Monday, March 11, 2013

Follow-up of my DC trip


After the debacle of “Snowquester” had passed, Washingtonians were feeling quite sheepish about shutting down the federal government for a non-event. Because of that, they were very accommodating to out-of-town visitors whose schedules had been needlessly disrupted so I had little difficulty rescheduling all my “Hill visits” for the following day.

Well stocked with talking points, charts and graphs, and “leave behinds,” I headed for Capitol Hill and a day of visiting members of the Minnesota Congressional delegation. As I met with members of Congress and their staffs in the Hart Senate Office Building or the Longworth or Rayburn House Office Buildings, the conversations generally focused on the need, despite budget deficits, to support basic public health infrastructure for the long-term benefit of our state and country. Specific discussions also occurred around the Public Health and Health Services Block Grant (something MDH has received since 1981 to support state and local public health services throughout Minnesota), the Prevention and Public Health Fund (part of the Affordable Care Act that funds Community Transformation Grants, quality improvement efforts, and environmental public health tracking, among others), Section 317 Immunization grants, and several more. However, as important as these issues are, most of the conversation revolved around Sequestration which had just gone into effect six days earlier.

There seemed to be consensus that Sequestration was not a good tool for making budget cuts, yet there was also consensus that it wouldn’t get resolved quickly. A great deal of blame and hostility was evident on both sides of the political aisle. Recognizing the animosity and divide between the two political parties, I left the Hill discouraged because it is obvious that the effort needed to sustain an effective public health system is going to be long and difficult.

On my way back to the hotel I saw a week-old sign in a bookstore touting the birthday of Theodor Seuss Geisel. [His birthday (3/2/1904) was the day after the Sequester began.] The day’s experiences made me immediately think of one of my favorite Dr. Seuss books, The Butter Battle Book, which begins:

On the last day of summer, ten hours before Fall…
my grandfather took me out to the wall.

For a while he stood silent. Then finally he said,
with a very sad shake of his very old head,
“As you know, on this side of the Wall we are Yooks.
On the far other side of this Wall live the Zooks.”

Then my grandfather said, “It’s high time that you knew
of the terribly horrible thing that Zooks do.
In every Zook house and in every Zook town
every Zook eats his bread with the butter side down!”

“But we Yooks, as you know, when we breakfast or sup,
spread our bread,” Grandpa said, “with the butter side up.
That’s the right, honest way!” Grandpa gritted his teeth.
“So you can’t trust a Zook who spreads bread underneath!

While the nuclear arms race was the basis of that story, Dr. Seuss could just as easily have used Sequestration or health care reform as his inspiration because, in Washington and throughout the country, people are using their Boom Blitzers, Blue Gooers, and Big-Boy Boomeroos to throw invectives at those who think differently than they do about deficit reduction and health care reform.

And what has this gotten us – a stalemate on most issues that affect the health and quality of life of everyone in our country and mutually assured destruction of anyone who tries to collaborate or compromise. Ironically, as Dr. Seuss clearly points out, what most people want is exactly the same – their bread and butter issues are similar. Most public health issues (safe food and water, safe and healthy environments, control of infectious diseases, healthy people at all ages, etc.), are bread and butter issues. Whether the butter is up or down, they shouldn’t be partisan issues.

As I continued on my cab ride, I wondered what it would take to get away from our current polarization on seemingly every issue of importance to our overall health. How could the voice of reason be heard among policy makers so they could come together and collaboratively develop rational health policies? It was then that it dawned on me that I wasn’t the only person from Minnesota visiting our congressional delegation on that day. At every office I saw Minnesotans raising their voices as they advocated for expanded bicycle use, affordable housing, women’s health, improved nutrition, expanded wetlands, and better health professional training in human and animal health. And these were just the ones I talked with in the waiting rooms. I’m sure there were many more throughout the day.

It was then that I realized the answer to my question also resided in another of my favorite Dr. Seuss stories, Horton Hears a Who.

"This", cried the Mayor, "is your town's darkest hour!
The time for all Whos who have blood that is red
To come to the aid of their country!", he said.
"We've GOT to make noises in greater amounts!
So, open your mouth, lad! For every voice counts!"

I hope my voice will help make a difference. That’s why I took the time to go to Washington. But I do know that my voice combined with your voice and those of our neighbors, family, and colleagues will certainly make a difference. For the collective good of our society, every voice is needed and every voice counts. For democracy to be effective it needs to be noisy. So, use your voice for public health and make some noise.


Greetings from D.C.

In the midst of Tuesday’s snow, I flew out of Minneapolis to attend the ASTHO (Association of State and Territorial Health Officials) board meeting and Day on the Hill in Washington D.C. My flight was delayed so I missed the morning meetings with the Assistant Secretary for Preparedness and Response, OMB Director for Health, and the Assistant to the President for Homeland Security. I was disappointed not only because I couldn’t meet with these folks but because I had never been in the Eisenhower Executive Office Building. My security clearance was for naught. Perhaps next year.

However, I was able to meet with the majority staff for the Senate Labor-HHS Appropriations Committee, and the majority staff for the House Labor-HHS Appropriations Committee. The two meetings were markedly different. Although both meetings focused on sequestration and the impact it would have on public health, the discussion in the Senate meeting was much more about the long-term strategy to protect and enhance public health. The House meeting discussion was much more about increasing efficiency, reducing duplication, and lowering spending. It was obvious that the 2 chambers have different agendas. Regardless of their differences, the bottom line in both meetings was that the next couple of years are going to be difficult ones for public health.

Of note with the Senate staffer was the discussion about Iowa Senator Harkin, who is on the Appropriations Committee and chairs the Health, Education, Labor, and Pensions Committee.  Senator Harkin has been a champion of public health and particularly the Community Transformation Grants and services to people with disabilities. He will not be running for reelection so the question was asked what he would be working on for the next two years. Besides specific public health issues, it was mentioned that he would be mentoring other Senators to take on leadership roles around public health. Of interest to those of us in Minnesota, Senator Al Franken’s name came up as someone who is being groomed to deal with chronic diseases.

This morning I woke up to the news that the federal government was closed because of the forecast of the biggest snowstorm of the season. Because of that, all my Hill visits were cancelled. Fortunately, we were able to hold the ASTHO board meeting today and I was able to reschedule all my Hill visits for Thursday. The irony in all of the weather drama was that there was no snow accumulation in D.C. all day. The temperature remained in the high 30s and the precipitation went back and forth between snow and rain. It was strange to have the federal government shut down because of snow when there was no snow. I hope tomorrow brings less drama.

Part of the ASTHO board agenda was honoring Mary Selecky one of its long-term members who will be retiring in the next couple of months. Mary has been the Secretary of Health for the State of Washington since 1999 and has served three governors. Her tenure is quite unusual. From what I’ve been told, the average tenure of a SHO is between 18 and 24 months. Since this was Mary’s last Board meeting, a surprise celebration party was held for her on Wednesday night. Many public health big-wigs showed up and said wonderful things about Mary. She has played a huge role in public health in the state of Washington and nationally. Most impressive, at least to me, was how she nurtured talent. She has been a mentor, supporter, and role model for hundreds of public health leaders throughout the country, including me. I think that will be one of her greatest legacies.

In talking about her entrance into public health and what has guided her throughout her career, she mentioned that as a child whenever she and her siblings complained about the chores they were required to do, her dad would recite the Henry Wadsworth Longfellow poem “A Psalm of Life.” The message she got from the poem and from her father was “don’t complain – do something to make the world better.” She then recited the following stanzas of the poem:

Life is real! Life is earnest!
And the grave is not its goal;
Dust thou art, to dust returnest,
Was not spoken of the soul.
Not enjoyment, and not sorrow,
Is our destined end or way;
But to act, that each to-morrow
Find us farther than to-day.
Lives of great men all remind us
We can make our lives sublime,
And, departing, leave behind us
Footprints on the sands of time;
Footprints, that perhaps another,
Sailing o'er life's solemn main,
A forlorn and shipwrecked brother,
Seeing, shall take heart again.
Let us, then, be up and doing,
With a heart for any fate;
Still achieving, still pursuing,
Learn to labor and to wait.

There were lots of misty eyes in the room when she finished. I also sensed that there was a renewed resolve among all present to follow Mary’s example and not let the problems of sequester and inadequate investment derail our public health efforts. Instead, I felt a new resolve in the group to “be up and doing” for the sake of the people we serve. Still, most of us acknowledged that, given our short tenure as SHOs, it is difficult to “Learn…to wait.”