Health Promotion Advocates: Initiation, Introducing Legislation, and Exploring for the Future

The first stage of our advocacy effort is about to end and the next two stages have already begun. This is a time for reflecting on where we are and retooling to make sure we can move forward as planned.

Initiation
The first stage in our advocacy effort included beginning to build a coalition of individuals and organizations and learning about the advocacy and legislative processes. Our structure consists of an executive committee and six subcommittees which are staffed by 35 talented volunteers. We have attracted 84 organizations to endorse our efforts. Our grass roots network of advocates consists of 275 people in 40 states. We have a website, briefing documents, logo, and a newsletter. Considering that we started with just an idea, this is an impressive organization. However, it is not without its weaknesses. We have no outside funding and the financial burden falls completely on the members of the executive committee. Most of the real work is done by a handful of committee members. Only a third of the grass roots advocates seem to really understand the advocacy process and have responded as promptly as necessary to our "calls to action." We have no advocates in 10 states and approximately 200 congressional districts. All of these weaknesses can be improved, and need to be improved in the next year. In early 2001, we introduced resolutions in the United States Senate (S Con Res 11) and the House of Representatives (H Res 115) which called for utilizing the powers of the federal government to develop the science base of health promotion and integrate health promotion into all elements of society. We utilized these resolutions to provide our grass roots advocates with the opportunity to meet the legislative staff of their Senators and Representative, and to educate members of Congress on the benefit of making health promotion a central feature within federal health policy. In the Senate, as of October 2, 2002, we attracted 49 Senators as co-sponsors of this resolution. This is about three times more than most resolutions attract. More importantly, we attracted a majority of the members of the two committees most important for our future work, the Health, Education, Labor, and Pensions Committee (15 of 21 members) and the Appropriations Committee (17 of 29 members). We also identified a handful of likely champions. In the House, we were not as successful attracting co-sponsors because we were not effective in matching our grass roots advocates with Representatives, and thus in targeting communications efforts toward specific Representatives. We attracted only 57 co-sponsors. However, we did get to know the staffs of the leadership of the important committees, and identified champions to work with when we introduce the Health Promotion Research Act. All in all, our initiation period was very successful. We formed the beginnings of a good structure, developed and tested some protocols, trained a lot of people within that structure, raised the visibility of health promotion within Congress, and formed good working relationships with a number of members of Congress. We have flaws in our system, but we know what they are and how to improve them.

Introducing Legislation 
Our next stage is to compose and introduce the Health Promotion Research Act. This legislation will provide approximately $200 million dollars to develop the basic and applied science of health promotion. We expect approximately $5 million to fund coordination of the effort, probably through the Secretary's office within the Department of Health and Human Services (HHS); $60 million to fund a trans-institute initiative at the National Institutes of Health (NIH) to develop the basic science; $120 million to fund programs in the National Center for Chronic Disease Prevention and Health Promotion and the Office of Extramural Research within the Centers for Disease Control and Prevention (CDC); and $15 million to fund synthesis and dissemination of research findings, probably through the Agency for Healthcare Research and Quality (AHRQ), Health Resources and Services Administration (HRSA), and the HHS Secretary's office. (This bill is described in more detail in my May/June, 2002 Editor's Notes, and on our website at www.HealthPromotionAdvocates.org.) Approximately 75% of these funds ($150 million) will flow through these agencies back to the health promotion community in the form of contracts, grants, and collaborative agreements with universities, colleges, think tanks, and other not-for profit and for-profit health promotion vendors. We are working with the legislative directors of each of the above HHS agencies and the staffs of a number of members of Congress to develop this legislation. We hope to have the bill introduced in the first quarter of 2003 and have it passed by the end of 2003. People attending our February 17-21, 2003, Art and Science of Health Promotion Conference in Washington, D.C., will have the opportunity to encourage their Senators and Representatives to support this legislation through a series of visits to Capitol Hill.

Exploring the Future 
We have chosen the Health Promotion Research Act as our first legislative issue for three basic reasons. First, we feel that a solid structure needs to be in place to continually enhance the science base of health promotion before we encourage large-scale expansion of health promotion programs. Second, we believe passing the Health Promotion Research Act is achievable because the cost is relatively low compared to other health-related legislation being considered by Congress, and Congress has historically viewed investments in health-related research very favorably. Finally, we believe it will be relatively easy to attract support from grass roots advocates to support this bill. Assuming we are successful in passing this bill during 2003, we need to start thinking about what we should advocate next. We will be following the four-step process described below. Dr. Richard Bellingham, Senior Vice President of People and Culture, PTC, will facilitate this process. We hope to have this process completed by the end of 2003. 

(1) Identify who to involve and invite them. This step will require an exhaustive look at all key stakeholders on this issue. First, we will attempt to identify all of the professional associations, advocacy groups, voluntary agencies, foundations, government organizations, colleges and universities, and other groups, as well as prominent individuals involved in health promotion. Next, we will decide how to invite their participation in this process and how to communicate with them as the process unfolds. Our goal is to make this a very inclusive process. The only criteria for participation is that participants must support our mission "To promote healthy lifestyles among Americans and thereby reduce medical costs and utilization, improve quality of life, and enhance productivity" and our vision of "A world in which health promotion is integrated into all health professions, and all elements of society, and all people have the opportunity to practice a healthy lifestyle." 

(2) Determine the issue options. This step will involve communication with all participants to ask them to review three current ideas and to add new ideas to the list. The three current ideas are (1) health promotion for older adults, possibly through the Medicare Wellness Act, (2) health promotion programs for children, possibly through the schools, and (3) programs for high risk populations. After expanding this list, we will review it and decide which issues we should pursue further and which to leave off the list. We will inform the group which issue(s) made the list, which didn't, and why. 

(3) Refine the criteria. This step will involve communication which explains the current criteria: (a) contributes to our mission, (b) has a realistic chance of success given our resources and support with congress, and (c) meets the needs of the people at the table. In short, the criteria are that the issue selected needs to be meaningful, doable, and desirable. We will ask people to comment on the criteria and possibly add one or two criteria, but we need to be clear that we will be using a small list of criteria to make our selection. 

(4) Choose the issue. This step will involve using participants' comments to identify the issue which best meets the criteria.

We are still refining the overall process, but have already started to identify the groups and individuals to involve. We welcome your participation in the whole process, starting with your suggestions on what groups and individuals should be involved, including yourself and your organization. To become involved, send complete contact information for yourself and the group(s) and individual(s) you recommend to Dr. Richard Bellingham, Senior Vice President, People and Culture, PTC, 140 Kendrick Street, Needham, MA 02494; (781) 370-5234; rbellingham@ptc.com.

Can We Succeed?  
As I ponder this endeavor, I am struck by the magnitude of the task before us, and the impact it will have on society. I am also confident it is within our grasp. If we are successful in transforming this vision into reality, health promotion will occupy a prominent position in the health care system, and we will improve the quality of life of millions of people. This is more than any group could expect to achieve in a lifetime. However, there are countless examples throughout our nation's history of small groups of people with fewer resources, less passion, and less worthy causes stimulating even larger shifts in the course of events. If they can do it, we can do it.

Michael P. O'Donnell, PhD, MBA, MPH
Editor in Chief, American Journal of Health Promotion