Working with Local Elected Officials

to Improve Public Health

Vaughn Mamlin Upshaw, DrPH, EdDSchool of Government

Chapel Hill, NC

Presentation Objectives

1. Describe the context for local government

2. Provide an overview of the dynamics in local government

3. Suggest strategies for working more effectively with local elected officials to improve public health

Local GovernmentContext

Forces of Change

• Financing systems• Shifting boundaries• Lack of trust• Information

technology• Changing workforce• Political changes• Demographic

changes

Demographic Changes

• Population change

• Aging population

• Racial variations

• Poverty

Population Changes

http://www.censusscope.org/us/map_popchange_90-00.html

Aging Population

http://www.censusscope.org/us/map_65plus.html

Racial Variation

http://www.censusscope.org/us/map_common_race.html

Poverty

http://www.censusscope.org/us/map_poverty.html

2005 County Legislative Priorities

1. Taxes and spending

2. Clean government

3. Health insurance coverage

4. School finance

5. Prescription drugs

6. Pollutant control

7. Criminal justice

8. Gay rights

9. Emerging technologies

10.Immigration

Source: Davenport, Melissa. Governing Magazine, January 2005, p. 30-31

America’s Top Health Concerns• Cancer 25%

• Obesity 21%

• Heart Disease 17%

• Diabetes 15%

• Lack of necessary

vaccines 7%

• Alzheimer’s 5%

• Anthrax/BT 4%

• Don’t Know/No Response 10%http://healthyamericans.org/reports/poll0104/

Emerging Public Health Threats

• Children’s health (asthma, cancer, lead poisoning…)

• Heat stress• Infectious disease• Risk of Illnesses from

Contaminated Food and water

• Respiratory Health

http://www.ncdc.noaa.gov/oa/climate/research/cag3/cag3.html

Context Recap

• Changing systems, workforce and technology

• Changing demographics

• Public health continues to be a priority for local government

Dynamics of Local Government

Local Government Pressures

• You’re on your own• Networks and

partnerships• Building community trust• Dealing with equity • Increasing standards• Recruitment and retention• Leadership development

Changing Local Roles

• Professional politicians

• Blurring boundaries• Changing elections• Mayoral veto• Sharing authority• Conflicting roles• Demand for

participation

Public Participation

• Lack knowledge• Declining voter turnout• Low trust• Oppose not propose• Elected officials think as

“outsiders”• Lack of conflict resolution

Value Conflicts

• Building consensus and working with communities means dealing with value conflicts

Why focus on Values?

• Even with all the facts, some problems have “no right answer.”

• Examples– New Industrial

Development – Waste Disposal– School Uniforms– Needle Exchange

What Do You Value?

●Achievement●Independence●Advancement ●Security ●Affection ●Integrity ●Intelligence ●Time ●Prosperity●Change ●Tranquility ●Tolerance●Purity●Quality of life ●Individual Rights

●Efficiency●Patriotism ●Work●Courage ●Creativity ●Decisiveness ●Nature ●Democracy ●Openness ●Honesty ●Economic

security ●Effectiveness ●Peace●Liberty

●Equality●Respect ●Friendships ●Religion ●Growth ●Reputation ●Family ●Social Equity●Health ●Responsibility ●Accountability ●Serenity ●Relationship●Ethics

●Knowledge ●Truthfulness ●Communication ●Leadership ●Unity ●Community ●Competence ●Wisdom ●Competition ●Loyalty ●Cooperation●Power ●Privacy ●Representation●Fairness

Values and Decision Making

• How do your values influence your decisions on the following issues?– New Development – Solid Waste Disposal– School Uniforms– Needle Exchange

Political Values

●Achievement●Independence●Advancement ●Security ●Affection ●Integrity ●Intelligence ●Time ●Prosperity●Change ●Tranquility ●Tolerance●Purity●Quality of life ●Individual

Rights

●Efficiency●Patriotism ●Work●Courage ●Creativity ●Decisiveness ●Nature ●Democracy ●Openness ●Honesty ●Economic

security ●Effectiveness ●Peace●Liberty

●Equality●Respect ●Friendships ●Religion ●Growth ●Reputation ●Family ●Social Equity●Health ●Responsibility ●Accountability ●Serenity ●Relationship●Ethics

●Knowledge ●Truthfulness ●Communication ●Leadership ●Unity ●Community ●Competence ●Wisdom ●Competition ●Loyalty ●Cooperation●Power ●Privacy ●Representation●Fairness

Influence of Political Values

Individual Rights

Social EquityGovernmentEfficiency

CitizenRepresentation

High

LowSource: John Nalbandian, NLC Presentation, October 2003, Charlotte, NC

Public Values…

●Achievement●Independence●Advancement ●Security ●Affection ●Integrity ●Intelligence ●Time ●Prosperity●Change ●Tranquility ●Tolerance●Purity●Quality of life ●Individual Rights

●Efficiency●Patriotism ●Work●Courage ●Creativity ●Decisiveness ●Nature ●Democracy ●Openness ●Honesty ●Economic

security ●Effectiveness ●Peace●Liberty

●Equality●Respect ●Friendships ●Religion ●Growth ●Reputation ●Family ●Social Equity●Health ●Responsibility ●Accountability ●Serenity ●Relationship●Ethics

●Knowledge ●Truthfulness ●Communication ●Leadership ●Unity ●Community ●Competence ●Wisdom ●Competition ●Loyalty ●Cooperation●Power ●Privacy ●Representation●Fairness

Value Compass

Liberty/Individual Rights

Equality/Equity

Community/Security

Prosperity/Efficiency

Issues for Local Governments

• Knowledge gap between professionals and politicians

• Decentralized services• Specialized staff• Redefining relationships• Connecting citizens to

local government

Understanding Elected Officials

• Realities for elected boards– No hierarchy– Public meetings– Vague tasks and

goals– Little feedback– Limited training

Recap Dynamics

• New pressures on what local government does

• Changes in how local government is structured

• Growing demands for public participation

• Value conflicts in public decision-making

• Realities for elected officials

Strategies for Working with

Elected Officials to Improve

Public Health

Federalism and Public Health

• Federal role in public health• Public health at the local level• National public health objectives• Performance measurement• Spending assessments• Structure and infrastructure needs

Source: Turnock, B. & Atchison, C. (2002, Nov/Dec) Governmental public health in the United States: The implications of federalism. Health Affairs, 21 (6), p. 68.

Local Structure of Public Health

• City• County• Region• State• Council-Mayor• Council-Manager

Who Is In Charge?

• Who has responsibility for public health at the local level?– Funding– Oversight– Hiring and firing authority

• Who has an interest in public health at the local level?– Who benefits?– Who is harmed?

Elevate Public Health in the Community• Get your message out• Educate the public• Work with local media• Involve citizens in future

planning• Involve citizens in health

improvement• Support neighborhood

initiatives• Improve access to local public

health • Use technology to engage

others

Link Public Health To Other Programs

• Schools• Recreation• Social services• Mental health• Emergency response• Hospitals• Health care providers• Business

Understand that Local ElectedOfficials Support Public Health

• NACO 2005 Health Platform Supports:– Public health infrastructure – Preparedness– Chronic Disease Prevention– Infectious disease Control– Environmental health– Injury prevention– Clinical preventive services

and health education

Working with Elected Officials

• Exchange programs• Team building• Problem solving and

decision making sessions• Share stories not just data• Provide evidence • Know what matters to

Elected Officials• Include elected officials on

public health boards

Improving Relationships

• Increase dialogue• Set clear measurable

goals• Develop shared desire for

good relationships• Respect other’s opinions• Value democracy• Trust in public servants• Exercise civility

Strategic Choices• Know what you are trying

to achieve• Know what political actors

are trying to achieve• Build leadership capacity• Think strategically• Develop partnerships• Embrace diversity as a

strength• Use technology to drive

innovations

Recap Strategies

• Recognize influence of federal system

• Understand who controls what

• Create a public health constituency

• Link public health to quality of life

• Relate local public health issues to local officials interests, goals

• Get local officials engaged in public health

Challenges Opportunities

• Context for local government is complex and changing

• Local government is under pressure to do more with less

• Local responsibility for public health is often diffuse

• Public health can contribute to successful change management

• Even modest investments in public health can lead to better quality of life

• Public health is experienced in working with others to get things accomplished

Conclusion• Local government

challenges are complex

• Local governments are working to adapt

• Values matter

• Public health issues are local government priorities

• Boards of Health can help demonstrate how public health contributes to quality of life