additional clout that helped people listen to me so that I could get things done."
Educating Others about Health
"Often people on the academic side of medicine and science think that working with policy-makers is not the best use of their time," said Lisa Kaplowitz, MD, MSHA, a 1996-1997 Health Policy Fellow, who discussed the science/policy link. "But it's our responsibility to work with policy-makers, including politicians, on medicine and science-based issues. In my experience," noted Kaplowitz, who is now director of the office of policy and planning at the HHS Office of the Assistant Secretary for Preparedness and Response, "people in government want to do the right thing, but it's sometimes difficult for them to understand and support complex health issues, especially in this era of limited economic resources. We need clinicians, scientists and public health experts to get involved."
"I never dreamed I'd be doing this. I was happy as a physician treating HIV/AIDS patients, but once I was exposed to health policy through the fellowship, I saw how much I would be able to accomplish working at this level," she added.
Kaplowitz's point about the need to redefine the public conversation about health was also shared by 1996-1997 RWJF Health Policy Fellow and former APHA president Linda Degutis, DrPH, who also spoke at the session. After moving from academic medicine to the Centers for Disease Control and Prevention, Degutis said, "I'm now able to help people have a broader view of health. When people talk about prevention as, say, mammograms, I say 'no, think about seat belts.' I get people to consider not just policies focused on health, but all policies that may in some way affect health."
"This is particularly important in getting people to understand the true public health burden of injury," explained Degutis, who is now director of the National Center for Injury Prevention and Control, a career move she attributes, in part, to her participation in the RWJF Health Policy Fellows program. "Injuries are the leading cause of death for people ages 1 to 44, yet the topic does not get the same attention as health problems. We need to educate people on the impact of violence and accident-related injuries in terms of years of life lost and disability. This is an area where we have the success of child safety seats and other initiatives, so we know that policy works."
Advancing the Policy Process
But understanding just how policy works is one of the most surprising experiences for fellows, said Gregg Margolis, PhD, NREMT-P, who talked about going from clinician to policy wonk. "When I came to Washington, D.C. as a clinician and researcher, I was bewildered as to why politicians did not choose what seemed to be the obviously 'right' answers when it came to health care issues. The process seemed irrational to me as a scientist," he said.
"But during my fellowship term, I came to the conclusion that my view was overly simplistic. Politics is not an exact science and if you engage only as a scientist you will miss many parts of the decision-making process," explained Margolis, a 2009-2010 RWJF Health Policy Fellow who worked in the office of Sen. John D. Rockefeller D-, W.Va., during the health care reform debate.
"While in D. C., I met with many people like myself who would come armed with mountains of scientific evidence about a health problem, but they did not consider all the other factors that play a part in decision-making. I came away with tremendous respect for the political process," added Margolis, who is now director of the Division of Health Systems and Health Care Policy in the Office of the Assistant Secretary at HHS. "Completing the RWJF Health Policy fellowship teaches you a more nuanced approach. It gives you more arrows in the quiver to engage in the process. It also provided me with an opportunity to make an impact on public health in a way that is not generally open to people with my background."
But working with people from backgrounds as varied as Margolis and his Health Policy Fellow colleagues is exactly what the program is designed to do, noted Michnich. "We want people from all aspects of public health to see themselves taking on the adventure of working in health policy. If you want a year of living dangerously in a fast-moving environment, the Health Policy Fellows program is always looking for adaptive leaders who want to seek out new opportunities and run with them."
The Robert Wood Johnson Foundation Health Policy Fellows program provides the nation's most comprehensive fellowship experience at the nexus of health science, policy and politics in Washington, D.C. It is an outstanding opportunity for exceptional midcareer health professionals and behavioral and social scientists with an interest in health and health care policy. Fellows participate in the policy process at the federal level and use that leadership experience to improve health, health care, and health policy.