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
Forces of Change
• Financing systems• Shifting boundaries• Lack of trust• Information
technology• Changing workforce• Political changes• Demographic
changes
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
Context Recap
• Changing systems, workforce and technology
• Changing demographics
• Public health continues to be a priority for 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
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
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.
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