Health Reform: Keeping It Real

Thank you for surfing into Real Health Policy, a blog cultivated by the health-writing, wonk-fearing Somerville resident Melissa King and her pug, who transitioned from her work in science journalism a few years ago to pursue a career in public health policy.

You are probably wondering what real health policy is all about. The answer came to me on September 15, 2008, when I was sitting in a hallway at St. David’s Episcopal Church in Austin, Texas. I had met homeless advocate Renee Hopper during a planning meeting for a citywide forum on homelessness, where she was doing what she does best: stirring things up.

When the group brought up the ten-year plan for ending homelessness, Renee had asked why we weren’t thinking more along the lines of a one-year plan. Her comment was dismissed as politically infeasible; clearly this brash older woman needed a reality check. Renee was visibly livid. A few minutes later the meeting was adjourned.

As we walked out of the meeting, I put my hand on Renee’s shoulder and asked if she could help me with some research on affordable housing. During my time at the LBJ School, Renee was the person I could count on to keep me updated on new housing-related legislation. I wouldn’t know until weeks later that she had been living, ironically, in the back seat of a car.

I bought us each a cup of coffee, and the conversation went something like this:

How do you think public housing legislation could be made better?

“People who go through a terrible divorce like I did, who have a health event that bankrupts them…They are pushed out of housing and forced into this cycle. The number-one fear of every senior or person with disabilities is the fear of being kicked out of their homes.”

Renee explained that there is little accountability to public housing residents at the local level. “The city is not required by law to improve a property unless you request it,” she said, adding that they have people come in now and then “to throw a few flowers around the place.” She wondered why they didn’t give these jobs to the residents. “Unless citizens come together and make suggestions, there are not going to be any changes.”

Aren’t these the type of issues that you can bring up at Resident Council meetings?

“People are afraid to go to the [resident council] meetings,” explained Renee, who had served for two years as president of her Resident Council. “They have become accustomed [to] nothing being done. And if you go to the meetings, there is a fear factor. The fear of losing your apartment or housing.”

So everyone has the philosophy that they had better keep their mouth shut.

“That’s right,” she said. “Public housing is the mire of the universe. That is why I went back to the streets, and why so many people go back to the streets."

For Renee, influencing public policy had become an exercise in pounding the pavement and having the gumption to believe that even the most marginalized citizens have ideas worth listening to. Her philosophy is that through democratic organizing, we can work together to build healthier communities now — not at some point in the future. These actions in turn send a powerful message to elected officials about community values. (Examples of democratic organizing might include facilitating a forum on homelessness or starting a neighborhood clinic that engages community members in all stages of program evaluation.)

Our country has a long tradition of promoting social change through democratic organizing. Clearly, however, there is some sort of disconnect between the process of democratic organizing and the outcome of influencing policy. The idea that democratic organizing is sufficient for promoting social change causes, shall we say, cognitive dissidence with what what you learn in policy school. Namely, that citizens typically must also:

  1. Effectively communicate their interests to “policymakers” (Renee once incorporated the use of paper airplanes in the Driskill Hotel lobby for this one);
  2. Hope that studies supporting their ideas are published in academic journals;
  3. Elect a leader who is sensitive to the issue; and finally
  4. Wait for a figurative galactic alignment that fosters immediate need for change.

We've got studies supporting the need for a better health system, a president that has gotten the health reform ball rolling, and according to my cousin Bobby, an actual galactic alignment. Yet there remains a need for more democratic organizing and, in turn, a means for citizens to communicate their interests to elected officials (like at Austin's Community Forum on Homelessness, right, where my friend and teacher Oliver Markley led a Future Search). Which brings us to the purpose of this Web site.

Let's begin with what this site is not. If you are looking for a wonk room, this is not the place to be. I am not a politician, although I did once stand on Nancy Pelosi's balcony and "Hi5" the Ambassador of Togo in Haitian Creole. This is a certified Wonk-Free Zone: I won't advocate a particular party line, try to sell you anything, or obsessively watch and comment on floor debates. I find regular people — and what they have to say — much more interesting.

Real Health Policy is a blog and community action resource with a simple philosophy: that the most successful health policies are developed in direct dialogue with community members. It is we who know when safe housing is the real cure for asthma, job security is the real antidote to stress and heart disease, and wage is the real determiner of where we live and what we eat.

This blog supports “real health policy” discussion that is rooted in an appreciation of community needs. Word on the Street serves as a digest of events promoting public dialogue on issues ranging from housing rights to health care access. The latter is designed to support community organizing efforts and provide a centralized list of opportunities for engaging in dialogue with elected officials — thereby creating a bridge between process (organizing) and outcome (influencing policy).

The job hunt beckons, so this is all she wrote for today. In the next entry, I will talk about the current movement to view public health issues through a social epidemiology lens — which emphasizes the influence of the physical and social environment on health.

In the meantime, take a moment this week to ask a friend or family member what (s)he thinks has the greatest influence on health in your community. Chances are health care access is a big issue, but I think you'd be surprised by how many people name factors that are social, economic or political in nature: job stress, for instance, or the ratio of supermarkets to package stores in their neighborhoods. It makes you question whether chronic illnesses such as heart disease and diabetes are at root an issue of health care or healthy communities.

Feel free to share your thoughts in response to this posting!