Welcome to PSR's Environmental Health Policy Institute, where we ask questions -- then we ask the experts to answer them. Join us as physicians, health professionals, and environmental health experts share their ideas, inspiration, and analysis about toxic chemicals and environmental health policy.
If one looks at the roots of my “advocacy” in the broadest way, I would date my involvement to when I was in elementary school, when I became aware of the Holocaust as regards to my family history, and the legacy of slavery given commemorative events centering around the 100th anniversary of the Civil War. I became centrally concerned about military and foreign policy issues soon after, given the unfolding of the Vietnam War, and issues of nuclear weapons highlighted by the Cuban missile crisis and seeing the movies Failsafe and Dr. Strangelove, the latter reinforcing the black humor that in many ways has sustained me since that time.
In the early to mid 1980s, I became very involved in work opposing the “contra-war” policies of the Reagan Administration, with emphasis on opposing the interventions in Central America (Nicaragua, El Salvador, Guatemala), and as a “general” PSR member worked to connect the anti-interventionist issues with the anti-nuclear work of PSR. I joined the Steering Committee of the San Francisco-Bay Area chapter of PSR around 1987, and became co-president in 1989, serving as President since that time. I joined the National Board in 1993, and have been a member since that time, serving as President in 2003. I have been in a leadership role of the Peace Caucus of the American Public Health Association since 1987 as well.
What do you see as being unique about health professional advocate, and how can health professionals highlight this?
Health professionals have the health-based knowledge, which gives us enormous credibility in our society, so thoughtful advocacy efforts can avoid the taint of being political on issues that are considered controversial. We also have an important role as translators of scientific information for the public and their representatives in government. We have certainly heard from interactions with friendly lawmakers that translating often complex scientific information into ways that illustrate the personal health connections can provide a potential way of effectively communicating our issues to conservative congresspersons who otherwise reflexively take a pro-business position.
The other thing about health professional advocacy and organizing efforts is that they provide the opportunity within the health sector to make significant changes to promote environmental health. To the degree that we can be influential in leveraging our own large institutions, we can have a major impact on climate change prevention/mitigation, as well as preventing toxic chemical exposures, perhaps best illustrated by the work many PSR chapters have been engaged in within the Health Care Without Harm (HCWH) coalition.
What is an example of advocacy work you’ve been involved in that has been successful?
Together with my colleagues in the Santa Clara County Medical Association and in the San Francisco Medical Society, over the last 15 years we’ve been able to get the support of mainstream medicine in California for a variety of policies that are beneficial for the environment and public health. We’ve passed numerous progressive resolutions about sustainable energy use, climate change, and chemical policy, including pesticides and healthy food, as well as supporting the abolition of nuclear weapons.
By getting these resolutions through the California Medical Association, we’ve been able to provide the support of organized medicine to these causes far beyond our usual “choir,” as these efforts, in conjunction with parallel PSR-led efforts in other states, have influenced extremely important policy developments in AMA regarding climate change, chemical policy and healthy food in hospitals. All of this has given enormous credibility to related ongoing organizing efforts within our own health institutions—in terms of changing hospital and clinic practices, as well as supporting educational efforts among our colleagues in Grand Rounds and other similar clinical fora. All of this work has allowed us to reincorporate public health issues into medical practice and effectively avoid the stigmatization of these as “political.”
How do you get these resolutions passed?
You have to become one of the guys – and I don’t mean that in a gender specific way. You have to become a member in good standing by joining your local medical or public health association and working collaboratively with those who often are much more conservative on a variety of social issues, such as health care reform. As such, when advancing our environmental health issues it is important to clearly connect these to the central health concerns of our colleagues that presumably motivated them to become physicians in the first place. For myself, that’s certainly a juggle when my association is supporting policies beyond those that I’m personally interested in or support. You have to always show respect for people who differ with you for whatever reason, understanding that the mainstream associations are generally representing a conservative socioeconomic group for which our positions on issues may be threatening at first glance. The important thing is to avoid rhetoric and preaching, and to develop policies that connect with people as being completely health-based and protective.
To work well with people in this way, you have to be willing to compromise on the minor issues while staying centered on getting resolutions passed that maintain the important, central principles that will advance our environmental health agenda. In the CMA, the “whereases” that provide the scientific basis and argumentation for our position disappear from the historical record after discussion at the reference committee hearings, so we have the extra challenge of developing “resolveds” that will stand alone after the deliberations and provide strong policy.
What is your advice for healthcare professionals who want to get involved in advocacy for the first time?
I think it’s very important to have models and allies when you’re doing this work, and as such it’s very important for those of us who have experience at policy development and related advocacy efforts to mentor new people on these efforts. I think it’s really important to give such support because it can be personally difficult for health professionals to go out on a limb supporting policies that may be controversial and not immediately understood as being relevant to clinical practice. It’s certainly important for people to be prepared with good scientific information and to talk through with them the “style of work” guidelines I mentioned previously. On the issues we work on, you really can’t afford to make mistakes that cause you to lose your credibility in the short- or long-term, so we really need to be expert on our issues and know how to effectively connect with the best in the people we need to convince. Doing this right also has proven effective in interesting additional people in our range of issues and allowing additional recruitment to our ranks.
How do you prepare for legislative meetings?
We need to know the background and politics of who are talking to. We need to understand what the challenges are going to be, and the issues and related concerns that will likely move them to support our positions, especially if they have a record of ideological opposition to our positions. Above all need to be effective translators of the science, and to clearly explain the heath issues involved, in a way that explains how our issues will protect their own constituencies, families and the larger community. Again, it’s all about connecting with the “best” in our audience to motivate them to support what protects the overall public health of us and the generations that follow us.
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