Practical Strategies to Achieve Your Health Policy Goals

20 | FPM | March/April 2019 www.aafp.org/fpm

CME

s busy family physicians, we see day in and day out how

public policy issues in our community aﬀect our patients

and their health. Doctors have been at the forefront of

passing laws that address issues as diverse as safe

streets, food deserts, and sugary beverage taxes as well as raising

the tobacco age, licensing direct primary care, and ensuring safe

drinking water.

You probably have one issue in your community — and likely

more than one — that you would like to address through advocacy

and legislation. However, like many physicians, you may not know

where to start or how to achieve health policy success with your

busy schedule.

RAVI GRIVOIS-SHAH, MD, MPH, MBA, FAAFP

Practical Strategies to Achieve

Your Health Policy Goals

As a physician, you can have a powerful voice in

bringing about change in your community.

Here’s how to go about it.

ABOUT THE AUTHOR

Dr. Grivois-Shah is a family physician with

Banner University Medical Group in Tucson, Ariz.,

and associate clinical professor at the University

of Arizona (UA). He is also medical director of

Alvernon Family Medicine and the UA Mobile

Health Program, which provides free care

to underserved communities throughout

Southern Arizona. Author disclosure: no

relevant ﬁnancial aliations disclosed.

individual user of the website. All other rights reserved. Contact copyrights@aafp.org for questions and permission requests.

www.aafp.org/fpm March/April 2019 | FPM | 21

This article will use examples from my

own advocacy eﬀorts to demonstrate prac-

tical strategies to pass health policy legisla-

tion on the state and local levels. Even if

you don’t personally agree with the politics

of the examples, the principles behind

them can help you achieve your health

policy goals.

ENGAGE ELECTED OFFICIALS

Engaging elected oﬃcials can be intimi-

dating. Our perception of politicians as

celebrity ﬁgures, unapproachable, too busy

for us, etc., stands in the way. Especially

in smaller communities and in the context

of locally elected oﬃcials like city council

members, village trustees, county oﬃcials,

and even state representatives and sena-

tors, the opposite is oen true. Here are

four steps you can take to engage them

eﬀectively.

Understand what motivates elected

oﬃcials. It’s deﬁnitely not the salary that

comes with your village councilman’s posi-

tion (which is likely voluntary) or the love

of weeknight meetings that can last well

past midnight or the riveting discussion of

zoning intricacies. The motivation for most

locally elected oﬃcials is that they really

do want to build a beer community. As

a physician, you are in a prime position to

help them get back to why they went into

politics in the ﬁrst place. If your health pol-

icy goals help your elected oﬃcials achieve

their goals, they’ll be ready and waiting to

listen to your solutions and work with you.

Make a connection. Most of us have

interests outside health care and are

involved in various civic organizations,

clubs, religious organizations, or activities

for our kids that our elected oﬃcials might

also be involved with. Make the most of

these social connections.

Also, consider “friending” locally elected

oﬃcials on social media. You can learn a lot

about them from their page, including their

interests and goals. Some oﬃcials are more

likely to respond to you on a social media

platform than to return your phone call

to their oﬃce.

It may be worthwhile to join member-

ship organizations in your community.

You may have something in common with

an elected oﬃcial who is also part of that

group. Going to political party meetings

or fundraisers is another excellent way to

connect with local oﬃcials.

Schedule a meeting. Once you connect

with an elected oﬃcial, leverage that into

a meeting where you’ll talk about your

policy ideas. A quick drink aer work may

be all it takes to get the ball rolling. For

example, not long ago, I became interested

in passing legislation in my community to

increase bike helmet utilization and reduce

serious injuries. I had previously met one

of the elected trustees in my community at

several local events and told him I wanted

to touch base on some ideas to help make

our community safer for kids. We set up

a time to meet at a local pub and talked

about what drew him to elected oﬃce and

what his goals were. I brought up my work

at the local high school to promote bike

safety and my idea to introduce legislation.

He almost fell out of his chair with excite-

ment about doing something positive for

public health in our community. In the next

few weeks, he reached out to other trustees,

who were quickly on board.

Serve on a commission, task force, or

advisory board. Many local governmental

bodies have commissions, task forces, or

advisory groups where policy discussions

originate and where the voice of a commu-

nity physician would be highly valued. The

community where you live may even have

a Board of Health that needs volunteer

The motivation for most locally elected

oﬃcials is that they really do want to

build a beer community.

KEY POINTS

• Physicians oen see ﬁrsthand how public policy issues aect

patients and their health.

• In many communities, the voice of a local physician is highly valued

and can help bring about needed policy changes.

• Making connections with elected ocials, understanding

jurisdictions, ﬁnding allies, and mitigating opposition are keys to

a successful strategy.

ADVOCACY

22 | FPM | March/April 2019 www.aafp.org/fpm

members, especially physician members.

Find a group that interests you, and get

involved.

Yes, this will require an investment of

your time, but meetings are generally just

an hour or two long once a month. Most

people are sympathetic to a volunteer phy-

sician’s busy schedule and will understand

if you can’t make all the meetings. But if

you’re serious about passing health care

related legislation, 12 hours a year aend-

ing meetings and serving on commiees

can save you dozens of hours in legwork

down the road.

JURISDICTION MATTERS

A sometimes diﬃcult step in the advocacy

process is ﬁguring out the best jurisdiction,

or governing body, for passing legisla-

tion. Does it make sense to try at the state,

county, or city level? A couple factors will

weigh into this decision.

Know the politics of the jurisdiction.

Passing a law on the state level likely will

have the most impact, compared to a local

law aﬀecting a much smaller community.

However, there may be greater partisan

barriers or organized opposition to passing

a state law, making the local route more

appealing. For example, in my previous

state of Illinois, state medical organiza-

tions had tried for years to pass a bike

helmet law, but groups advocating for

motorcycle users had a powerful lobby and

successfully blocked a statewide bicycle

helmet law for youth. At the local level,

however, we were successful in geing leg-

islation passed.

The lesson is if at ﬁrst you don’t succeed,

try a diﬀerent jurisdiction, either a diﬀer-

ent level (state versus local) or a diﬀerent

city or county in your region, that may be

more receptive to your cause. Also, save

time and don’t reinvent the wheel when

introducing legislation. When I took the

bike helmet legislation from the state level

to the local level, I kept the same language

in the proposal.

Know what legislative authority your

local jurisdiction has. Each state has dif-

ferent rules, usually wrien into the state’s

constitution, on where laws can be made

and what types of laws can be made. In a

few states, enforceable laws are only made

at the state level. In others, most coun-

ties, cities, and villages can pass laws and

enforce them as long as they don’t contra-

dict state law. Sometimes, even elected

oﬃcials don’t know for sure who has juris-

diction, so if there’s any question, check

with a lawyer early in the process.

ACTIVATE YOUR ALLIES

While a lone doctor working with an

elected oﬃcial can pass legislation, the

process will be easier if you do so as part of

a coalition.

Tap into the power of a coalition.

Building a coalition can help in a number of

ways. First, it gives your cause gravitas and

momentum. Instead of a minor nuanced

issue from a local doctor, the issue becomes

a health policy concern driven by a known

organization. Second, it gives you connec-

tions. Local organizations, especially those

with legislative and advocacy arms, likely

have well-established relationships with

elected oﬃcials and can get you in the door

for a meeting. Finally, these allies may be

able to help push an issue to the front of

the legislative agenda through their lobby-

ing prowess.

Find the right allies. Some coalitions

on health care issues are well established.

Health care societies (such as your state

chapter of the American Academy of

Family Physicians) are an obvious place

to start. Brainstorm other groups that are

likely to support your cause as well. For

example, on tobacco issues, your local

respiratory and cancer groups, such as

the local chapter of the American Cancer

Society, would be logical partners. On

issues related to senior care, the AARP

may be a good ally.

When I became involved with pass-

ing legislation to allow expedited partner

therapy, which permits clinicians to give

extra medication or prescriptions to

their patients with chlamydia or gonor-

rhea so the patients’ partners can also be

If at ﬁrst you don’t succeed, try

a diﬀerent jurisdiction that may be

more receptive to your cause.

www.aafp.org/fpm March/April 2019 | FPM | 23

ADVOCACY

treated, it was an organization-driven

campaign. I participated as a member of the

Government Relations Commiee of the

Illinois Academy of Family Physicians, and

we joined other organizations such as the

AIDS Foundation of Chicago and Planned

Parenthood. Because of our combined

eﬀorts — sending doctors to lobby legisla-

tors in our state capitol and using the inﬂu-

ence of our partner organizations — we had

the ear of supporting legislators, which was

key when opposition arose.

But ﬁnding allies isn’t always that easy.

When I became interested in legislation to

ban conversion therapy for LGBTQ youth in

Pima County, Ariz., I had no organizational

support. It was simply an issue I was pas-

sionate about. To ﬁnd allies, I ﬁrst reached

out to other physicians in my university

health system, including those in adolescent

medicine and psychiatry, and then I con-

tacted the local community health center,

whose physicians run transgender youth

programs. I now had a group of doctors in

support of the cause. Next, I reached out to

the South Arizona AIDS Foundation (SAAF)

and met with their legislative aﬀairs staﬀ

who immediately jumped on board. They

were able to set up a meeting with one of the

Pima County supervisors who had worked

with SAAF on similar issues, and suddenly

my concern reached the top of the supervi-

sor’s legislative agenda.

Think outside the box. You may need

to get creative when looking for the right

allies. For example, let’s say you want to

address clean air and pollution in your

community. Perhaps a major labor union

that works on health policy issues has a

local chapter in your community with con-

nections to elected oﬃcials, or maybe a

local church with a health justice interest

has the ear of someone in oﬃce. These less

obvious allies might turn out to be your

most powerful ones.

Be an ally yourself. You will likely

ﬁnd that, as a physician, you’re a highly

desirable ally for others who are trying to

advance a health policy agenda. As you get

more involved in your local community,

and as others get to know you and your

general passions, they will increasingly

turn to you as a community physician to

lend your voice to their issue. Oen, most

of the legwork will be done for you, and you

can step in as a physician and make a posi-

tive community impact by joining a coali-

tion, helping a community group, and being

an advocate for others trying to advance a

cause you support.

For example, several years ago, I was

approached by some local community

groups who were unsuccessfully ﬁghting

to limit the soot and particulate maer

emied from two coal power plants in

Chicago. At the time, I was working for the

Cook County Health & Hospitals System,

whose physicians were unionized through

the Doctors Council Service Employees

International Union (SEIU). I had not heard

of soot or particulate maer before being

approached, but I did some research, got

behind the cause, and became one of the

physician leads on this issue. Soon, our

union joined the coalition seeking to pass

an emissions limit.

Our parent union, SEIU Illinois State

Council (at the time the largest labor union

in Illinois), backed our local eﬀorts. When

the lead alderman opposing the legislation

faced a runoﬀ election a few months later,

he did not want to lose crucial union sup-

port and decided to support our legislation.

A few weeks before the runoﬀ election —

and just a few months aer I ﬁrst learned

of this issue — I stood next to the alder-

man at a press conference to announce our

union’s endorsement of him and to thank

him for his (new) support of the ordinance

limiting soot and particulate maer.

MITIGATE THE OPPOSITION

You’re going to face opposition any time

you enter the political sphere, but some

legwork at the start of your eﬀort can

make a big diﬀerence in the time and

energy you may need to expend to pass leg-

islation down the road. ➤

One way to lessen the opposition

is to demonstrate how your

legislation ties into a larger agenda

that has wide support.

24 | FPM | March/April 2019 www.aafp.org/fpm

ADVOCACY

Identify potential opposition.

Brainstorm the individuals and orga-

nizations who might oppose your issue

and research their positions using your

community contacts, asking those in the

know, and learning from others who have

advocated a similar issue. However, under-

stand that planning and strategizing won’t

always identify all potential sources of

opposition that can stymie your eﬀorts.

Some may come from le ﬁeld, and some-

times groups you thought would be your

allies actually end up opposing your health

policy goals.

Diminish the opposition. One way to

lessen the opposition is to demonstrate

how your legislation ties into a larger

agenda that has wide support. For example,

before taking the bike helmet legislation

from the state level to the local level, I

had worked with a bicycle advocacy group

to provide bike safety and maintenance

training and free helmets to high school

students. Surprisingly, although the group

advocated for education on the use of bike

helmets and promoted their use, they

opposed legislation that mandated

their use.

To help mitigate the opposition, I put

together a coalition of bicycle advocates in

our community, including bike shop own-

ers, community activists, school represen-

tatives, and elected oﬃcials. We developed

an entire plan to advocate for bike use,

from bike lanes and signs to storage of hel-

mets in schools to social media campaigns.

An ordinance requiring bike helmets for

youth was simply one part of the larger

agenda, for which we now had broad

support from major players in the

community.

Additionally, at the time, I was a mem-

ber our local Board of Health. We unani-

mously passed a recommendation to the

village board to require bike helmets for

youth. With a formal recommendation

from health care professionals and the

support of a coalition of community

members, the village trustees had the

backing they needed to pass the bike

helmet requirement.

Go around the opposition. Sometimes,

it’s best to ignore the opposition and push

the legislation forward, especially if you

know you have the votes you need to pass

the legislation. Other times, the only way

forward is to go straight to your elected

oﬃcials and do the hard work of convinc-

ing them that your position is best for the

community.

For example, the main opposition to

our expedited partner therapy legislation

came from a source I had not anticipated —

trial lawyers. A provision of the legisla-

tion indemniﬁed doctors who provided

prescriptions to their patients’ partners

to treat chlamydia or gonorrhea, mean-

ing these partners could not sue the doc-

tor if there was a bad outcome. This was

important because, in most cases, doctors’

malpractice insurance would not cover

any lawsuit for medical care given to

someone without an established medical

relationship.

The Illinois Trial Lawyers Association

got wind of the indemniﬁcation clause and

came out in opposition to the legislation.

With urban Democrats from the Chicago

area being our main support for this leg-

islation, and with trial lawyers as a group

being one of the largest contributors to

Democratic candidates and parties, our

eﬀorts stalled.

Success took a multiyear eﬀort of meet-

ing with state legislators one-on-one to

advocate on this issue and coordinating

with allies who had strong relationships

with party leaders. Eventually, we con-

vinced enough legislative leaders that this

legislation was important, and they con-

vinced the trial lawyers to back down.

YES, YOU CAN PASS HEALTH POLICY

LEGISLATION

Passing legislation may seem daunting,

but don’t get intimidated. It may take years

working on an issue before you ﬁnally

make the inroads you need to pass it, and

you may need to convince entrenched

politicians to support your cause, but you

can do it.

With the right strategy in place, you

can make a big impact by adding your

voice and perspective as a physician and

bringing about needed change in your

community.

Send comments to fpmedit@aafp.org, or

add your comments to the article online.