As busy family physicians, we see day in and day out how public policy issues in our community affect our patients and their health. Doctors have been at the forefront of passing laws that address issues as diverse as safe streets, food deserts, and sugary beverage taxes as well as raising the tobacco age, licensing direct primary care, and ensuring safe drinking water.
You probably have one issue in your community — and likely more than one — that you would like to address through advocacy and legislation. However, like many physicians, you may not know where to start or how to achieve health policy success with your busy schedule.
This article will use examples from my own advocacy efforts to demonstrate practical strategies to pass health policy legislation on the state and local levels. Even if you don’t personally agree with the politics of the examples, the principles behind them can help you achieve your health policy goals.
Physicians often see firsthand how public policy issues affect patients and their health.
In many communities, the voice of a local physician is highly valued and can help bring about needed policy changes.
Making connections with elected officials, understanding jurisdictions, finding allies, and mitigating opposition are keys to a successful strategy.
ENGAGE ELECTED OFFICIALS
Engaging elected officials can be intimidating. Our perception of politicians as celebrity figures, unapproachable, too busy for us, etc., stands in the way. Especially in smaller communities and in the context of locally elected officials like city council members, village trustees, county officials, and even state representatives and senators, the opposite is often true. Here are four steps you can take to engage them effectively.
Understand what motivates elected officials. It’s definitely not the salary that comes with your village councilman’s position (which is likely voluntary) or the love of weeknight meetings that can last well past midnight or the riveting discussion of zoning intricacies. The motivation for most locally elected officials is that they really do want to build a better community. As a physician, you are in a prime position to help them get back to why they went into politics in the first place. If your health policy goals help your elected officials achieve their goals, they’ll be ready and waiting to listen to your solutions and work with you.
Make a connection. Most of us have interests outside health care and are involved in various civic organizations, clubs, religious organizations, or activities for our kids that our elected officials might also be involved with. Make the most of these social connections.
Also, consider “friending” locally elected officials on social media. You can learn a lot about them from their page, including their interests and goals. Some officials are more likely to respond to you on a social media platform than to return your phone call to their office.
It may be worthwhile to join membership organizations in your community. You may have something in common with an elected official who is also part of that group. Going to political party meetings or fundraisers is another excellent way to connect with local officials.
Schedule a meeting. Once you connect with an elected official, leverage that into a meeting where you’ll talk about your policy ideas. A quick drink after work may be all it takes to get the ball rolling. For example, not long ago, I became interested in passing legislation in my community to increase bike helmet utilization and reduce serious injuries. I had previously met one of the elected trustees in my community at several local events and told him I wanted to touch base on some ideas to help make our community safer for kids. We set up a time to meet at a local pub and talked about what drew him to elected office and what his goals were. I brought up my work at the local high school to promote bike safety and my idea to introduce legislation. He almost fell out of his chair with excitement about doing something positive for public health in our community. In the next few weeks, he reached out to other trustees, who were quickly on board.
Serve on a commission, task force, or advisory board. Many local governmental bodies have commissions, task forces, or advisory groups where policy discussions originate and where the voice of a community physician would be highly valued. The community where you live may even have a Board of Health that needs volunteer members, especially physician members. Find a group that interests you, and get involved.
Yes, this will require an investment of your time, but meetings are generally just an hour or two long once a month. Most people are sympathetic to a volunteer physician’s busy schedule and will understand if you can’t make all the meetings. But if you’re serious about passing health care related legislation, 12 hours a year attending meetings and serving on committees can save you dozens of hours in legwork down the road.
A sometimes difficult step in the advocacy process is figuring out the best jurisdiction, or governing body, for passing legislation. Does it make sense to try at the state, county, or city level? A couple factors will weigh into this decision.
Know the politics of the jurisdiction. Passing a law on the state level likely will have the most impact, compared to a local law affecting a much smaller community. However, there may be greater partisan barriers or organized opposition to passing a state law, making the local route more appealing. For example, in my previous state of Illinois, state medical organizations had tried for years to pass a bike helmet law, but groups advocating for motorcycle users had a powerful lobby and successfully blocked a statewide bicycle helmet law for youth. At the local level, however, we were successful in getting legislation passed.
The lesson is if at first you don’t succeed, try a different jurisdiction, either a different level (state versus local) or a different city or county in your region, that may be more receptive to your cause. Also, save time and don’t reinvent the wheel when introducing legislation. When I took the bike helmet legislation from the state level to the local level, I kept the same language in the proposal.
Know what legislative authority your local jurisdiction has. Each state has different rules, usually written into the state’s constitution, on where laws can be made and what types of laws can be made. In a few states, enforceable laws are only made at the state level. In others, most counties, cities, and villages can pass laws and enforce them as long as they don’t contradict state law. Sometimes, even elected officials don’t know for sure who has jurisdiction, so if there’s any question, check with a lawyer early in the process.
ACTIVATE YOUR ALLIES
While a lone doctor working with an elected official can pass legislation, the process will be easier if you do so as part of a coalition.
Tap into the power of a coalition. Building a coalition can help in a number of ways. First, it gives your cause gravitas and momentum. Instead of a minor nuanced issue from a local doctor, the issue becomes a health policy concern driven by a known organization. Second, it gives you connections. Local organizations, especially those with legislative and advocacy arms, likely have well-established relationships with elected officials and can get you in the door for a meeting. Finally, these allies may be able to help push an issue to the front of the legislative agenda through their lobbying prowess.
Find the right allies. Some coalitions on health care issues are well established. Health care societies (such as your state chapter of the American Academy of Family Physicians) are an obvious place to start. Brainstorm other groups that are likely to support your cause as well. For example, on tobacco issues, your local respiratory and cancer groups, such as the local chapter of the American Cancer Society, would be logical partners. On issues related to senior care, the AARP may be a good ally.
When I became involved with passing legislation to allow expedited partner therapy, which permits clinicians to give extra medication or prescriptions to their patients with chlamydia or gonor-rhea so the patients’ partners can also be treated, it was an organization-driven campaign. I participated as a member of the Government Relations Committee of the Illinois Academy of Family Physicians, and we joined other organizations such as the AIDS Foundation of Chicago and Planned Parenthood. Because of our combined efforts — sending doctors to lobby legislators in our state capitol and using the influence of our partner organizations — we had the ear of supporting legislators, which was key when opposition arose.
But finding allies isn’t always that easy. When I became interested in legislation to ban conversion therapy for LGBTQ youth in Pima County, Ariz., I had no organizational support. It was simply an issue I was passionate about. To find allies, I first reached out to other physicians in my university health system, including those in adolescent medicine and psychiatry, and then I contacted the local community health center, whose physicians run transgender youth programs. I now had a group of doctors in support of the cause. Next, I reached out to the South Arizona AIDS Foundation (SAAF) and met with their legislative affairs staff who immediately jumped on board. They were able to set up a meeting with one of the Pima County supervisors who had worked with SAAF on similar issues, and suddenly my concern reached the top of the supervisor’s legislative agenda.
Think outside the box. You may need to get creative when looking for the right allies. For example, let’s say you want to address clean air and pollution in your community. Perhaps a major labor union that works on health policy issues has a local chapter in your community with connections to elected officials, or maybe a local church with a health justice interest has the ear of someone in office. These less obvious allies might turn out to be your most powerful ones.
Be an ally yourself. You will likely find that, as a physician, you’re a highly desirable ally for others who are trying to advance a health policy agenda. As you get more involved in your local community, and as others get to know you and your general passions, they will increasingly turn to you as a community physician to lend your voice to their issue. Often, most of the legwork will be done for you, and you can step in as a physician and make a positive community impact by joining a coalition, helping a community group, and being an advocate for others trying to advance a cause you support.
For example, several years ago, I was approached by some local community groups who were unsuccessfully fighting to limit the soot and particulate matter emitted from two coal power plants in Chicago. At the time, I was working for the Cook County Health & Hospitals System, whose physicians were unionized through the Doctors Council Service Employees International Union (SEIU). I had not heard of soot or particulate matter before being approached, but I did some research, got behind the cause, and became one of the physician leads on this issue. Soon, our union joined the coalition seeking to pass an emissions limit.
Our parent union, SEIU Illinois State Council (at the time the largest labor union in Illinois), backed our local efforts. When the lead alderman opposing the legislation faced a runoff election a few months later, he did not want to lose crucial union support and decided to support our legislation. A few weeks before the runoff election — and just a few months after I first learned of this issue — I stood next to the alderman at a press conference to announce our union’s endorsement of him and to thank him for his (new) support of the ordinance limiting soot and particulate matter.
MITIGATE THE OPPOSITION
You’re going to face opposition any time you enter the political sphere, but some legwork at the start of your effort can make a big difference in the time and energy you may need to expend to pass legislation down the road.
Identify potential opposition. Brainstorm the individuals and organizations who might oppose your issue and research their positions using your community contacts, asking those in the know, and learning from others who have advocated a similar issue. However, understand that planning and strategizing won’t always identify all potential sources of opposition that can stymie your efforts. Some may come from left field, and sometimes groups you thought would be your allies actually end up opposing your health policy goals.
Diminish the opposition. One way to lessen the opposition is to demonstrate how your legislation ties into a larger agenda that has wide support. For example, before taking the bike helmet legislation from the state level to the local level, I had worked with a bicycle advocacy group to provide bike safety and maintenance training and free helmets to high school students. Surprisingly, although the group advocated for education on the use of bike helmets and promoted their use, they opposed legislation that mandated their use.
To help mitigate the opposition, I put together a coalition of bicycle advocates in our community, including bike shop owners, community activists, school representatives, and elected officials. We developed an entire plan to advocate for bike use, from bike lanes and signs to storage of helmets in schools to social media campaigns. An ordinance requiring bike helmets for youth was simply one part of the larger agenda, for which we now had broad support from major players in the community.
Additionally, at the time, I was a member our local Board of Health. We unanimously passed a recommendation to the village board to require bike helmets for youth. With a formal recommendation from health care professionals and the support of a coalition of community members, the village trustees had the backing they needed to pass the bike helmet requirement.
Go around the opposition. Sometimes, it’s best to ignore the opposition and push the legislation forward, especially if you know you have the votes you need to pass the legislation. Other times, the only way forward is to go straight to your elected officials and do the hard work of convincing them that your position is best for the community.
For example, the main opposition to our expedited partner therapy legislation came from a source I had not anticipated — trial lawyers. A provision of the legislation indemnified doctors who provided prescriptions to their patients’ partners to treat chlamydia or gonorrhea, meaning these partners could not sue the doctor if there was a bad outcome. This was important because, in most cases, doctors’ malpractice insurance would not cover any lawsuit for medical care given to someone without an established medical relationship.
The Illinois Trial Lawyers Association got wind of the indemnification clause and came out in opposition to the legislation. With urban Democrats from the Chicago area being our main support for this legislation, and with trial lawyers as a group being one of the largest contributors to Democratic candidates and parties, our efforts stalled.
Success took a multiyear effort of meeting with state legislators one-on-one to advocate on this issue and coordinating with allies who had strong relationships with party leaders. Eventually, we convinced enough legislative leaders that this legislation was important, and they convinced the trial lawyers to back down.
YES, YOU CAN PASS HEALTH POLICY LEGISLATION
Passing legislation may seem daunting, but don’t get intimidated. It may take years working on an issue before you finally make the inroads you need to pass it, and you may need to convince entrenched politicians to support your cause, but you can do it.
With the right strategy in place, you can make a big impact by adding your voice and perspective as a physician and bringing about needed change in your community.