One of the policy statements the Governing Council adopted at APHA’s November 2007 Annual Meeting addresses a major federal health policy calamity of which not only the general public but even the public health community and advocates have been largely unaware. The calamity is the programmed dismantling of traditional Medicare by the 2003 “Medicare Modernization Act” (MMA). That law was enacted with such stealth that it is widely misunderstood to be simply a “Medicare prescription drug law.” The policy APHA adopted in November includes a broad set of legislative recommendations aimed at undoing the MMA’s damaging provisions.[1]

What soon followed is an instructive example of the potential of a new APHA policy to inspire a valuable initiative by another organization. By the happenstance of one person’s overlapping memberships (full disclosure: I was that person), the new APHA policy quickly came to the attention of an organization, Rekindling Reform, that was already concerned with the destructive impact of the MMA on Medicare. Rekindling Reform recognized APHA’s recommendations as the potential core of a national campaign to save Medicare. As a result, formation of a coalition of key national organizations to that end is now well under way. (APHA has of course been invited to join.)

For APHA, there should be two take-home lessons: the immediate potential of a fresh APHA policy to stimulate important action by other organizations; and the value of publicizing new policies promptly to take advantage of time-sensitive opportunities – for possible action by APHA member units or unrelated organizations, impact on public debate, impact on state or federal legislation/regulation, or the like.

The foregoing experience has prompted me to reflect more generally on ways to increase APHA’s effectiveness in the policy arena. We see ample indications of how seriously APHA takes policy. But, as I will suggest further on, there are possibilities to do more.

Current evidence that we take policy seriously

·         Members, membership units, volunteer committees and the Governing Council invest extensive time and energy in drafting, critiquing and refining policy drafts before approving new policies. Further, there is substantial investment in reviewing old policy for timeliness and scientific validity, often leading to the “archiving” of policy that is deemed outdated.

·         A small but able, dedicated staff acts on our policies by educating and lobbying government officials, issuing blast e-mails to induce APHA members to act similarly, and coalescing with other organizations with whom we share objectives as reflected in policy.

·         APHA Annual Meetings often feature sessions on advocacy and lobbying skills.

Dimensions of strategic policy work

When objectives and policies are clear, a strategic plan for policy work needs to include, among others, these three dimensions: potential pathways for impact, potential mechanisms for impact, and alternative time frames. In the following outline, I highlight the areas that offer the most room for improvement:

Pathways for APHA policy impact

1. Staff initiatives
2. Member unit initiatives
3. Stimulation of initiatives by others, outside of APHA

Mechanisms for policy impact

1.       Coalition development

2.       Educating the public or professional communities

3.       Visits and other communications to officials

Time frames for policy-driven strategies

1.       Near term

2.       Longer term

As to pathways, my sense is that APHA rarely if ever appreciates its potential for stimulating action by other organizations. Indeed, it appears that some Executive Board members last year voiced the view that what other organizations do on an issue is not APHA’s concern. How could APHA build support for its proposals if it took that position?

As to mechanisms, we know that APHA often joins advocacy coalitions. I am quite unclear about how often it initiates one. When it neglects a coalition building opportunity, its own position gets less support than it merits and could realize. Yet, typically, focus is limited to our own communications with officials.

On the matter of educating professionals, a bigger role for The Nation’s Health could be a place to begin, with a series of 500-word articles about the new policies to be published during the first half of the year. TNH staff could write the articles in consultation with the policies’ authors. Articles could suggest possibilities for reader involvement.

With regard to the time frame of strategic thinking, I can’t recall an example of longer term strategic policy thinking by APHA beyond its designation of three priority areas[2] for policy work. Given the focus on these priority areas, there should be room for longer term strategic thinking in each area, particularly in developing coalition work.

Setting priorities for advocacy

We need more transparency in APHA’s assigning of advocacy priorities among policy areas. Choices appear driven mainly by near term legislative opportunities and traditional externally initiated coalitions. Rarely if ever are opportunities pursued for major campaigns by nontraditional coalitions on such key determinants of population health as poverty. APHA priorities are better aligned with the perspective of traditional public health agencies than with holistic strategies to protect and enhance population health.

Timely publicity on new policy

For reasons never adequately explained, the sparse press releases about policy action at the November meeting failed even to list all of the issues addressed by new policy. Such omission misses opportunities to generate media interest that could enhance coverage when full text is released later. As already noted, it also risks missing time-sensitive action opportunities. Copy editing of final policy text took two months. An investment to speed this up would be worthwhile.