1. Working with Local Elected Officials to Improve Public Health Vaughn Mamlin Upshaw, DrPH, EdD School of Government Chapel Hill, NC

2. 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

3. Local Government Context

4. Forces of Change Financing systems Shifting boundaries Lack of trust Information technology Changing workforce Political changes Demographic changes

5. Demographic Changes Population change Aging population Racial variations Poverty

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

7. Aging Population http://www.censusscope.org/us/map_65plus.html

8. Racial Variation http://www.censusscope.org/us/map_common_race.html

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

10. 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

11. 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/

12. 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

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

14. Context Recap Changing systems, workforce and technology Changing demographics Public health continues to be a priority for local government

15. Dynamics of Local Government

16. Local Government Pressures You’re on your own Networks and partnerships Building community trust Dealing with equity Increasing standards Recruitment and retention Leadership development

17. Changing Local Roles Professional politicians Blurring boundaries Changing elections Mayoral veto Sharing authority Conflicting roles Demand for participation

18. Public Participation Lack knowledge Declining voter turnout Low trust Oppose not propose Elected officials think as “outsiders” Lack of conflict resolution

19. Value Conflicts Building consensus and working with communities means dealing with value conflicts

20. 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

21. 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

22. Values and Decision Making How do your values influence your decisions on the following issues? –New Development –Solid Waste Disposal –School Uniforms –Needle Exchange

23. 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

24. Influence of Political Values Individual Rights Social Equity Government Efficiency Citizen Representation High Low Source: John Nalbandian, NLC Presentation, October 2003, Charlotte, NC

25. 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

26. Value Compass Liberty/ Individual Rights Equality/ Equity Community/ Security Prosperity/ Efficiency

27. Issues for Local Governments Knowledge gap between professionals and politicians Decentralized services Specialized staff Redefining relationships Connecting citizens to local government

28. Understanding Elected Officials Realities for elected boards –No hierarchy –Public meetings –Vague tasks and goals –Little feedback –Limited training

29. 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

30. Strategies for Working with Elected Officials to Improve Public Health

31. 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.

32. Local Structure of Public Health City County Region State Council-Mayor Council-Manager

33. 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?

34. 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

35. Link Public Health To Other Programs Schools Recreation Social services Mental health Emergency response Hospitals Health care providers Business

36. Understand that Local Elected Officials 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

37. 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

38. 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

39. 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

40. 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

41. 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

42. 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