For many of us, we go into public health because we want to make a difference, we care about our communities and our neighbors, and we believe in health equity for all. We think of ourselves as health strategists grounded in science and facts. We work together and expect others to embrace our collaborative approach to addressing complex problems. But what happens when we embrace our ideas above others? When we become insular and tribal in our beliefs about the correct course to solve problems? Often without being aware of it, we tune out different ideas and approaches, especially if the person or group espousing them comes from a different “tribe.”
When I was the health commissioner of Virginia, Governor Kaine asked for my engagement on a particularly polarizing issue – implementing a smoking ban in restaurants.
Virginia is a state built on tobacco. The first settlers of Jamestown barely survived until they found that tobacco crops thrived in the Piedmont soil and weather. Over time, the tobacco and cigarette industries have been instrumental in Virginia’s growth and economy. The inside of the state capitol rotunda, designed by Thomas Jefferson, is embellished with tobacco leaves. Altria, the world’s largest tobacco manufacturer, is headquartered in Richmond. Previous efforts by Virginian legislators to increase tobacco taxes had been unsuccessful. But this time, we were proposing a law to ban smoking specifically in restaurants.
Sides lined up for and against the proposed law. Supporting the law were public health professionals, healthcare providers, and most Democrats. On the other side, lobbyists for the tobacco and restaurant industries argued that people already had a choice to not frequent restaurants that allowed smoking. Libertarians and Republicans feared the expansion of the “nanny state.” Despite the data showing the prospective health gains, the debate quickly devolved into a “tribal” discussion mired in political gridlock.
To break this impasse, we engaged another group that would be largely impacted by the legislation but whose voices were stunningly silent – restaurant workers. From students working as waitresses and busboys to people working in the kitchen, these individuals represented a diverse group of lower-income, hard-working taxpayers, many of whom had no health insurance. They came forward to share their powerful stories — about asthma exacerbations, difficulty in removing the smell from their clothes and body, and concerns about their increased risk of getting lung cancer or heart disease. We highlighted restaurants that were voluntarily smoke-free and engaged their owners to comment on profitability, which had generally not been affected. We were able to bring a few key Republican leaders around, including one whose son sang in upscale restaurants for a living, exposing him needlessly to carcinogens. Most important, we worked to understand the concerns of restaurant owners. We committed to providing criteria for “smoking rooms” in restaurant, as long as they provided separate ventilation, access to rest rooms, and staff weren’t forced to enter the space.
These efforts moved enough lawmakers on both sides to vote for the bill — just enough to move it to the governor’s desk for signing. A year later, all restaurants became smoke-free – making Virginia the first Southern state to put a restaurant smoking ban in place.
Not everyone who supported the ban was satisfied. A few restaurants opted to create smoking room and cigar bars – and the American Lung Association and the American Heart Association were unhappy that we had made that compromise. Many advocates had wanted significantly higher taxes and a complete elimination of smoking in any public place, and the ban fell well short of that. The bottom line was that to reach an agreement that could work in our unique culture, we tried to meet everyone where they were, which made everyone uncomfortable, and no one got everything they wanted.
How did we move ourselves beyond our own tribal approaches and find ways to cross the aisle? We didn’t dig our heels in and become mired in our first approach. We spent time learning what mattered to key leaders opposed to the bill — jobs, the economy, the local impact on businesses, the perception of too much control and regulations — and we developed positive messages to address each of those issues. Everyone got something they wanted and gave in on other areas. Even though neither side got everything they wanted, the smoking ban was an important win for the health and well-being of our state.
I think these are some of the keys to finding common ground.
- Let everyone share their ideas. Take the time to listen, and don’t immediately say no. Even if they are berating you, at least you’ll understand why they are so passionate, and you may be able to use their expertise and ideas in a positive way.
- Avoid jumping into your “tribal role.” Don’t take the bait, and never take it personally. Look at people for their ideas, not their role or their politics. Don’t value some tribes over others, even the public health tribe. Make sure you can back up your ideas with facts and science.
- Find creative ways to agree to continue to work together toward mutually successful outcomes. For the people you need to influence, understand their motivations and passions. This can help you personalize the issue for them. Even if this seems unlikely, keep an open mind and find ways to involve people who initially oppose you.
Polarization can be particularly damaging in an issue like public health that affects every citizen in a meaningful way. As we seek solutions that improve health for all, we need to embrace and celebrate different approaches and ideas. If we can do that, we can turn our differences into strengths and not obstacles.