January 20, 2013 by amberpulaski
For a few years now, I have pictured myself living in DC after graduating from UNC’s MPH/RD program, working for an organization that supports public health initiatives, and influencing big changes in the quality of school lunches, military food, among other issues. I must admit, I now find this embarrassingly overzealous. During our class trip to DC earlier this month, I heard 20+ representatives from many organizations that are key players in public health policy speak about current initiatives. Listening to their perspectives, I quickly realized my view of my future career was pretty unrealistic. I quickly modified my view: I want to move to DC and make SMALL changes in public health policy. Even just a small policy change can take a long, long time. For example, many advocacy groups worked for over 10+ years promoting bans on indoor smoking in public places before changes began to happen (and the battle continues in some states). I will keep my passion for improving public health alive, but I am going to have to add a hefty amount of patience to the mix. I realize now more than ever that it takes a long string of people working hard for years to make enough small changes to add up to a big change. I am content working hard to make some sort of small change that will help make the “healthy choice the easy choice” (a popular quote among many panelists we heard during the trip).
I came away from the trip thinking about how important, but difficult change can be to accomplish. I began developing a “recipe” for influencing change based on panel discussions. Here’s what I have so far:
1. Quality research: A proposed policy change should be supported by strong research. It is a waste of time and money to implement something on a large scale only to find out later that it doesn’t even achieve the desired outcome. For example a representative from the USDA’s analysis office spoke about a small pilot study done by their office that evaluated the effectiveness of a proposed policy change to make school breakfast available to all children regardless to income. Intention of this change was to improve academic performance. However, the evaluation showed no change in academic performance. Policy change was shelved and debates ceased. Research ensures the proposed change will actually make the intended difference.
2. Money: A proposed policy change should have a funding source identified and justification as to why this particular change should be supported over other potential uses of the funds. Is the proposed change truly the best use of funds at this point in time? People and organizations have competing interests, and the most prominent interests usually win out, even if all changes could provide some benefit. In addition, the proposed change has to be more beneficial than reducing the deficit. Many of the panelists spoke of the desire to reduce spending, due to the federal deficit.
3. Involvement of all stakeholders: A proposed policy change should have been developed with input from all stakeholders. Many of the panelists spoke about the importance of understanding all stakeholders’ positions and interests related to an issue. Everyone has biases, and a successful change intervention treats all stakeholders with respect and makes a sincere attempt to understand and include policy modifications that support their goals. It is important to not treat any stakeholders as the enemy. For example, nutrition community often vilifies industry. However, many businesses have made small changes to improve quality of food, and these changes should be celebrated. Industry will be more likely to get involved, if their needs are being valued and considered.
Of course, these are only a few of the ingredients to consider before proposing a change to an existing policy or program. Change is complicated, sometimes messy, and often uncomfortable. For this reason, I think it’s important to reiterate my fellow classmate, Laura’s sentiments that we need to make sure these changes that are so difficult to accomplish are in fact backed by good science. I am going to end this blog article with one of my favorite quotes about change. It’s by Margaret Mead: “Never doubt that a small group of committed citizens can change the world. Indeed it is the only thing that ever has.” On that note, I would just like to say cheers to those working hard to advocate for changes that will make it easier for people to make healthy choices.