By Catherine D. Patterson, MPP
In states and cities across the nation last week, Americans voted “yes” for public health – passing ballot initiatives that have the potential to improve community health through housing, education, financial security, and other areas.
As I was leaving my local polling place, a reporter from the Wall Street Journal stopped me to ask why I had voted in the mid-term election. When I told him I was interested in a number of the local ballot measures, his eyes glazed over. He clearly wanted to focus on my state’s gubernatorial election, and my answer wasn’t what he was looking for.
This interaction reminded me that many people (and the media) often overlook how important our local choices are. This year’s ballot initiatives show the power that local residents have in shaping the environments where they live, work, and play. Here’s a look at how some ballot initiatives fared.
At the state level, three conservative states voted to expand Medicaid. Voters in Idaho, Nebraska, and Utah approved ballot referendums to expand coverage to about 300,000 people. While insurance coverage doesn’t guarantee improved health, the resounding support for healthcare access in these states was notable.
Financial security has a clear tie to health and well-being, and citizens in Arkansas and Missouri voted to raise the minimum wage. In an advisory referendum, voters in Chicago showed their support for an increase in the minimum wage and voiced their approval for paid sick leave.
Californians approved two statewide measures that will fund affordable housing efforts. These will complement Measure C in San Francisco, which will tax local businesses to pay for housing for the city’s homeless. Affordable housing measures also passed in Austin, Baltimore, and Charlotte.
Baltimore voters passed a creative measure that aims at eliminating structural and institutional racism. The so-called “Equity Assistance Fund” will provide assistance to city residents who have experienced discrimination based on their race, gender, or economic status. Given the link between health and discrimination, it will be interesting to see how this policy is implemented and evaluated.
Dallas, Indianapolis, San Diego, and Seattle all passed initiatives to support education. Seattle’s measure provides funding for pre-K through community college, and will provide a certain number of local high school graduates free tuition to community college. Dallas’s successful education tax will, among other things, increase funding for early childhood education and expand the number of pre-K classrooms in the city.
In Denver another initiative focused on children received broad support. Voters in the Mile High City passed a ballot measure designed to provide fresh, healthy food to low-income children.
A number of cities passed measures that will fund improvement to their infrastructure. Austin, Tucson, and Charlotte all passed transportation bonds that will increase access to bike lanes and improve walkability in their municipalities. These policies are very similar to Complete Streets, which helps ensure safe streets for motorists, pedestrians, mass transit, and cyclists.
If you’re interested in learning more about some of these local measures, see Ballotpedia’s “Local Ballot Measure Elections in 2018,” and CityLab’s “On Ballot Measures, A Progressive Sweep.”
Catherine Patterson is Managing Director of Urban Health and Policy at the de Beaumont Foundation.
By Catherine D. Patterson, MPP
I love to vote. I remember going to vote with my mom as a kid. We’d wait in line, get her ballot, and then cram into one of those make-shift booths behind a flimsy curtain. I’d watch her fill in each oval, curious about the hushed tone that lay over the entire room (usually a school gym). Once finished, she’d let me hand her ballot to the local poll worker, and then I’d proudly stick out my chest for a coveted “I voted” sticker. I still get a ridiculous amount of satisfaction when I get one of those stickers.
At the de Beaumont Foundation, we believe that the community conditions in which people live impact health. CityHealth, an initiative of the de Beaumont Foundation and Kaiser Permanente, provides cities with a curated list of policies that are proven to make cities healthier places to live, work, and do business. CityHealth rates the performance of each of the 40 largest cities on the following nine policy recommendations: access to high quality pre-K, paid sick leave, safe streets, affordable housing, Tobacco 21, alcohol sales control, restaurant grading, healthy food procurement, and smoke-free environments.
Given what we now know about what actually contributes to overall health, choices about local policies become an opportunity for residents to vote for better health. While access to healthcare is important, it is not sufficient. For the upcoming election, I reviewed ballot measures in the nation’s 40 largest cities. What are city residents being asked to consider? And which measures will affect public health? Here’s what I found.
Four cities (Austin, Baltimore, Charlotte, and San Francisco) have housing measures on the ballot. Most of these are bond initiatives attempting to make housing more affordable. San Francisco’s Measure C is proposing to tax local businesses in order to provide the funding to house the city’s homeless residents.
These local measures could have a major impact on community health. Affordable housing has been shown to be associated with improved health outcomes, and having access to quality, stable housing reduces exposure to environmental toxins and has positive benefits for mental health.
At least four cities have education initiatives (Dallas, Indianapolis, San Diego, and Seattle). Dallas voters are deciding whether to increase taxes to pay for certain programs, such as early childhood education. Done right, pre-K can have significant effects on kids. Pre-K participants have shown increased rates of immunizations and screenings, regular visits to the doctor, and routine dental care. Long term, children who attend high quality pre-K programs show increased high-school graduation rates, complete more years of education, have higher earnings, and show reduced rates of crime and teen pregnancy.
Denver has a local tax initiative that would provide fresh, healthy food to low-income children. The tie to health here is very clear, and this effort complements a recent executive order from Mayor Hancock to adopt a healthy food procurement policy for vending machines on city property.
Chicago voters are being asked to consider both earned sick leave and raising the minimum wage (both of which have been shown to improve health outcomes). However, these measures are nonbinding and are purely being used to gauge public opinion about the issues.
Local decisions can have an outsized impact on communities. The choices that voters will make on Nov. 6 will have an effect on the health and well-being of our nation’s communities. While some of these local ballot initiatives may not look like a traditional public health interventions, there is no doubt that evidence-based policies are essential for achieving better health for all.
I look forward to reporting back after the election to let you know the voting results for these and other issues.
Catherine Patterson is Managing Director of Urban Health and Policy at the de Beaumont Foundation.
by Soledad O’Brien
One thing I’ve learned over the years about storytelling is that it is as much about people as facts. Facts make your case, they convey information, they give credibility and heft to your reporting. What they don’t always do is make you want to know more.
For public health leaders who are trying to convey the importance and successes of public health, this is an important lesson. The narrative of public health is complicated. Public health involves every element that allows us to live in society — housing, access to food, daily stresses, the environment, and more.
The best way to tell that story is through the eyes of people, not by leading with complicated lessons on the “social determinants of health.” (When I hear that term, I think, “What the heck does that mean to anybody outside of public health?”) People are the ones experiencing the benefits of public health in life-transforming ways — the family that escaped the fire because of the smoke detector, the hospital staff that kept functioning after the hurricane because the generator was on the roof, the kids who were spared the deadly flu because of a vaccine. Then you can get into the equally important details of how and why things happen.
I was recently invited to address a group of public health officials about the power of storytelling. People spoke up about the many challenges they face when telling the story of the public health’s impact. When public health is going well, it disappears from the media landscape. When there is a water crisis or a flu epidemic, it comes roaring back. You can help change that by helping people understand the role you and your colleagues play in addressing these crises and preventing the next one. You can be the real-life story behind the public health triumphs that improve and save lives.
When you help people understand what you do, you’ll be more successful in attracting support for your work, forming partnerships and building credibility in your community. That’s where stories come in, whether you’re talking to community leaders, business executives, elected officials, or the media. More than statistics or infographics, good stories trigger understanding and empathy — which is more likely to drive action and change behavior.
Public health leaders have an opportunity to take the same approach to build support for their important work. Here are a few guidelines:
Focus on solutions, not problems.
Instead of framing problems as problems, frame them as solutions. At my company Starfish Media Group, we explore race, class, wealth, opportunity, and poverty, which can be divisive issues, and we find it more effective to present successful solutions instead of “raising awareness” about problems.
Lead with people, not data.
Many health professionals, researchers, and scientists don’t like to hear this, but good stories aren’t about data. The best stories give us data without us actually realizing we’re receiving data. Your work is about the people whose lives you impact every day. Tell their stories.
Brainstorm with your staff and partners.
Try to identify five things that make you think: “That story rips your heart out. Let’s go tell that one.” And when you have a few ideas, tell those stories to people who aren’t in your profession — your spouse, your kids, your friends — and see what they think. If other people don’t understand your story or don’t care, keep looking.
Focus on individuals.
Instead of sharing statistics about asthma, for example, show your audience what it’s like to live with asthma. What happens at school? At recess? At home? A story about a condition like asthma is often a story about poverty, or lack of access to proper care, or about the inability of a single parent to juggle the needs of multiple children.
Don’t be shy.
I’ve been so impressed with the public health professionals I’ve met around the country, and I think they are sometimes too humble about the important work they do and the impact they have on people’s lives. Don’t be shy. Figure out what your story is, and push it out constantly. Maybe your narrative can be: “We are in the trenches every day, and we save lives.”
Soledad O’Brien is an award-winning journalist, documentarian, news anchor, and producer. She is the founder and CEO of Starfish Media Group and an executive producer of the What Works Media Project. She hosts the weekly political magazine show “Matter of Fact” on Hearst networks. She also serves on the advisory committee for the de Beaumont Foundation’s initiative PHRASES (Public Health Reaching Across Sectors).
This was first published on the APHA Annual Meeting blog as part of the de Beaumont Foundation’s “Fresh Perspectives” series.
With Halloween coming soon, watch out for these scary health problems — and see how city policies can make them better or worse!
Paid sick leave laws reduce the spread of contagious illnesses, increase employment, and save cities money in healthcare costs.
2. UNSAFE RESTAURANT FOOD
Policies requiring food establishments to publicly post safety inspection “grades” empower consumers, reduce foodborne illness rates, and cut down on health care costs.
3. DANGEROUS STREETS
From street lighting to bike lanes to crosswalks, complete street policies ensure that all residents have safe, convenient ways of getting around and staying active—regardless of their age or ability.
4. SECONDHAND SMOKE
Smoke-free air laws protect non-smokers from secondhand smoke and reduce consumption of tobacco, the leading cause of preventable death in the United States.
5. ALCOHOL-RELATED CRIME
Neighborhoods with high concentrations of alcohol sales are linked to more drinking and higher rates of violence and driving under the influence. Policies that limit the amount of alcohol sales in a neighborhood can reduce crime, increase safety, and reduce spending on health care and criminal justice.
CityHealth, an initiative of the de Beaumont Foundation and Kaiser Permanente, promotes healthy policies proven to improve community health, and evaluates cities on their adoption of the policies. Visit www.cityhealth.org to see the policies and how your city rates.
by Mark R. Miller
My father is an entomologist (a scientist who studies insects), but I was always more of an etymologist (someone who studies words). And now I work for an epidemiologist. It’s a mouthful, and maybe that’s why people often refer to epidemiologists as “epis” or “disease detectives.”
Whatever you call them, they play an important role in protecting communities, our nation, and the world against health threats. They identify the causes, factors, and patterns of illness, determine who’s at risk, gather evidence to recommend preventive actions, and implement control measures. As a profession, epidemiology gets some attention for responding to major hazards like Zika, Ebola, and natural disasters like hurricanes and floods, but every day, epis are addressing threats to community health like obesity, diabetes, cancer, drug abuse, HIV/AIDS, and preventable injuries.
Today the Big Cities Health Coalition (BCHC) and the Council of State and Territorial Epidemiologists (CSTE) released a study documenting a shortage in the field, especially in the areas of chronic disease, substance abuse, and infectious disease. The 27 BCHC health departments reported that:
- 1,100 epidemiologists work in big cities, protecting more than 55 million Americans.
- Most focus on infectious disease, maternal and child health, disaster preparedness, chronic disease, vital statistics, and environmental health.
- Fewer departments have epidemiologists working on mental health, substance abuse, and injury prevention.
- To reach full capacity, these departments would need a 40% increase in the number of epidemiologists, or 434 more. Specifically, they would need them in these areas:
- 121% increase in injury/violence
- 86% increase in maternal and child health
- 72% increase in chronic disease
- 66% increase in disaster preparedness
- 51% increase in substance abuse
Don’t miss the webinar on the report’s findings on Oct. 24 at 2:00 EDT.
The report identifies a number of challenges in meeting the demand for more epidemiologists, including these:
- Advocating for resources can be hard because many people don’t understand the role of epidemiologists or public health departments.
- While health departments often receive short-term funding to respond to a disaster or epidemic, there is a lack of sustainable funding, which makes it hard to recruit and retain employees. Many epidemiologists work under federally funded contracts, and funding can be delayed or cut.
- The positions for epidemiologists are often very specific, and it’s challenging to attract a strong pool of qualified candidates.
- There is a need for new skills in areas including systems thinking, informatics, data analysis, communications, community engagement, and cross-sector partnerships.
See the full report for detailed findings — Big Cities Health Coalition Epidemiology Capacity Assessment, 2017.
Register for a free webinar with BCHC and CSTE at 2:00 EDT on Oct. 24.