epidemiologist win a Democratic primary<\/a> for a U.S. Senate seat in Michigan. It was so unusual to see someone run for office with a background in public health that it helped me see the scale of the power vacuum.<\/p>\nThe training added another level. It reminded me that having facts on your side doesn\u2019t mean you\u2019ll win a policy fight, especially absent power. Whether it is the dangers of flavored tobacco, the benefits of vaccination, or the urgency of addressing climate change\u2013public health has an impressive body of evidence.<\/p>\n
The wins\u2026less so.<\/p>\n
Being right isn\u2019t nearly enough<\/h4>\n
Public health professionals spend an enormous amount of time solving problems. We identify health risks, collect data, conduct studies, estimate odds, evaluate programs, model outcomes, and synthesize evidence. When the evidence isn\u2019t clear, we work harder to produce better evidence.<\/p>\n
Eventually, though, we need somebody to do something with it. And that\u2019s where things get complicated. You can have a stack of peer-reviewed studies showing that a policy will likely improve health, and you can explain the evidence clearly. But when it comes to changing policy\u2013you can still lose.<\/p>\n
The obvious reason is that people with power don\u2019t make decisions solely with evidence. Elected officials, CEOs, directors and school boards (all common power holders) face constituents, clients, and consumers. They balance budgets, donors, and investors, and juggle public opinion and relationships. There are nearly always competing priorities.<\/p>\n
Evidence matters a lot. But evidence isn\u2019t power.<\/p>\n
Afterschool soda and competing interests<\/h4>\n
I\u2019ve encountered it at my children\u2019s elementary school, where a few years ago I figured out how to stop the \u201cstudent store\u201d from selling soda and huge tankards of sugary iced tea. I knew from my work in this area that the district had a rule against this, but it took me a while to get something done about it.<\/p>\n
I recruited my 5th grade son to help solve this, thinking it might be a good experience. He was not only a constituent and consumer, but he served on the school\u2019s student leadership body. Putting aside his own strong preferences for sugar, he raised questions, and quickly found he was up against \u201ccompeting interests.\u201d<\/p>\n
When that didn\u2019t work, we recruited a few other families who then shared the concern with others. But it wasn\u2019t until I found myself having a conversation at school with a parent who knew the principal that the power map became clear.<\/p>\n
The principal walked up to say hello, and we explained that we were just discussing who to talk with about the sodas. The public health evidence was easy to express, and it helped that the sale of soda was likely breaking district rules. But the relationship was key; the principal knew and trusted this other parent. By the afternoon, sodas were gone.<\/p>\n
That\u2019s power.<\/p>\n
I think that is why this morning\u2019s advocacy training resonated with me. Some of the ideas were familiar because we encounter them in common spaces. I\u2019ve often thought about who I need to talk with to solve a problem and how to build support for a solution. What I hadn\u2019t done was think of that knowledge as a formal public health skill set. I now realize that maybe we should.<\/p>\n
Teaching public health to understand power<\/h4>\n
Most public health students take some form of health policy class. After the Lerner Center training this morning, I\u2019m less certain that we teach them how to navigate power. There is a wide gap between knowing<\/em> what should change and actually making <\/em>the change. Power may need to become a more explicit part of public health education.<\/p>\nThere is an obvious complication here. A large share of the public health workforce is employed by government, universities, and nonprofits where the boundaries around lobbying and political activity can be complicated. Public health also has good reasons to value scientific independence, especially with trust in its institutions at a low-point<\/a>.<\/p>\nThe answer isn\u2019t to turn every epidemiologist into a political operative. But does the pressure to remain credible makes us too discomfited by power itself? To change the conditions that help communities stay healthy, eventually somebody has to change a budget, regulation, ordinance, or law. And somebody has to motivate<\/em> that person to do it.<\/p>\nMaybe that means teaching the tools of advocacy\u2013including understanding power\u2013to more students. Public health already excels at generating good evidence. We may need to become more comfortable and capable with the skills to turn that evidence into action.<\/p>\n
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Gregory D. Stevens, PhD, MHS is a health policy researcher, writer, teacher and advocate. He is Chair of the Department of Public Health at California State University, Los Angeles. He serves on the editorial board of the journal Medical Care, and is co-editor of The Medical Care Blog. He is also a co-author of the book Vulnerable Populations in the United States.<\/p>\n<\/p><\/div>\n<\/p><\/div>\n
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