Special Expertise, Special Concern
July 28, 2011
As a health professional or as a physician, when one is
treating an individual, that is important for that individual and you will
improve quality of life for that individual. Hopefully you can cure some
conditions and control others. But that really does not affect the health of
the population as a whole. So as a physician with a concern about the health of
people, I think one has to be involved in both levels: health-related policy as
well as treating individuals. With respect to health-related policy, the way
that physicians can contribute there is through advocacy based on science and
I went to public health school prior to medical school, so I
had an orientation toward population and public health and primary prevention
kinds of activities. I was involved in college in a variety of social advocacy
activities, and really the medical degree was an extension of that social
In medical school I was involved with the Medical Committee
for Human Rights, which was working on access to care, health disparities, and racism
in health care. In my second year of medical school we had a large conference
here in Chicago that pulled together the major unions in town and discussed
occupational health. The only occupational physicians at the time were
corporate physicians. Physicians committed to worker health either in academia
or for unions were very rare. You could count them on both hands. So after that
conference, the Medical Committee for Human Rights developed a program related
to occupational health and was instrumental in creating the COSH groups, the
Committees on Occupational Safety and Health.
Following medical school I did my residency at Cook County hospital
in a joint program in internal medicine and occupational preventive medicine.
This allowed me to get the skills I needed both to treat individuals and
workers but also to be involved in advocacy, right-to-know, improvement of
health in the workplace, OSHA, and adequate controls on workplace health. When
I was a senior resident, the Vietnam
vets began to come to us and were concerned about dioxin and Agent Orange
exposures, so that led us into investigation and more understanding about
environmental health and pesticide exposures. Somewhere in the late 1980s I
became more involved in environmental health issues as well, mostly from the
point of view of toxics and toxics control.
What makes a visit
with a lawmaker go well? What makes it go badly?
The best method of putting together a good meeting with
either a representative or senator is to
work with a supporting organization and have good staff work done beforehand. The lobby staff understand the issue, understands
who are the appropriate congressional staff people, and integrates the
immediate legislative issue with the longer-range, big-picture stuff one is
trying to educate them about.
With that as the groundwork, they can set up an appointment for you in which you
are brought in to discuss what this issue means to your patients, and what it means to the public’s
There should be some consideration about how many people are
going to be in the room, and is it a big enough room? Should you attempt to meet
the member him or herself? How can you establish
an ongoing relationship with the office and with the member him or herself? When
it works best, you’re there as part of a thought-out strategy. It’s been set up
so you’re walking in there as the
doctor or expert-type, and you are able to intertwine the science and the
concern about the public health with the specifics of the policy.
A bad meeting is where they meet you out in the hall with
staff, there’s no specific thing planned, there’s no room to have the meeting
and you’re meeting with a summer intern. That kind of a meeting is created by bad staff work of the organization
that is coordinating your effort. So if you don’t have good staff work, then pounding
the corridors is not particularly effective.
The best thing is when you have an ongoing relationship with
the legislative office around one or another particular issue so you’re able to
work on it over a period of time, not just when you’re on the Hill sitting in
How do you talk to a
lawmaker who is not supportive of your issue?
You have to have a clear point of view of what you want to
accomplish. Nobody is opposed to the public’s health. So there are always wedge
issues and ways to raise questions. Then you figure out exactly how you’re
going to go about talking about it. How are you going to share your thinking
about why your commitment to public health brings you to your opinion on this
specific piece of legislation or general policy position?
What has been your best
experience doing legislative meetings?
There’s not one template like that. Sometimes you meet with
people because they are crafting legislation, and you work with them on making sure that it’s as
good as possible. Other times you will
meet with middle-of-the-road folks, and you’re going in there and saying I am a
constituent or from the same state and I
want to talk to the member about this
issue because it’s very important to their constituents. Still other times you
will go in there and they’re opposed to what you think should happen. Then you want
to say, look, I’m from your state, and this is my concern and the concern of
many voters in the state.This is what I think you ought to be doing about the
The legislature is only one part of it. Regulatory issues
are very important for environmental health. So testifying and being involved
with the various administrative agencies is very important.
Do you have any advice
or tips for healthcare professionals interested in doing advocacy work for the
First of all I think it’s very important to do. I think that
integrating curative activity with public health policy is critical. A health
professional thinking of getting into this should recognize that society looks
to them as having special expertise in these areas and special concern for the
health of the public. Then they need to live up to that, in other words, they
need to be evidence-based. They need to understand the science and the
limitations of it, and they need to be giving appropriate preventive or public
health or precautionary advice with respect to legislation. They should not get upset with any of the
machinations on the Hill or the fact that the people who are mobilized
primarily for economic reasons against one or another of our issues have many
more people and much more money to spend on the issues.