Two recent commentaries about politics and health–one in Medical Care by Dr. Ranit Mishori, and one in The New York Times by Dr. Paul Krugman–made me think about how my pre-academia work experiences might be able to help me have the greatest impact with my research as a new public health faculty member. I decided to take my inner monologue external in hopes it could be beneficial to others, too.
I started my career as a legislative assistant on Capitol Hill. Immediately prior to starting my PhD, I worked in government relations (GR) for a university health system. I helped policymakers understand the system’s priorities, and I tried to help system executives understand what policymakers wanted and why. Granted, the latter was often inscrutable.
Political Determinants of Health
These past experiences tie into Dr. Mishori’s commentary. She wrote eloquently about the Political Determinants of Health (PDoH), identifying four general spheres of influence: judicial decisions, state laws, federal laws, and executive orders. Importantly, she reminded us that these spheres are comprised of real people making decisions that often have far-reaching impacts on people’s health.
These elected and appointed officials’ actions are only possible because voters put them in positions of power. Yet sometimes it seems that voters elect politicians who don’t seem to have their best interests in mind for economics, education and health care. Dr. Krugman similarly argues that “Red America” has largely inflicted its rural healthcare crisis on itself, as voters have elected policymakers unfriendly to pro-health policies. He writes about Tennessee, but his words hit home, as I reside in another non-Medicaid expansion state, Kansas.
There seems to be a disconnect between what most people probably want (i.e., better health for all people) and the election results that translate into legislators who make policy decisions (the PDoH).
As academics, we are uniquely positioned to understand how election results lead to PDoH, what those are, and why they matter. We also understand how we might go about improving PDoH. Is it appropriate, though, for us to go beyond collecting, analyzing and reporting evidence to advocating for change?
I’ve talked to researchers who say yes. Others firmly believe that publishing in journals is itself “speaking up”. They are not comfortable using their findings to bring about change any other way. As a brand-new (read: not tenured) faculty member, I am left feeling uncertain, not only about what is right and proper, but also about what my responsibility is to my department, school, university, and field more broadly. Are there things I should or should not say? What should I do or not do?
Collaborating with Government Relations Professionals
So, I think back to my past life in public policy. GR professionals, in my opinion, are hungry for health services and other public health research. Really. They may just not know how to ask for it.
Let’s back up further: they may not even know you exist.
Recently, I had conversations with two former co-workers (both in the health care industry) and I mused whether “research” meant same thing to me that it does to other people. As I talked about how I was trained to do research, their eyes began to glaze over. They shook their heads.
No, they agreed, that’s not what they think of when someone says “research”. We discussed that most people, including many who work in health care delivery, probably think research means a person in a lab coat running experiments and writing down numbers. That can be part of it, sure, but the complexity of the whole process and the caveats that come with many of our findings are often lost on the everyday person.
GR professionals work for employers and health care organizations that, in large part, want what we want: better health for everyone. In my experience, the majority of policymakers also really do want a bright future for us all, and those who have (or seem to have) ill intentions are, in fact, few and far between. They just get a lot of press, making them appear more numerous.
During my time in GR, I worked extensively with our state hospital association. GR professionals played a significant role in the association’s pro-Medicaid expansion campaign by gathering first-hand experiences from their healthcare organizations about the effects of not having Medicaid expansion. (Importantly, the affected patients and providers were constituents of the state representatives and senators we were trying to persuade.) The association and other collaborators included those on-the-ground experiences with additional evidence from health services research. While our state still has not expanded Medicaid, public opinion polls indicate that more than 70% of Kansans favor expansion. The pro-expansion message has reached voters, and GR professionals undoubtedly have been part of that success.
If you want to learn more about what government relations professional do in our field, the Association of American Medical Colleges runs a Government Relations Representatives group. You can also read about the American Hospital Association’s Advocacy Agenda. Your work may or may not align with these groups, but these pages can give you a sense of what our GR colleagues at academic medical centers, hospitals, and health systems do.
A Call to Action: Find Your Government Relations Colleagues
Seek out the GR professionals at your institution. Help them understand why your work is valuable, how it is nuanced, and how you might be a resource. Ask them what they need that you might be able to provide. Pro tip: GR professionals love to be able to show policymakers how good policy helps their constituents. Bonus: GR professionals are often engaged in community relations too, or work closely with others in that field.
By educating your new friends about what evidence you can provide (and why research findings are not always as clear-cut as we’d all like), you help orient policy conversations around facts. Then, through their community relations work, you also reach voters. With the perspective of an eager, not-yet-jaded, new faculty member, I say that we are capable of retaining our credibility as objective experts and being advocates.
Collaborations with government relations professionals can help give us the best of both worlds.
From the Editors: Readers of this blog who are members of the American Public Health Association (APHA) might be interested to know that there is a government relations group that plays a big role for the organization. Not only do they keep members updated on activities in Congress, but they offer tips and strategies for advocacy work, and even an internship in GR.
Dorothy Hughes