Special Expertise, Special Concern

Interview with Peter Orris, MD MPH

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 evidence.

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 commitment.

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 health.

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 their office.

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 particular issue.

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 time?

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.

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