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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.


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Nurses as Environmental Health Advocates: A Trusted Voice

Posted on July 28, 2011

Interview with Brenda Afzal, MS RN

I have been doing environmental health advocacy for more than a dozen years now. I returned to nursing school to update my degree and had the good fortune to be in the  first class in the nation on environmental health and nursing. I clearly remember sitting in that class feeling gut angry about what I was hearing.  What do you mean  there is something in my water? What do you mean if it’s on the shelf it might not be safe? Who is in charge here? Why isn’t somebody protecting my three sons?

I will be forever grateful to Barbara Sattler who taught that first class and hired me to work with her for the next dozen years.  I learned to channel that passion into thoughtful work. Someone had to speak up about these issues that were plaguing the country. It’s was alarming, the exposures that were happening.

Right out of graduate school I began to work on water issues, raising nurses’ awareness around the country about drinking water; what was in the water, what were the resources they had and some of the opportunities they had to provide comments to policymakers about water issues. This resonated well with the health community.

I got very interested, a few years ago, in air quality issues in Maryland, my state. I was invited to participate as a health representative in a large coalition of the environmental organizations that was working on an important piece of clean air legislation in Maryland. It was the first time that the group had brought in a health voice.

I really loved working on the coalition and the issue.  It was rewarding and important work.   I brought nurses to Annapolis. I engaged the Maryland Nurses Association in the work, and we took nurses literally door to door to speak with every single legislator in both house and senate. We gave testimony. We sent letters. We did the traditional organizing that the environmentalists had been doing, but we did it from a health perspective.  We were perceived a bit differently by policy makers than our environmental colleagues were.  I have yet to walk into a policymaker’s office where they are not welcoming to me as a healthcare professional. They appreciate my perspective and knowledge about public and environmental health.

I am working now with Health Care Without Harm as their US Climate Policy Coordinator.  In that capacity I am once again working with a coalition of environment and health organizations, but this time at the national level working to defend the Clean Air Act and the EPA.  As before, it is rewarding and important work.   

Have you had the experience of talking with a legislator hostile to your cause? How have you dealt with that?

Generally what I find is that legislators are not hostile to nurses. They might be in opposition to your ideas and perspective on an issue; they are not, however, hostile to nurses. I am almost always greeted with “I love nurses!” We are perceived as not taking sides. We gain nothing from the passage of a bill except the protection of the public’s health. So I think we are seen as ethical purveyors of the science, and as good translators of the science. Most of the time they listen respectfully to what I have to say.

The one thing I continue to do, even with those policymakers who might be perceived as “lost causes,” is to continue to talk with them and their staff. They may roll their eyes when they see me, but I go in with a smile, and I share my material. On occasion they have taken a step back, and one or two have said to me, “I can’t vote for this issue, but I won’t vote against it.”

How do you prepare for meetings with lawmakers?

When I say policymakers, I don’t always mean legislators. I think we have opportunities to make a difference not only in the legislative and regulatory process. Policy is broader than that. You make policy when you are working with a hospital administrator and they decide that they are going to purchase something without DEHP in it for the NICU. So you can be doing policy at different levels. It can be with the governor or at the local level, or legislators at the state and national level, but it can also be with decision makers in a hospital or university settings.

How to prepare? I always review the science. I encourage healthcare professionals to know the science as best as they can before they visit a policy maker. I don’t think they have to quote backwards and forwards every piece of science, but we have to be able to translate the basic science. It’s important that our work remains science based.

I identify who I need to take with me. Sometimes I go along with a coalition of faith groups and environmental groups. Sometimes I go in just as a public health entity with other public health folks. If that member has been hearing from environmental organizations and industry lobbyists, then I might decide that they need to hear from somebody they perceive to be unbiased, so I think about the situation and assess who are the right people to go into that meeting.

I meet with the group I am going with – usually no more than two or three people – and I make sure that each person has something to say. Each person introduces him or herself. I prefer not to go in with a full packet of information. I think a one-pager that’s bulleted, with lots of white space, with contact information, with just the most important information: what’s the issue, why are you there, what’s the science, what are the health implications. If you want to put it in a folder to make it look more official, that’s fine, but these are busy people who will appreciate your making it a little easier for them to grasp the key issues.  

Everybody should arrive a few minutes early, keep it professional and polite. Today’s enemy is tomorrow’s partner. Don’t get angry with what you’re hearing. Just respond with your message. I always make sure that every member of the team visiting the policy maker knows what “the ask” is. We make sure that we make the ask, we wait for the commitment (or lack of one), and we tell them we are going to be following up with the meeting.

Be sure to call the scheduler or secretary before the meeting to confirm you are coming and let them know who is going to be in your group. Make sure they know what the issue is that you are coming to talk about. You don’t want to blindside them, that can really backfire.

What has been your worst experience doing this work?

I have had meetings where I am there to talk about environmental health and they want to steer the conversation to another issue.  The point is not to be taken off topic.  When a policy maker does this, redirect the topic back to what you are there to talk about.  So you might say something like, , “I think there are many voices that say that is not an accurate representation of the issue,  but what I’m really here to talk to you about today is public health.”  I continually reframe it back to the issue that I am there to talk about, and I don’t allow them to take me off message.

What is unique about the health professional advocate? How should health professionals highlight this in their meetings with decision makers?

I will speak specifically about nurses. Why nurses? First, we are perceived as not having a side on the issue, other than the protection of public health. Second, there are a whole lot of us. There are 3 million nurses in this country, so we have the power of many.

I often use the statistic that one every 100 Americans is a nurse. I might even talk about some of the polls that show that nurses are the most trusted conveyers of health information for our patients, community members and policymakers. We are trusted and we are everywhere. There is a nurse in every community, in every health care center.  

Do you have any advice or tips for a health professional thinking of doing advocacy work for the first time?

Do it! Start it! Don’t be afraid. Choose the issue that is most important to you or to your practice. If you’re a pediatric health professional, choose something that relates to children. If you work in cardiovascular health, you might work on something that has to do with air quality. If you’re a midwife or obstitritian you might chose to do something relating to mercury exposures. Don’t feel like you have to be an expert on the environment – you are already an expert in health. Don’t feel that you have to know everything about the issue, or know about every issue. Take a small bite. Reach out of your comfort level, call your legislator and tell them how you feel about an issue. Call your friends and tell them how you feel about an issue. Just get started.


Nancy Swan said ..

Thank you for this article. I use reliable health information to educate parents and those in disadvantaged areas about the need to protect children and unborn children from environmental and chemical harm. As a victim of toxic injury, I use my experience and education to open doors few ever get to enter, including doors of politicians. Hope I can be of help to PSR and return the favor.

August 2, 2011
Sr. Corde Rea, OSF said ..

I think these are wonderful ideas of good strategy to get on the positive side of our legislators! And nurses care for us all!

August 1, 2011

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