APHA Mid-Year Meeting, Day 3: Advocacy and Closing Remarks

Day three of the mid-year meeting started off with one last break-out, then moved to the closing general session and a break-out luncheon for the section representatives and state public health affiliates. I attended the “Assuring Population Health: Advocating for Prevention and Wellness” session, which left me wondering how the presentations in this session related to the topic. While I appreciate learning about how different communities are using their Prevention and Public Health Fund grants, I found myself asking where the advocacy was in some of the slide presentations.

One presentation which I did find interesting was one on “The Employer’s Perspective on Health and Health Care Reform” by Larry Boress, President and CEO of the Midwest Business Group on Health. Mr. Boress brought some very good points on the role of businesses in providing and advocating for health coverage (“We pay for everything, so we are advocating for how our money is spent”), as well as the incentive for employers to provide coverage for their employees – “It’s not because we’re altruistic. We do it for business reasons.” I was disappointed, however, when my question about a graph on one of his slides was completely sidestepped. It looked at the breakdown for how businesses answered the question, “How likely is it that drop health insurance coverage and let employees buy individual insurance from the new health insurance exchanges?” Twenty-six percent answered “Unlikely” while 27 percent said “Not likely” – what is the difference between these two? Are they not the same response? Unfortunately, Mr. Boress responded by explaining to me why employers would choose to provide health coverage to their workers.

On a more positive note, I was very impressed with the closing speech given by Dr. Lawrence Wallack, Dean of the College of Urban and Public Affairs at Portland State University. Not only did he spare us from a script on slides, he drove home some very important points about why health care and health reform are important, how we need to be framing the debate, and how we should engage the opposition when advocating for it. He said that there are two prevailing mentalities among Americans: the “yo-yos” (You are On Your Own) and the “wits” (We are In this Together). While the yo-yos stress personal responsibility and the idea that a person will do whatever it takes to get what he or she wants, wits believe that communities have to stick together to improve the common good, and that one person’s well-being is intimately connected to that of his or her neighbor. Most of us strike a balance between these two, and we need to appeal to the wit philosophy when framing the need for reform.

“If they can get you asking the wrong questions, they don’t have to provide the answers.” Dr. Wallack reminded the audience that we need to stop being distracted by questions that cannot be adequately answered and focus on framing the debate in terms of values that all Americans hold in common. He cited Lakoff’s three levels of analysis:

  1. Big ideas and universal values like fairness, equality, justice, family, community
  2. Issue types such as housing, education, etc.
  3. Specific issues such as beer taxes, toxic waste sites, and health care coverage

During debates, progressives tend to argue from level three down, while conservatives argue at level one. Wallack argues that if we frame the health care issue at level one, we will have success at level three.

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