Week Three Coalition Testimony Individual Presentation 8-12 SLIDES

Slide 1

Chapter 5 will look at the Social Determinants of Health (aka SDOH) and the interactions between the policy systems and environment and its impact on the SDOH.

Slide 2

The SOCIAL DETERMINANTS OF HEALTH include education, income and employment, housing, the built environment and social cohesion. They help to shape the contexts in which individuals live their lives and have significant health consequences. Policies that affect social and economic determinants of health are ultimate prevention policies as they get to the “fundamental causes” of health or lack of health.

Slide 3

Upstream factors, (the non-medical social and economic factors, such as social inequities of race and gender) have a great deal of influence on health status. As you will see in this week’s video resource, Unnatural Causes, these upstream factors have influenced rather intractable health outcomes, such maternal and infant death rates being higher among African American women, despite their income or education.

Addressing the upstream and midstream factors is gaining interest, but policymakers and individual consumers continue to invest most of their attention and resources to pay and deliver health care

The paradox is that as a Nation, we spend more money on healthcare, but have worse health outcomes than most developed nations.

Slide 4

This is Frieden’s Health Impact Pyramid, a model of the relationship between societal impact and types of interventions. At the top of the pyramid, you see healthcare delivery, 1:1 care, impacts primarily the individual only. Near the bottom are policies that make the ideal options for health the easiest… And at the base of the pyramid are addressing the SDOH, where the largest impact on population health will be a result of providing equal access to fundamental resources

Policies that consider not only the delivery of health care services, but also social services, education, employment, and the built environment are the most promising for preventing illness, injury, and premature death.

Slide 5

Social and economic policy interventions will likely improve the well-being of children, youth, and families. For example, socioeconomic disadvantages start in Early Childhood

In comparison to households with twice the poverty line, children who live in poverty are more likely to report poor health and are about 50% more likely to be overweight in adulthood! Early childhood care and education policies to increase accessibility for low-income families, such as Head Start and child care subsidies, have the potential to improve the health of low and middle- income families.

Slide 6

Education policies that help prevent school dropout and support higher educational attainment can also function as preventive health interventions. Increase in years of education results in living longer and healthier lives. A 1% increase in of Americans with some college education could save $1.3 billion per year in avoidable medical care for diabetes.

Policies can include school-based health programs, such as school- based health clinics and mental health programs, which can not only improve health outcomes, but help keep youth in schools longer. School-based health clinics/centers (SBHCs) have been shown to Improve access to services students might otherwise find challenging.

Slide 7

Policies to support wealth building can act to prevent social and economic disparities, and thereby health disparities. Some states have automatic Child Development Accounts (CDAs) - savings or investment accounts opened at birth. The goal is to that children have the resources to reach milestones such as postsecondary education or starting a business. In a longitudinal study, CDAs led to better social and emotional development for the most socially disadvantaged young children who received a $1,000 CDA at birth. Economic development can have the same impact as a typical health intervention

Slide 8

Living in a neighborhood with a low socioeconomic status (SES) is associated with increased risk of mortality compared with living in a neighborhood with a higher SES. Community development policies that promote better housing options have been shown to enhance safety and reduce the likelihood of being exposed to crime. The Affordable Care Act (ACA) established National Prevention Council which issued the National Prevention Strategy, with a Focus on housing quality and cross-sector collaboration in community development planning to improve health. This is promising trend towards the consideration of Health in All policies. This is a strategy that recognizes the role of SDOH, and encourages decision makers in all sectors to consider the impact on health that a given policy may have. In fact, a type of policy analysis, a Health Impact Assessment, is now regularly conducted in some sectors (such as transportation and land use planning) to assess the health impact and possible unintended consequences of policies that are not specific to health.

Slide 9

On pages 98-103, the Education and Health initiative is covered; its goal is to build support for strong educational initiatives as a way to improve health outcomes, and to bridge the research and the policy maker. Their main message is that supporting education can reduce disease rates and help control rising health care costs.

Slide 10

The EHI created Multiple products, such as issue briefs, videos, and web content aimed at specific audiences to disseminate Scientific findings of the relationship between education and health Watch these videos for research findings about the link between education and health.

Slide 11

EHI used a Strategic Communication, adopting a Multifaceted communications strategy. Short videos and graphics to raise awareness of the education–health connection, issue briefs and web-based content, and Presentations at academic conferences. Media Advocacy resulted in Media coverage for the briefs included articles in National Public Radio affiliates, Coverage in the newsletters or mailing lists of organizations such as the National Governors Association, the U.S. Senate Committee on Health, Education, Labor, and Pensions, and the American Public Health Association. Social media was employed, and Twitter content was shared by a number of influential voices in the spheres of public health and education- One phases resulted in 3.3 million impressions. This campaign provides a good look at the topics in Chapter 16, communicating research to policy makers, as well as Media Advocacy which we will cover in the last section of the lecture.

Slide 12

Chapter 8 covers Policy related to physical activity. The importance of physical activity for disease prevention and health promotion is well established. Known health benefits include prevention of cardiovascular disease, Improvements in functional health and mental health, and Reduction in premature deaths

Slide 13

2008 Physical Activity Guidelines for Americans established guidelines for the amount of physical activity

Adults should participate weekly in at least 150 minutes of moderate intensity activity, 75 minutes of vigorous intensity activity, or a combination. Children should participate in 60 minutes or more of moderate to vigorous physical activity each day. However, only 36.5% of children and 41.1% of adults met these guidelines in 2009–2010 and rates have shown little improvement over the last decade

Surveillance data also demonstrates that physical activity prevalence varies by population subgroup: For example, Female, older, Hispanic, g lower levels of education, and higher (BMI) are shown to be associated with being less physically active.

Prevalence of physical inactivity is also of concern and varies by state. In 33 states, almost one quarter of the population reported not engaging in any leisure-time physical activity. The prevalence of inactivity and increasingly sedentary behaviors will result in increases in adverse health effects

Technology coupled with reduced physical activity in occupational work, home/domestic work, and travel have all contributed to an increasingly sedentary population. The 2018 Physical Activity Guidelines Advisory Committee submitted its Scientific Report to the Secretary of Health and Human Services in February 2018. The report summarizes the scientific evidence on physical activity and health and will be used by the government to develop the second edition of the Physical Activity Guidelines for Americans.

Slide 14

Policy and environmental changes provide opportunities, support and cues to help individuals become more active have 3 main policy and environmental strategies: Creating or enhancing safe places for physical activity, Enhancing physical education and physical activity in schools and Supporting street and community-scale designs that facilitate physical activity.

Policies can be particularly relevant in reducing barriers that often inhibit physical activity, such as

Automobile-oriented transportation systems, Lack of physical education in schools, and a Lack of or poorly maintained parks and public spaces

Slide 15

A policy approach to increasing population physical activity requires collaboration and interaction among a wide variety of stakeholders and policymakers. Cooperation and creating a shared vision of varied goals and objectives across stakeholders is key to successful policy initiatives to promote population physical activity. For example, Increasing the number of children who walk or bicycle to school will inevitably increase the time students spend being physically active. Key stakeholders reported a variety of reasons for supporting the policies. Public safety officials cared about Traffic abatement around the school (; School administration favored the Reduced bus costs, and teachers cared about Better student attention and focus for lessons.

A great example of multisectoral collaboration and coordination is found in the National Physical Activity Plan. See the link for more information about the alliance, its goals, membership and activities.

Slide 16

This table shows examples of policy strategies related to physical activity. In the right hand column, typical policy instruments, LS means legislative policy instruments, RA means regulatory or administrative law, and B refers to Ballot initiatives. These are just a few of the many physical activity policies that can be applied to this problem. They can be viewed on page 167 of your text.

Slide 17

Advocacy for physical activity policies is important as many stakeholders don’t yet see this as a behavior influenced by a wide range of policies and environments. The first step in increasing awareness:

Communicating with key decision-makers regarding the importance of a physically active population to the health, well-being, and economic welfare is imperative. Advocates need to provide evidence-based and easy to understand arguments to increase awareness.

Policies promoting physical activity can impact other aspects of the community, and may have unintended consequences. Requiring sidewalks and bike lanes on streets may encourage active transportation, but these policies also may affect automobile travel. Modifications in roads, such as “traffic calming” measures can cause controversy within transportation planning as well as the community

Slide 18

Several national and international agencies serve as advocates for policies that promote physical activity at the international, federal, state, and local level. This excerpt from Table 8.2 lists some

Slide 19

Class will break into three groups to discuss three case studies from chapter 8. Review one and think in depth about the policy types, stakeholders, opposition, etc. Identify at least one takeaway that you could share about this case study.

Slide 20

Why Chapter 16: Communicating Research to Help Influence Policy and Practice?

Public policies (laws or regulations) have a major role in improving population health across a wide range of issues and topics, but for evidence-based scientific information to have an impact on policy decisions, it must be communicated effectively in a policy making environment. It is difficult to communicate science to policymakers to persuade them to approve and implement a public policy. Few policymakers are trained in or familiar with scientific approaches. The Public health professional may be the expert source of information for them.

Slide 21

Box 16.1 identifies recommendations for communicating with policy makers. Policy makers are also known as elected officials, whether they are Congressional Representatives or City council members, State Senators, or School board trustees. We will go into more depth to explore the policy making environment and communication planning

Slide 22

First, the Policymaking environment: Learn about the Formal policymaking process in the jurisdiction of interest. Elected policymakers operate as part of a system with formal rules for legislative or regulatory policymaking, funding decisions, and implementation. These are often different depending on the city or county or the state level (Remember in week one, we discussed levels of government) and there are also different processes at the same level. For example, one city may follow a certain process, but another city has a different process. Advocates need to learn as much as possible about rules within specific jurisdictions in which you are where one is seeking adoption of a new policy. They may have a certain time period allowed and a procedure to follow, when a new bill or regulation may be introduced, or how committee hearings with witnesses are held for a specific state legislature or city council.

Slide 23

This is true for any level of legislator and any jurisdiction: When communicating with a policymaker in writing or in person about legislation or regulation, it is ALWAYS best to select an individual who resides within the policymaker’s jurisdiction. A policymaker may be unlikely to consider, and may not accept, testimony from someone who does not live within their jurisdiction. A resident has “standing.” This refers to the reason why this testimony should be heard; a person may be sufficiently affected by the matter at hand. Subject experts have credibility, and can also testify, but a resident of the jurisdiction is always best. If you want to adopt a new smoking ordinance in San Francisco, then find people residing or working in that city to speak to the city council.

Slide 24

Understand your policymaker’s characteristics and interests. It is critical to Know your audience!!

Make every effort to learn about the characteristics and preferences of a specific policymaker(s) of interest. This can help you overcome objections, help you encourage them to become a champion for the policy, and build support. What characteristics can you think of that we may want to learn about the policymaker?

Slide 25

Internet searches will likely be the best way to find detailed information about individual policymakers.

Learn about their opinions and beliefs through voting records, sponsored or proposed legislative bills, News media stories, and their social media. Most national and state elected policymakers are likely to have dedicated web- sites, Facebook pages, blogs, or Twitter accounts. Learn about their Political party affiliation and donors.

Assess their personal involvement, personal relevance or level of interest for a specific topic or issue. Do they have a personal connection to the health issue of concern?

Slide 26

Relationships with policy makers and their staff is important. Policymakers often very busy, and often don’t have time to review all the details of a bill or issue. They rely on aides or assistants, who act as gatekeepers, deciding who has direct access to policymakers & the information to which they are exposed. Advocates should Build relationships with both the policy maker and their staff via in-person meetings & regular communication. Identify and use their preferred communication channels. Building trust is key. Follow through on promises in a timely manner and don’t forget to thank them.

Slide 27

Provide an information subsidy to the policy maker. This means that you provide information that is readily useable and easy to understand. They may not be experienced or knowledgeable in the issue, and public health professionals can provide a clear, concise and compelling reasons to support the policy. Another recommendation is to Know your Role: As an advocate on your own behalf, as a citizen, you have leeway about what you say and how you do it. However, when you are speaking on behalf of an organization, Know your area of expertise and don’t speak outside of it. You also must Portray your organization’s party line, even if it is not your personal opinion.

Slide 28

Seeking Media attention is another guide for communication with policy makers. They pay close attention to news media stories, especially those they consider relevant to their constituents. Its important to gain supportive media coverage for a policy issue to get the attention of policymakers.

Media advocacy is Communication via mass media intended to influence a policymaker or a vote. In one of this week’s readings, “Public Health and Media Advocacy,” authors Dorfman and Krasnow review many aspects of media advocacy. Media advocacy is a communication that targets policy makers and those who can be mobilized to influence them through the media.

Slide 29

Media advocacy targets the policy decision maker—sometimes a single person or a few committee members. According to Dorfman and Krasnow, the news media largely sets the agenda- what issues we think about, how we think about them, and what kinds of alternatives are considered viable options.

Framing and the default frame are important concepts in media advocacy. Framing is about how people take meaning from content; when they get new information, they integrate it with their pre-formed ideas about how the world works, why there is a problem, and who should fix it. We call that the default frame and it, like a worldview, sets the way a person sees a problem and its solution. Media advocacy is about using these frames to change the way people think about problems and solutions. One of those framing tools is media bites- concise statements that are used to increase the chance that their most important points are repeated. They can be a straightforward statement about the problem, an analogy that brings a picture to mind, a statement that evokes strong, shared values, such as “can-do spirit,” or they are statements that makes the magnitude of a problem more visible. For example, “the number of people dying from tobacco-related diseases is equivalent to two jumbo jets crashing every day.” This is also an example of social math, where larger numbers are broken down by time, or place, or compared to something familiar or ironic. “The average American consumes 45 gallons of sugary drinks a year. That’s 29 pounds of sugar—as much as a 5-year-old child weighs!”

Slide 30

Other recommendations fall under the concept of communications planning. Communication planning consists of devising the strategy, and creating messages, for policymakers. They help to Persuade policymakers to approve a new public health policy that is evidence-based and highly likely to be effective

An active strategy will be used to engage policy makers and gain their attention; do not use solely a fact sheet on a website. Communication efforts with policymakers will be coordinated with supporting organizations & other allies. Show a united front among supporters

Slide 31

At the core of this planning is the storyline, also known as the meta message. This is the major conclusion one is trying to convey to policymakers. Public health policy storylines are usually straight- forward because they are the policies themselves. For example, “All children must be vaccinated against MMR before entering elementary school” or “Manufacturers must install Safety Device B in motor vehicles within 3 years.”

Slide 32

Selecting the Messenger or Source: Ask yourself: To whom will they listen? The messenger, either an individual or organization is critical to how well the message will be received. As previously discussed, it is best if it is from within the policymaker’s jurisdiction. The messengers Credibility, whether they are perceived to be fair, unbiased, and capable of providing accurate, relevant information about the issue. While a science background sounds great, sometimes the most effective messenger is a young adult, or youth, a business owner or community leader who can speak from personal experience.

Slide 33

General considerations when developing the key messages are convincing them that there is a public health problem, the new public health policy will solve or alleviate the problem, the “price” to solve the problem is worth it, it helps constituents, makes the policy maker look good (to voters or media?)

Generally, STATE Major conclusion first, then back it up with key messages that provide the rationale used to support the storyline (meta message, i.e., the public policy)

Slide 34

Incorporating data into policy briefs or testimony can define a particular public health problem and demonstrate the magnitude of the problem, such as the number of people impacted and the expected positive impact of the new policy.

A common and effective strategy is to use public health surveillance data (the more local the data, the better). Highlight the magnitude of a specific health problem, followed by findings to demonstrate the cause(s) of the problem or the projected impact of the policy (the solution)

Reduce complex data into understandable information. Use Metaphors such as in Los Angeles, there are more tanning salons than schools, supermarkets, and gas stations combined. Another way is to use Narratives, such as personal testimony to support your meta message.

Slide 35

Another way to communicate data is to use visuals. Visuals are used to present data and demonstrate magnitude, highlight changes, or make comparisons to increase understanding and interpretation by the target audience. There is an entire field of science devoted to visualizing data. We will look at several common uses. Looking at this bar chart, you don’t need to know the exact numbers to see which age group is severely impacted.

Slide 36

This visual tool, the pie chart, can show the relative proportions. In this case, you can easily see that friends and relatives is the largest source for pain medications. Note that there is no “best way” to present data. It probably depends on your goals, the situation, the policy maker and the policymaking environment.

Slide 37

A line graph can show trends over time. Recall the tobacco consumption line graph that plotted historic events to demonstrate the policies that impacted tobacco consumption

Slide 38

Written materials are often helpful to allow a policymaker to understand the issues and policy options, highlight key points, timely information, resources for more in-depth information. Fact sheets, also known as one pagers, and policy briefs. Box 16.4 includes recommendations for developing fact sheets. Note that the previous recommendations about communicating data are included here.

Slide 39

In person is another way to deliver your message. It can occur in several ways

In a Legislative hearing, it may Involve one or more experts providing short testimonies to policymakers, followed by questions from legislators. Testimony is short (a few minutes), and it is sometimes prepared in advance and read to committee members. Data is presented via posters, PowerPoint or some other type of slide presentation software or is provided to the members of the hearing. Come well-prepared to communicate key messages, and responding appropriately to questions. This is the type of in person meeting your group is developing for part two of your group assignment.

Slide 40

Box 16.5 provides recommendations for in-person meetings. All are valuable to incorporate into your planning for the meeting. One that isn’t explicitly listed here is to maintain a calm demeanor, and not get defensive, even if your position is attacked by the policy maker or staff. This also applies to legislative hearings as well.

Slide 41

It is essential to anticipate opposition arguments and be prepared to counter them. Box 16.6 on page 318 in your text provide common arguments and strategies used by public health policy opponents. We often hear them, no matter the issue (tobacco control, sugar sweetened beverages, even funding for the NIH.) Severe economic consequences if the policy is enacted; infringement on personal liberty; challenging the science or the agency putting forward the policy; create doubt that the evidence is adequate, and minimize the need for a policy or redirect to a different issue. Advocates should be prepared to address these arguments as they attempt to move a policy forward.

Slide 42

Follow up is crucial. Send a thank you for their support regardless of the policy outcome. If information is requested of you, send within 24-48 hours.

When communicating with policymakers it is important to Have a good understanding of the policymaking environment and use Communication planning to create a strategy and develop key messages

Other challenges and barriers may arise that may derail progress, regardless of the great planning your team has done. Policy makers ignore and even dispute scientific facts. Votes (what constituents say) and money- to run their next campaign, are key influencers of a policy maker. You and your group may not have the time or resources necessary to prevail against a well-funded opposition. Sometimes they ask you for evidence that has not yet been made to answer how effective the policy will address the problem in my community, and what are the costs for this policy. Bad luck, circumstances beyond your control can often disrupts what might be a smooth policy process. However, the work you do can often set the stage for future policy change, so don’t give up on an issue if one of these roadblocks comes into your path.