Share Public Health Transcript: Advocacy, Celebrate Every Win

Season 2 Episode 3

Deborah Thompson: Welcome to Share Public Health, the Midwestern Public Health Training Center’s podcast connecting you to topics, issues and colleagues throughout our region in the country, that highlight what we all share in public health. Thank you for tuning in to this series that focuses on public health advocacy.

Hey, public healthers, thank you for tuning in to this episode of Share Public Health. My name is Deborah Thompson, I’m a public health advocate and for eight years, I was the point of contact for legislators at Iowa State Health Department. These days, I spent my time volunteering for the Iowa Public Health Association’s advocacy committee with my dear friend Hannah Shultz who’s the producer for this podcast series, and I’m your host. This is the second of four episodes about advocacy. In this series, we’ll explore the motivations public healthers all over the Midwest feel about advocating for their craft. They’ll give us advice on how to be successful, and they’ll ask that you consider finding your voice to aid in our collective efforts to promote and improve the health of the Heartland. Thank you for listening and your feedback is welcomed. We’re going to start today’s episode with Becky Tuttle. Becky proudly serves her community as an elected official on the Wichita City Council in Kansas. Her resume as a public health professional is extensive, ranging from school readiness to tobacco prevention, and she’s successfully moved across sectors to promote healthy choices. So thank you to the citizens of Wichita for letting us borrow Becky for a bit.

Becky Tuttle: And I’m Becky Tuttle and I’m currently serving on the Wichita City Council representing district two. I represent about 70,000 constituents in our northeast portion of our great city. I consider myself to be a public health professional. I started my career working in schools. After that, because I realized when I was working in the schools, instead of just focusing on trying to make kids better, maybe we should focus on trying to make the community better for kids. And so then found a position where it was a bridge between the community and the schools. And that was really my first experience working in public health was actually housed at a local health department. And then went to work at the Kansas Department of Health and Environment in the tobacco use prevention program and became the Quitline manager and started the Kansas tobacco Quitline. But for a little bit, I was also the media and policy coordinator. So I got some more experience with policy, especially with trying to get our great state to go tobacco-free, to go smoke-free. Fighting for clean indoor air at the community level and then at the state level. And then I spent some time at our local health department and had a great experience working in health promotion, but also with the accreditation process, quality improvement, strategic planning, and worked at the Medical Society of Sedgwick County. Again, most people wouldn’t consider it a public health path, but was coordinating a federal grant to prevent obesity, diabetes, heart attack and stroke. And then I went to our Greater Wichita YMCA, where I was the Executive Director of Community Development. And I tell people, it was all things not swim and gym. So all of our outreach programs, our urban outreach, youth employment, which is obviously public health issue, also our disease management program, worksite wellness, healthy eating and physical activity. So now, I was appointed to fulfill the last year of of term in City Council in January of 2018. And in November of 2019, was successful in a campaign and now I’m serving on a four-year term the City Council.

Deborah Thompson: Let’s listen to Becky’s thoughts on our shared responsibility to advocate for public health, no matter the real or perceived barriers. Remember, if it can’t be you, then find your allies. Funders and elected have to know about the work we’re doing so they find it valuable. Trust me listeners, most of them will find it valuable, but we got to help them connect the dots.

Becky Tuttle: Absolutely, we have a responsibility. And I’ve worked at the local level in the local health department, I’ve worked at the state level at the state health department. So I understand that it’s tricky, especially when you’re funded by public dollars that you can’t maybe always be the actual advocate. And some will say what you do in your free time in the evening is your own time. But I understand living in a community… Greater Wichita I hear is about 500,000 people but still people knew who I was, they didn’t just say, oh, she works at the health department but, so I had to toe that line. But even if you can’t be the voice for the advocacy, you can find people to be the voice for the advocacy work. So I often say where people live, learn, earn, play and pray. So if we were working on an initiative, let’s say Clean Indoor Air, and at the time, I worked at the state health department and I worked at the local health department. I never went before the elected body when it was happening, but I got people to go before the elected body. And we got people from faith-based organizations or the YMCAs or education, or businesses, whatever it may be, who could be the voice that I could not be. Unfortunately, in much of public health funding comes from the government level. And so we need to make sure that we have a loud local voice, if you will, that they know that the work that we’re doing. You mentioned, about public health, what I always say is, people recognize public health, when there’s the absence of it. When it goes away, then they go, “Oh,” so we have to work really hard to make sure that that doesn’t happen. And people know how important it is. And again, that public health is not just for one segment of the population, public health impacts everyone in every community, every state, everyone in our nation everyday, whether they recognize it or not. I joke with our public … I just had a meeting today with our public works director, think water, roads, bridges all of that. And I tell him, you’re a public health professional, you just don’t know it, right? Because they’re working on things that are so impactful, and if we didn’t have quality roads, or bicycle and pedestrian transportation options, or whatever it may be, clean water, sewage. They’re doing public health work, they just don’t know it. So building some of that common ground as well. More public health professionals need to do what I did, and need to take the leap not only of being advocates, that’s fantastic, but I would love to see many more benches across the state, across the nation filled with people who are have a public health background. And that’s something that’s daunting and scary and if anybody ever wants to call me at any time, or email me and talk about what’s it like to be an elected official from my perspective, I’d be more than happy to spend some time sharing it. But I’m really glad that I did it and I think I’m obviously doing impactful work. I was doing, sometimes I think, more impactful work before. But more public health professionals not only need to be advocates, but they also need to think about being elected officials and lead your community and your state with your public health hat on.

Deborah Thompson: Public healthers, if you run for office, you’d have my vote. Now, it’s been said before that public health is not for sissies, you have to be tough, you have to take the good with the bad and you can’t get discouraged. Advocacy is no different. It’s absolutely necessary, but it is equal parts, frustrating and rewarding. You’re not always going to get what you want. And sometimes the wins are going to take a lot longer than you have the patience for. That’s why it’s critical to celebrate small victories to stay motivated. Remember, you’ve been called to a lifelong marathon with no finish line. Burnout is not an option, because candidly, there’s just not enough of us. Becky recounts her wins and losses and the lessons she’s learned along the way. Let’s listen.

Becky Tuttle: I helped lead our fluoride initiative. Wichita is the third largest city in the nation that does not provide fluoride in our water to the optimal level. So by no big surprise, we also had the third highest caries rate for elementary school children in the nation. We were not successful in that initiative, and I learned as much from that initiative as the successful ones. I’ve also worked significantly in the built environment, and been an advocate and also a fund seeker to help develop our 10-year master bicycle plan our 10-year master pedestrian plan. And help launch Bike Share in our community, which was a huge win for the city of Wichita. And then I’m really also involved in healthy eating initiatives. In 2013, did some research with other folks and found that 25% of our population lives in a food desert. We have 44 square miles of food deserts within the city of Wichita. And now we’re an [inaudible 00:09:21] to champion a 10-year master food plan for the city of Wichita. And I was at a meeting a couple of weeks ago where we’re still plugging through this work even in the COVID environment, and somebody said, “We’ve been doing this for five years.” And I said, “I know it’s only taken five years.” And a lot of people on the call, the Zoom meeting, if you will were taken aback by that. But I understand that sometimes these aren’t quick technical issues that we’re dealing with where there’s just a fix. If you have a flat tire, you know exactly what to do, you change the tire. But when we’re looking at big systemic issues, it takes time and it takes multiple people with different seats on the bus and realizing the change in environment. But just having a lot of tenacity and making sure you’re keeping your eye on the end goal, keeps hopefully people motivated and keeps them with you as you keep pushing forward. So I think having an understanding of this isn’t going to be easy, and it’s not going to be fast in the very beginning, sometimes can help keep people engaged in the process. I think sometimes people always think if you’re doing advocacy work that you have to change an ordinance or resolution or law to have a win. And what I found is that, there’s a lot of little wins along the way to get you to the big win. And I talk a lot about little P versus big P. and little P is focusing on where people live, learn, earn, play and pray. So for example, I – and I always go back to Clean Indoor Air, because I think it’s something that a lot of public health professionals can resonate with – but we didn’t just go to the state and say we want to Clean Indoor Air law, thank you. First, we went to the schools, and we got the school grounds to go tobacco-free, smoke-free. And then we went to hospitals, because that makes a lot of sense, who should be smoking in a hospital? And then we went to businesses and got some pushback, especially from the hospitality industry, but these are going to be the benefits of you going smoke-free. And then also not-for-profits, and even in people’s own homes. And so we had a lot of small victories that added up so that when we were trying to go to the elected for the city, we could say, look at all of these wins we already have, it’s just the next step in the progress of protecting the health of the community. The schools have done it, the hospitals have done it, work sites have done it, not-for-profits have done it. So now let’s take it to the next level and make it a more comprehensive win. So it’s not always just going straight for the big, you got to get a lot of little wins along the way.

Deborah Thompson: Throughout this whole podcast series, the theme of building relationships has dominated in our interviews. That’s because changing the status quo, even for the better is a heavy lift. And be honest, you wouldn’t help a stranger move. Pack up their heavy boxes and move them across town. But you do the heavy lifting for a friend. Knowing your elected officials prior to an ask is key to accomplishing your goals before you even know you have them. It’s reciprocal, though, we’re a resource for them too. We know things that they don’t know about the health of their community, we have the power to help them be better public servants too.

Becky Tuttle: You need to build your friendships before you need friends, especially if you’re doing work in this arena. It’s best if you already have a base of constituents, a base of stakeholders, and then also a base of your elected officials, already a relationship established. So that way when you’re going to go and talk to them and get their advice on how to proceed and understand where you are, in terms of how likely your initiative is going to be successful. And an example of a time when it didn’t go well for me was, as I mentioned, working in fluoride, and trying to get our community to optimize our water fluoridation level to the optimal level. And so that we could… And truly for me, it was an equity issue to make sure that everyone in the community has access to one of the essential… We know it’s one the public health wonders if you will, like seat belts or Clean Indoor Air. And we didn’t win, we weren’t successful, we lost and ended up being 54 to 46%, it ended up going to the general vote. And so it was a little bit not only disheartening for me being involved in the initiative and the coalition being involved in the initiative, but then also trying to rebuild our trust and our case, if you will, with the public health, excuse me, the electeds in our community. We were champions for Clean Indoor Air and got a lot of good relationships established, but then when we lost an initiative, we realized that we had to go back and remind our electeds that the public health community in Wichita was a trusted, neutral and reliable source. And even though that initiative wasn’t successful, there are going to be other things that we continue to push forward and work on.

Deborah Thompson: Becky Tuttle is a rare gem. It’s uncommon for elected officials to have any knowledge of the public health sector upon entering into office. It is common for them though to want to do right for their constituency. And this does include their health. Becky offers some tips to show them how the work you do benefits their constituents. You know, the people who vote for them every few years.

Becky Tuttle: When elected officials are making decisions, they’re representing their constituency. And so as a public health professional, if you’re going to take something to them that’s a policy initiative, you need to show them why it’s important to their constituents and how it would help them to benefit their constituents. I think sometimes public health professionals we forget that, we just think, “Oh, this is the way it should be, the science and data tells us that”, but not everybody is a public health professional. And I do a lot of advocacy presentations in the community and I always preface it by saying, assume that your elected officials do not know what you know, because I guarantee they don’t. And for example, right now, in our city council, one of our electeds, one of my colleagues is a real estate agent. He doesn’t know anything about public health, but he’s open to it, and he wants to learn about it. But you have to present him the information in a way that he knows. Just like when realtors come to me or developers come to me as a elected and they want me to do something, I sometimes have to go, “Okay, you got to give me the 101 because I don’t even know what you’re talking about.” So making sure that they don’t ever assume that electeds know what you know as a public health professional, they don’t.

Deborah Thompson: Becky’s also participated in events that simultaneously educate elected officials and the public. What a great way to feed two birds with one seed.

Becky Tuttle: I helped to lead and champion, a candidate forum on health. And I think we’ve done it six years in a row now. And at the time, it was kind of a foreign concept in our community. It had never been done and I think even the electeds that were running are like, “What is this? We don’t do anything with health, we’re city council” or whatever. And so just like arts and education, and businesses, they all have forums, or they endorse candidates in some way, we bring, every year we bring the candidates who are running for city council or county commission to a forum. And we ask them questions like, what do you think the biggest public health challenge is in the community? If you’re elected, 1% of funding for transportation in the city of Wichita right now is dedicated towards active transportation. If you were elected, what percent would you recommend? Or how would you address food deserts? But the other thing that we do that is, I think, really good is that we send them the questions in advance with the links to where they can find the answers, such as our community health improvement plan, or our work on food deserts, or whatever it may be. And so a great example of a success was – this would have been like five years ago now, I think. We had … it was the city council. And we sent them the information on food deserts, and asked them and had the forum and gave them time, and we do with the League of Women Voters, and it’s a really formal professional forum and process. And I remember one of the candidates coming up to me afterwards and saying, “I didn’t even know we had food deserts. I’ve read the whole food desert study. This is fascinating. Why aren’t we doing more?” And so our thought is, not only are the people who are watching the forum, able to learn about the candidates so they can make better decisions, you’re also educating the candidates. So then they have more tools in their tool belt and a better understanding of public health initiatives. And this is something that we do with little or no cost. It’s just some sweat equity from some public health professionals who really care.

Deborah Thompson: What are the unintended consequences? Make sure you’re ready for this question from elected officials. It’s a popular one. I’ve heard it regularly myself, and it might help you catch something you’ve missed. After all, it’s better to prevent problems before they start. Right? Becky explains.

Becky Tuttle: One of the things that we say, as electeds in my community, and I hear all the time from my colleagues is, what are the unintended consequences? So if a really well intentioned group – public health or education or whatever it may be – comes to us and says, “We want you to do blank.” In our minds we’re thinking, yeah, okay, that sounds great, but what are the implications that may come from that? And if I can share an example, almost immediately, when I got appointed, I had a bike-ped advocacy group come to me. And they knew my background, and so they picked me to come to first, and they wanted to pass an helmet ordinance in our city. And I think they just assumed that I was going to say, “Yep, I am a huge advocate for bicycling, done a lot for the built environment, let’s having helmet ordinance.” And I actually said, “No, I’m not going to champion this for you. I believe in helmets. I am a huge advocate for helmets. I’ve given away free helmets for five or six years. But if you ride your bike, you got $1,000 bike and you ride 100 miles on the weekend, you can afford a helmet. If your only form of transportation is a bike or walking or maybe using public transit, you probably don’t have a helmet because you can’t afford a helmet. And so now we’re going to fine people for not having helmets who already can’t afford it.” So the unintended consequences to me didn’t outweigh the policy work. And so just thinking like that. There’s always the expression of, the movers and the shakers, you want to work with the movers and the shakers. And I’d say all the time, I want to think about and work with the moved and the shaken. Who’s going to be impacted by the work that we’re doing, and what it’s going to mean to them at the end? So really digging a little bit deeper. And I think most good elected officials are thinking of that and thinking of the unintended consequences. And for me, for example, there are some people who are a one-cause profession. Because my work was in health promotion and focused on physical activity, healthy eating, oral health, fetal infant mortality, worksite wellness, whatever, I had a broader scope. So I was always keeping my finger in some sort of policy initiative for public health and just trying to keep the balance. And then also, you don’t want to wear people out, including your electeds. If you do something, and then you win, or you don’t, and then two weeks later, you come right back to them again, it doesn’t look strategic or methodical. So thinking about what’s the environment in the community, what’s going on in the community, what’s going to benefit the community and in the most impactful way, and not just throwing a bunch of stuff out there and seeing what sticks. So it kept me focused too on, okay, these are the one or two things that we can work on and do well, and then we’ll move on to the next.

Deborah Thompson: As the saying goes, “hindsight is 20/20.” But it’s also true that different perspectives offer different lessons. Becky spent years advocating and lobbying elected officials, now she is one. We asked how she’s looked back on some of her tactics now that she’s on the other side.

Becky Tuttle: I did some things really well, and it’s made me think, ooh, I just did things really poorly. Just knowing and thinking about timing. Also, again, I say this all the time, but the building friendships before you need the friends. There are groups and organizations that come to me, who are interested in different platforms that they have and I know them, I respect them, I trust them. And then other groups, and I’m like, “Where did you come from? And what is this?” So those are some of the things that I think that initiatives that I’ve been involved in have done well, and that’s why they were, for the most part had been successful. I do think timing is really key. Some people are coming to us now, like I said, in the COVID world with wants and we’re like this probably isn’t the time we need to focus on that, we’re just trying to protect the health of the community. One thing that did come back to me and my public health professionals and my colleagues and City Council [inaudible]. In 2015, the majority of our Sedgwick County Commissioners presented a budget that was going to slash the public health department and specifically the programs that I was involved with. And so we developed an initiative, we developed a coalition of coalitions building a case for public health, really moved forward with an educational opportunity to remind the community what public health was and what it was not because there was a misconception that public health was just for – and I’m using my quote fingers – “poor people”. And the majority of our County commissioners thought that too. And so really educating that public health is for everyone. I remember a County commissioner asked me how many people in the community I served as a public health professional, and I said, every single one of them. Because everybody’s impacted by public health, whether you walk in front door of the health department or not, you’re being impacted by public health. But one of the things that we help do is for the budget hearings for the County, we packed the room with probably 75 folks who talked about the impact of public health and what it would do if these positions were cut. And now as an elected official, when people come and pack the room, whether it be they want masks or they don’t want masks or they want to defund the police or fund the police, I’m laughing going, “okay, I guess this is karma coming back to me”, because now I’m sitting here with this packed room of 75 people who are passionate about an issue, and it’s what I used to do to them. And I think sometimes as public health professionals, we just think, “oh, it’s what we do” but people need to know what you do and recognize the importance, and then also not just to public health – tie it back to economic development, tie it back to attracting and retaining talent, attracting and retaining businesses, whatever it may be. Companies will move to a city because it’s a healthy community. Companies will stay in a community that’s healthy. And we don’t oftentimes do a good enough job of making that dotted line a little bit more solid so that elected officials understand that.

Deborah Thompson: In her previous example, Becky talked about building a coalition. Even a coalition of coalitions. So we asked her to talk more about their importance and what’s key to building a successful one.

Becky Tuttle: Coalition work is something that I’ve done for years and I tell people it’s like nailing jello to a wall. It’s messy, but it’s a lot of fun, right? And coalitions truly to me are the way that community mobilization and things get changed. And I see that even more clearly now being an elected official, and even more than when I was boots on the ground, leading the initiatives. But, if you think about any typical coalition that you go to, the only reason that those people are in that room together, in that environment together, striving for that cause together, is the common goal of they want the same thing. For the most part, those same people would never be together on an initiative if it wasn’t for that cause or that issue that you’re working on. So just making sure that people have a common goal, they have a common end in sight. I tell people all the time, if I was going to leave Wichita and trying to get to New York City, if everyone on the coalition was going to say, we’re going to leave right now and get to New York City, all of us might take a different path to get to New York City, but we’d all end up in New York City. So just making sure that we all know what the goal is, celebrating the small successes and wins along the way, but then also understanding when challenges happen, or if things don’t go the way we would, what lessons can be learned. And sometimes there isn’t always consensus of the group. And I’ve had different initiatives where we’ve had partners who had to walk away, because they said, “qe’re not going to be able to get everything we want from this so we can’t stay at the table”. And that’s okay, but always to bringing in new people. And one of the things that I’ve done too, when I’ve been involved in coalition work, and if we know we’re trying for a city ordinance let’s say, is to say, how many people have been to a city council meeting? If you haven’t, we’re going. How many people have met with your electeds? If you haven’t, we’re going. Our database that we have for coalitions especially … I’m chair of the Health & Wellness Coalition of Wichita, still even as city council member and we focus on healthy eating and physical activity for every generation living in the Greater Wichita area. And our database of members is sorted, we have their name, first and last name, email address, we also have their address, and then the last column is what city council member district they live in. And we keep an eye on that too, to make sure that if we do need to go talk to, let’s say, council member in district one, it may be the chair of the coalition, but it’s also constituents for district one. So when people think about the coalition work that they’re doing, thinking forward of making sure that you’re getting a really large scope of the community on the coalition, so that when you have an issue and you need to go talk to an elected official, it’s always best if you could take one of their actual constituents with you.

Deborah Thompson: Becky’s passion is contagious. I admire how often she stepped up for her community. Listening to her is extremely motivating and that’s what this series is about, finding your advocacy voice and walking in your motivation. We’re all advocates and we all have a sphere of influence to tap into. And I definitely agree with Becky, we need public healthers in more places where decisions are being made. Thank you for role modeling civic service, Becky, I wish I could vote for you.

Now our next interviewee is Cathy Callaway. Talk about influence? Cathy Callaway is one of the most influential voices on tobacco use prevention policy in the United States. She’s the director for state and local campaigns for the American Cancer Society Cancer Action Network. Here in Iowa, she led the charge on our state’s Smoke-Free Air Act along with many other partners. Thanks to her, we can breathe easier indoors. Listen closely to her words of wisdom.

Cathy Callaway: Well, I work for the American Cancer Society Cancer Action Network, and I am the director of state and local campaigns. So what I do is I work with all of our staff and volunteers throughout the country on prevention campaigns. And underneath that prevention umbrella includes tobacco control, healthy eating, active living and environmental issues and we do some skin cancer policies as well. I went to Iowa State University and I graduated with a degree in community health education. And from there, I met some wonderful people that worked at the American Lung Association of Iowa, and so I started my career there. Towards the end of my career at the American Lung Association was when the state attorney general sued the tobacco companies that resulted in the master settlement agreement, and that was my entry into the advocacy world.

Deborah Thompson: Cathy’s been working on tobacco control policies for many years. Think of her as David in the fight against a well-funded Goliath that is the tobacco industry. But if Cathy can experience successes against this gargantuan opponent, imagine what you can do in your fight. Be inspired listeners.

Cathy Callaway: With tobacco control, we have a very well-funded opponent with Big Tobacco. And I think it is, if you look, historically, there’s been a lot of ups and downs in tobacco control policy and tobacco use. And we can certainly track the trends in tobacco use in line with where the tobacco companies are spending their marketing dollars and how they’re marketing their products. It seems like over the years, it seems like every time we put a policy into place, the tobacco industry either finds a new product, or they find a new way to work around those policies that we’ve put in place. They’re extremely savvy, and they have a lot of money, like I mentioned, they also have a lot of attorneys. It seems every time we pass a policy, they’re filing a lawsuit against the policy in order to delay implementation of any effective policies in order to protect their bottom line. So I think over the years, we have had a lot of success but the industry continues to evolve and we need to continue to evolve as well, not only in our policies, but in how we approach elected officials about passing the policies that we’re working on in order to be successful. And I think we have to be in it for the long game. The tobacco industry isn’t just going to pack up and go away. So I think it’s really important that we do look at the incremental progress that we can make. I think it’s important as we plan campaigns that we build in opportunities for success. It can be very frustrating to try and pass a policy when you don’t have the support of the governor, when you don’t have support of legislative leadership, and it can just feel like you’re banging your head up against the wall to no avail. So I think it’s very important to figure out where you can factor in those incremental wins or that incremental progress. It doesn’t always have to be a policy win. But it can be building your coalition, it can be little steps towards that policy win, getting organizations to sign on in support of the policy. It can be passing local resolutions in support of a statewide policy, it can be passing local ordinances. I think that is one of the hallmarks of success in the tobacco control movement is working community by community and passing those policies, doing that public education, building that momentum, to reassure state lawmakers that the sky isn’t going to fall if they embrace a certain policy and implement it statewide.

Deborah Thompson: Maybe it’s better to say that the tobacco industry is like Medusa. Seems like they can regrow their snake heads too, my goodness. Many campaigns that Cathy’s been a part of just haven’t gone the way she’s wanted. This will happen to all advocates, including you. Cathy has some great advice for how to handle setbacks.

Cathy Callaway: Sometimes I think it’s okay to put a campaign aside and work on something else where there is feasibility. It can really be frustrating to individuals and to coalitions to just bang your head up against that wall. And in order to keep people from getting frustrated and leaving the movement, it’s finding an avenue where you can be successful or where you can have that success. And sometimes that means we’re just not going to work on raising a tobacco tax this year, we’re going to look at doing something else. And I think going into 2021, with everything that’s going on in the world, I think it’s going to be really important to protect things that we have in place. I think money is going to be tight, I think we’re going to have to defend the appropriations that we’ve advocated for for years, and now more than ever, we need to make sure that people have access to health care. And I think that’s really going to be important. And I think we need to go in, into it with our eyes wide open and looking for those opportunities that may not be exactly in line with what we’re hoping to do at this point in 2021. When we’ve killed bad legislation, that’s a win in our book. It’s not just getting a new law in place or something new, but if we can stop something bad from happening, or stop funding from being rolled back, those are wins as well. And I think it’s important as leaders of campaigns and leaders in public health, that we’re adequately communicating that to people that we’re working with. So that it shouldn’t be seen as we didn’t get anything new this year, but if we protected bad things from happening, that’s big.

Deborah Thompson: Remember, earlier, when Becky Tuttle said that electeds only know so much? Well, Cathy agrees. Elected officials know a little bit about a lot of things, and public health needs to be one of them. But public healthers, have confidence when talking to these people, that you are the subject matter expert in the room, you are the knowledgeable one and knowledge is power.

Cathy Callaway: When you’re dealing with elected officials, I think it’s important to remember that they know a little bit about a lot of things. They are not going to be the experts that we are on a certain issue in public health. And so I think it’s important to have patience, it’s important to speak to elected officials, to meet them where they’re at. Find out what they are interested in and educate them without overwhelming them. I think … it’s also the process of how policy happens. We don’t always have to pass a law, sometimes we can do things through rules and regulations. And I think just educating volunteers and coalition members, it can be very frustrating if you don’t know what the process is, and if you can lay out that process, I think that helps set expectations, as well as timelines and I think it also can help lay out when you get those wins. Like if you get a bill sponsor, that’s a win. If you get a bill introduced in the committee you wanted it introduced in, that’s the win. And all of those little baby steps should be celebrated as wins I think.

Deborah Thompson: Listeners, did you know that you’re doing something right when you’re sued? Cathy, thinks so. Here’s more.

Cathy Callaway: A lot of what I do in my role is help states plan their legislative campaigns from the very beginning of doing public education around the issue, to full blown implementation and defense of a policy. And I think preparing… You know you’re doing something, right when you’re sued, when there’s litigation against you. And not every lawsuit is going to be as big as the master settlement agreement against tobacco companies. I mean, right now, throughout the country, big tobacco is filing lawsuits against ordinances and even a California state law that would regulate the sale of flavored tobacco products. And so we anticipate that, we know when the industry is going to sue, we build that into our campaign. But it’s incredibly important on both sides, I mean, the American Cancer Society Cancer Action Network, has along with our public health partners, has sued the Food and Drug Administration for how they’re handling the regulation of the E-cigarettes. And that’s very important because that moves the agency to do something, to change the way they are regulating the product. And I think on the flip side, when the tobacco companies sue, when court decisions are made, that gives us the path going forward. If they win, we know we have to adjust, if we win, we continue to go forward. So it’s a very important part of the public health process.

Deborah Thompson: Public healthers how’re you feel about politics these days? Not only does it feel divisive, and incredibly counterproductive in a pandemic, but there’s so much money involved in the political economy, too. It’s really hard to gain influence without a king’s wealth it seems. We may as well be the monopoly guy with our pockets turned out, or worse yet, Oliver Twist asking for more porridge. Cathy suggests that we look to local leaders instead. You know, our neighbors who happen to be the mayors, city councilors, county supervisors, or members of the local boards of health. Not only are you from their neck of the woods, but there aren’t as many of them to win over to get some wins. And these little bites are often critical to taking the whole cake. Cathy explains.

Cathy Callaway: I think in public health, especially on policies where we’re dealing with big, well-funded opponents, working at the local level is key. I think you have a smaller community to educate, you usually have a smaller decision-making body to educate and fewer votes to get, and you also often have less campaign contributions from Big Tobacco or other opponents, Big Sugar, Big Food. And so really working at that local level is where you can test the waters. And we know that corporate America knows this, because we’re seeing so many preemption bills. Preemption is when legislation sets the ceiling rather than the floor. We were working on smoke free and making the State of Iowa workplaces, restaurants and bars smoke-free. And we passed the local ordinance in the city of Ames and Big Tobacco sued, and it was determined that communities in Iowa were preempted from passing local smoke-free ordinances. So we launched the campaign to repeal or to clarify that preemption language in the state law. And that, in the end, resulted in the Smoke-free Iowa law. Unfortunately, that law still excludes casino workers. So while we celebrated that law, unfortunately how many years later now, 10, 12? 12 years later, we feel that we still haven’t protected casino workers and their right to breathe smoke-free air. So wins are important to celebrate, but it’s also important not to forget about those that are left behind and come back and closing those loopholes. But back to my original point, Big Tobacco knows preemption works. They know they have more control over state legislatures. They know they have more control in Congress than they do in small rural Iowa communities like Des Moines, Iowa City, even. But it’s really important if we can get those ordinances passed at the local level. People are educated, people understand the policy better when you start at the local level, implementation of local policy is often easier. And you can get any kinks out of an enforcement effort worked out at the local level before launching a policy statewide. There’s just a lot of benefits to working at the local level before working at the state level. Oftentimes, we start in communities where we know the city council and the city attorney are going to be friendly to our issues. So we can get some successes under our belt before we start on the harder issues, or in areas of the state where it’s politically more difficult. And I think one thing that that does is if you can get a city attorney on your side, they can talk to other city attorneys. I am not an attorney, and I have found that when we can connect attorneys with other attorneys, they have that lawyerly speak to one another, it goes a lot further than it does hearing from the crazy cancer lady again. So I think that’s definitely a best practice. And we’re very fortunate throughout the country to have several public health legal centers. There’s the Public Health Law Center in St. Paul, Minnesota and they’re more than willing – I mean, they cannot lobby and they do not lobby – but they are more than willing to talk to a city attorney and say this policy has triggered… They’re monitoring litigation throughout the country and so they can easily say that these are things in your ordinance that may trigger a lawsuit because we also saw it in this community, or this is how a court decision came out on this issue and so you might want to take that into consideration as you’re drafting your ordinance. But it’s a very important part. And getting the city attorneys on our side is really important, they can make or break an issue for us.

Deborah Thompson: Public healthers, who are your allies? Allies are people or groups of people who have the same interests as you, or they might have the capacity or resources to help you achieve your advocacy goals. No one sector can tackle the health and wellness challenges we face in the 21st century alone. Think of how many sectors are involved in social determinants of health issues, schools, businesses, health care, law enforcement. Find your community allies, including parents. Speak to your shared purpose and ask them for help. In fact, as Cathy explains, parents have been key partners in the fight against electronic cigarettes. Think of the powerful economic development arguments that businesses can make. They want a healthy workforce. Public health reaching across sectors is what advocacy for public health is all about. Listen to Cathy’s tips for finding your allies.

Cathy Callaway: When we lay out a campaign plan, we take a lot of consideration as to who should care about this issue. And we just try to do a brainstorm of anybody that you could think of that would care about this issue. I think one of the exciting things that has happened with the recent rise in e-cigarette use among kids throughout the country, is moms. Moms are really – and dads too – I mean, they’re really fired up. And we’ve had a lot of people engage just because of their personal experience of having their kid come home with a jule pod in their backpack or something. They were shocked to know that one, their kid was using these products and two, that they were not safe products. And I think that that personal reaction, that personal experience is one way that people seek us out and are like, “how can I get engaged in this? What can I do as a parent to reduce tobacco use in my home, in my community, in my state”. But I think there’s also looking at … we know tobacco use increases the amount of money that the state spends on Medicaid, for example. And so some lawmakers that may not have done anything on tobacco use, or some organizations that may care about health or care about the state’s fiscal state but may not be engaged in tobacco use, but when we can tell them that by reducing tobacco use, we will reduce the [inaudible] state that will free up other revenue for other projects that the state needs money for, that can get them engaged, that can also get a lawmaker on our side too where they may have not thought about it, all the impacts that tobacco use has on the state. And I think too just going back to some of the tobacco tax campaigns that we’ve won over the years. We’ve been able to pull in a lot of different organizations that maybe don’t care about tobacco use, but they need money for something. And when say budgets are tight, if there’s a new revenue stream that’s helped get non traditional partners on board with “I can support that” and that’ll free up some revenue for whatever a pet project may be in the state.

Deborah Thompson: Remember, Becky Tuttle’s warning about unintended consequences? Well, Cathy had her own cautionary tale to share, keep listening.

Cathy Callaway: A lot of states have been engaged in raising the age of sale for tobacco products to 21. And we have advocated for the penalties for someone selling to a person underage to be on the retailer, the tobacco retailer that holds the license to sell tobacco products. And against our guidance, a community retains penalties on kids. Like $500, I mean, a lot of money on a kid. And that policy passed and what they have found is that those penalties on underage persons in that community are largely being placed on black and brown members of the community. And so it’s not only an ineffective penalty, but it also impacts the health equity of the policy, which is incredibly important. So learning those lessons and doing that education upfront … I mean, fortunately, the individual that cut the deal, sees the light now and the community is working to fix that policy now. But a lot of kids had to receive that fine for that to happen. But I say that just as with every campaign, we learn lessons, and it’s important to share those lessons and make sure that we’re moving forward.

Deborah Thompson: One final tip that Cathy offers on effective advocacy relates to harnessing the power of the media, both social and traditional. Part of the strategy is to educate the public. Oh, and knowing how your opponent gets their message out, can help direct your efforts too.

Cathy Callaway: Media advocacy is huge. The social media aspect of campaigns is like none other than we’ve seen in previous years. But it’s so important, the tactic of utilizing media – we build that into all of our campaigns. We can communicate one-on-one to people only so much, but getting your issue out in the media to educate the masses is incredibly important. Oftentimes, we will do public opinion polling so that we can demonstrate too … Well, first we learn from it. If we don’t have a majority of support on an issue that tells me we have a lot of education to do. If we do have a lot of support on an issue, we can show that to lawmakers to show them that their constituents support this issue, and we need them to take action on it. It also helps us with creating our messaging for a campaign. And we usually do a press conference or press release when we have poll results. I think that’s just one tactic to get media. We also work on letters to the editor, believe it or not, they are still very important. Opinion Op-ed, those pieces are very important. We look at who is signing those letters to the editor, we look who is signing those op-eds, we’re strategic about that because we want to make sure that it’s a reputable voice that both the public and elected officials will listen to. And on social media as well, getting our message out there, doing education. I mean, it’s certainly something that we recommend building into a campaign. And the industry is doing it. Every tobacco company has a grassroots online presence and they’re getting better at it. It used to be a space that we felt we owned, but they’re doing a lot with getting their message to tobacco retailers, to tobacco users out in the state. They all have… They’re good at Twitter and unfortunately we’ve seen in recent years, some promotion of their products on how to use their products through YouTube and other social influencers. And I always like to look at what the tobacco industry is doing. That tells me that’s what we need to be doing or the space we need to be occupying as well. So it’s something that we track all the time. And getting out there in the media is very important. We’re always focusing on who has the power to give us what we want, and making sure that we are using tactics that move those people that have that power. And I mean, you can go do a lot of work. I’m sure, we remember, back in the day where there were a lot of poster contests and giveaways for kids around drug prevention and tobacco prevention, and you can spend a lot of time, resources, and effort on doing things that may not necessarily move the needle on your policy. And so I think it’s really important of looking at what your goal is, who has the power to give us what we want, and then engaging first and foremost in the tactics that will move those people.

Deborah Thompson: As this podcast episode of Share Public Health comes to a close, a big thank you to Becky Tuttle and Cathy Callaway for sharing their stories, expertise and passion for public health advocacy. Now we know we have to celebrate our wins, learn from our losses and place our focus locally. Find those community allies and build relationships on a shared community purpose too. Be sure to listen to the other episodes of this podcast series on public health advocacy. Now, go, go on, go tell somebody your public health story for the good of the cause. And don’t forget to celebrate those wins. This is Deborah Thompson and thanks so much for listening.

Thank you for tuning in to this episode of Share Public Health. Thank you to Sonja Armbruster, Brandon Grimm, Jeanine Moody, Hannah Shultz and Kristin Wilson for helping to plan and produce the series. Thank you to Melissa Richlen for audio production and support. This podcast is supported by a grant from the Health Resources and Services Administration. A transcript and evaluation for this episode is available at mphtc.org and in the podcast notes.

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