Ned_Baker-2005 by zhangyun

VIEWS: 4 PAGES: 42

									      Working with
 Local Elected Officials
to Improve Public Health
Vaughn Mamlin Upshaw, DrPH, EdD
      School 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
Government
Context
           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                           6. Pollutant control
   spending                            7. Criminal justice
2. Clean government                    8. Gay rights
3. Health insurance                    9. Emerging
   coverage                               technologies
4. School finance                      10.Immigration
5. Prescription drugs
   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         ●Efficiency      ●Equality         ●Knowledge
●Independence        ●Patriotism      ●Respect          ●Truthfulness
●Advancement         ●Work            ●Friendships      ●Communication
●Security            ●Courage         ●Religion         ●Leadership
●Affection           ●Creativity      ●Growth           ●Unity
●Integrity           ●Decisiveness    ●Reputation       ●Community
●Intelligence        ●Nature          ●Family           ●Competence
●Time                ●Democracy       ●Social Equity    ●Wisdom
●Prosperity          ●Openness        ●Health           ●Competition
●Change              ●Honesty         ●Responsibility   ●Loyalty
●Tranquility         ●Economic        ●Accountability   ●Cooperation
●Tolerance              security      ●Serenity         ●Power
●Purity              ●Effectiveness   ●Relationship     ●Privacy
●Quality of life     ●Peace           ●Ethics           ●Representation
●Individual Rights   ●Liberty                           ●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       ●Efficiency      ●Equality         ●Knowledge
●Independence      ●Patriotism      ●Respect          ●Truthfulness
●Advancement       ●Work            ●Friendships      ●Communication
●Security          ●Courage         ●Religion         ●Leadership
●Affection         ●Creativity      ●Growth           ●Unity
●Integrity         ●Decisiveness    ●Reputation       ●Community
●Intelligence      ●Nature          ●Family           ●Competence
●Time              ●Democracy       ●Social Equity    ●Wisdom
●Prosperity        ●Openness        ●Health           ●Competition
●Change            ●Honesty         ●Responsibility   ●Loyalty
●Tranquility       ●Economic        ●Accountability   ●Cooperation
●Tolerance            security      ●Serenity         ●Power
●Purity            ●Effectiveness   ●Relationship     ●Privacy
●Quality of life   ●Peace           ●Ethics           ●Representation
●Individual        ●Liberty                           ●Fairness
   Rights
Influence of Political Values

 High
                                             Citizen
                                             Representation

  Government
  Efficiency                                 Social Equity


                                             Individual Rights
 Low
    Source: John Nalbandian, NLC Presentation, October 2003, Charlotte, NC
                     Public Values…
●Achievement         ●Efficiency      ●Equality         ●Knowledge
●Independence        ●Patriotism      ●Respect          ●Truthfulness
●Advancement         ●Work            ●Friendships      ●Communication
●Security            ●Courage         ●Religion         ●Leadership
●Affection           ●Creativity      ●Growth           ●Unity
●Integrity           ●Decisiveness    ●Reputation       ●Community
●Intelligence        ●Nature          ●Family           ●Competence
●Time                ●Democracy       ●Social Equity    ●Wisdom
●Prosperity          ●Openness        ●Health           ●Competition
●Change              ●Honesty         ●Responsibility   ●Loyalty
●Tranquility         ●Economic        ●Accountability   ●Cooperation
●Tolerance              security      ●Serenity         ●Power
●Purity              ●Effectiveness   ●Relationship     ●Privacy
●Quality of life     ●Peace           ●Ethics           ●Representation
●Individual Rights   ●Liberty                           ●Fairness
        Value Compass

             Liberty/
             Individual Rights


Community/                       Prosperity/
Security                         Efficiency



                Equality/
                Equity
  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 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
    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   • Public health can contribute to
  complex and changing                successful change
                                      management
• Local government is under         • Even modest investments in
  pressure to do more with less       public health can lead to better
                                      quality of life
• Local responsibility for public   • Public health is experienced in
  health is often diffuse             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

								
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