Successful Social Networking

In the highly competitive global economy, government entities are increasingly turning to social media outlets as an avenue to attract new business to their localities.  Log onto Facebook, MySpace, or Twitter and you are likely to find countless accounts created by agencies dedicated to economic growth across the nation. 

We have all attended seminars and workshops where leaders boasted of a social networking page for their organization only to be extremely disappointed when finally having the opportunity to display the content posted.   Simply having a social networking account with bits of information posted to the world will not foster economic development, and in many instances may work counterproductive to the mission of the organization.  Business, especially venture capitalists and corporations seeking to relocate, expect government and non-profit groups to understand how to use the new media as a tool for success and will be attracted to entities with a well constructed social media plan.

Like any successful marketing campaign, social networking requires a sophisticated strategy designed to showcase the positives of your community to a targeted audience.  Unfortunately, many entities create a social networking account for their particular agency before writing a plan on how the new media outlet can be employed to reach the organization’s goals and objectives. 

I offer the following tips for economic development agencies when using social networking.

1. Customize the Page:  Your name, pictures, information, etc. should reflect your agency.  Be sure to include a description of the services your agency offers or how your agency can facilitate economic development.
2. Find Followers: Just having a social media account does not mean your agency will be found by your targeted audience.  Successful social media campaigns seek out existing users and network by joining existing groups, etc.
3. Use Your Social Networking Accounts: Nothing will turn off a potential business or client more than an agency that fails to use social media.  All too often, agencies create social networking accounts and forget to use them as a tool.
4. Use Hashtags:   Hashtags allow people to categorize your messages. For example, economic development can be searched allowing anyone to find messages that include the hashtag.

I hope you find these suggestions useful.   If you wish, I would enjoy working with your agency to develop a social networking plan.  Please email me at electionconnection@gmail.com if you have questions or comments.

Office Parties & Holiday Dinners

In the 1990s, I was a welfare worker and fresh out of college, wanting to help people and change the world.  Like most of my young, wide-eyed colleagues, I learned that work in public service was unexpectedly complex, rule-bound (most times for good reasons, like equity), and a matter of balancing the needs of a variety of important constituents. As so many have learned before me, Wilson’s public-administration dichotomy was just an idea: nearly everything we did required the expertise of educated, well-trained public servants with a knowledge of law and policy, but political considerations were woven throughout.

After this realization that public service was much more than good intentions. I developed a healthy and respectful appreciation for the dedication and expertise of my profession and rolled up my shirtsleeves. As I’ve moved through a variety of levels of local government over the past 20 years, from case worker, to supervisor, to planner, and now a researcher in academia, I’ve had the privilege to serve my fellow citizens, develop an array of skills, and continue to learn about the fascinating relationship American’s have with their governments.

One important realization has come to me at family dinners and office parties (usually for my spouse’s private-sector company) where individuals hate government and feel it is my obligation to respond to their complaints and questions.  People hold the most amazingly inaccurate or uninformed perspectives of government and what it does. These perceptions range from musings about just why there are always so many forms for every process (usually because someone’s rights may be or have been violated, not because government workers like them) to a failure to connect their property tax cap (which they appreciate) to the fact their streets aren’t cleaned as often.  Occasionally these conversations are unproductive and partisan and I’ve had to walk away but more frequently, they are rich opportunities to talk with others about the good work done in government. Oftentimes my dinner companions will say “you’ve given me something to think about” or “thanks for explaining that to me”.  It has made me realize how little people know about what we do in public service.

It wasn’t until I returned to school for my doctorate that I began to examine American public knowledge of government in earnest.  I am not alone in suspecting that citizen lack of awareness, or lack of “civic literacy” as Milner (2002) and Delli Carpini & Keeter (1996) call it, is behind a number of damaging trends in government like negativity and chronic defunding. Occasionally an editorial or polemic (Goodsell, 2003)  addresses misconceptions and reminds us of the importance of our governments, but many believe that the future of public agencies is exemplified by continuous belt-tightening (Osborne & Hutchinson, 2004).

Lots has also changed in terms of how ordinary Americans obtain their “civic” news and learn to think critically about government. It will be important for governments to re-think their approaches to communicating with their citizens.

Happily Ever After

The last time I babysat my younger grandchildren, we watched one of those age-appropriate Hollywood fairy tales where the good guy defeats the bad guy and then the story ends because—it is understood by all, even five-year olds—that everyone will now live happily ever after.

Too many students enter our classes believing a version of that simple fantasy: in order to make good public policy, we just need to elect the “good guy.” Once that happens—once the candidate with the good ideas wins—the story’s over. (If we elect the “bad guy,” the story’s still over, but with an unhappy ending.) This childlike belief explains much irrationality on both the right and left, and it complicates a public administration professor’s efforts to explain how a bill really becomes a law.  

 As I write this, tea party “patriots” and others on the right are screaming that health-care reform is a Nazi plot and Obama will single-handedly destroy America. At the same time, their left-wing counterparts are charging Obama with “selling out” to the power structure, and threatening to sit out the next election.

Our students are not immune to this superficial, bipolar approach to America’s policy processes.

Our job in the classroom is to explain that changing the course of institutions—particular large, entrenched ones—is extremely difficult. Systems matter, and they can favor or smother efforts to change direction for good or ill.  Constitutional constraints on government power are important in a nation that values the rule of law. As the old saying goes, one person’s accountability is another’s red tape. Achieving a workable balance is an ongoing challenge. But political systems also create roadblocks that are neither constitutionally required nor democratically sound.

 Let me offer a very few examples.

•  Gerrymandering frustrates efforts to create a more competitive political playing field, and protects incumbents from constituents who want to retire them.
• In the Senate, filibusters—as we have seen—allow legislative minorities to frustrate the efforts of majorities, even when those majorities represent overwhelming percentages of the population. Our system gives every state, no matter how thinly or densely populated, two Senators. You can argue the pros and cons of such a system, but love it or hate it, it’s the system we have. As a result, a couple hundred voters from Montana have the power to frustrate a million from California or Texas.
• The Senate also observes quaint and arguably indefensible “traditions” like the one that allows any Senator to put a hold on any Presidential nomination for any reason. Recently, Senate Minority Whip Jon Kyl decided to show his displeasure with a delay in the enforcement of internet gambling prohibitions. So he put a hold on six of the Administration’s pending nominations to fill positions in the Treasury Department. No one has a problem with the people who’ve been nominated, mind you. But because Jon Kyl wants action on internet gambling, the Treasury Department is operating without needed management personnel during a global economic meltdown.

The moral of this story? Systems matter, and many of ours are broken.

Our job is to teach students how to fix those systems, without telling them fairy tales, or leading them to believe that the election of one or two “good guys” will usher in a future in which Americans live happily ever after.

Those who can, do. Those who want to learn, evaluate.

As an aspiring writer in middle school, I took a writing course one summer. (Yes, middle school. Yes, summer. I was a nerd. I’m still a nerd. It’s served me well.) Use imagery, my brilliant instructor said, but be sure not to mix metaphors. Use adjectives sparingly, and make them count. Eschew adverbs altogether. Keep the cadence interesting by mixing long and short sentences. And on and on and on.

I’d like to think my writing got better over that summer. But it wasn’t until I hit college that those lessons truly sank in. No, it wasn’t the skilled professors or the dozens of research papers. It was the fact that I was hired as a writing tutor. Having to read other student’s work – and groan through their myriad bad practices, or fly through the occasional well written piece – was what made all those lessons sink in. Seeing what sabotaged other people’s writing, or what made it work, allowed me to be a better appraiser of my own output.  To wit, if you want to become better at something, get yourself in a position to evaluate it.

I’ve always considered myself to be descent at job applications and interviews, but when I had the opportunity to be the one making hiring decisions, I gained a whole new level of understanding and appreciation for the process. (Yes, we really do only glance at your resume and cover letter; and yes, we do somehow manage to notice your gross errors in those few seconds).  In reviewing articles, I gained a better sense of what works for scholarly submissions. I’ve never had a chance to evaluate grants, but those who have tell me it’s a game-changing opportunity.

A certain level of competence is usually required to be allowed access to the evaluating sphere. But you don’t have to be a pro or an expert. You just have to be willing to seize the opportunities that come by. So say yes to that offer to be part of the accreditation panel, or the budget review committee, or the program evaluation team. Sign up to be a discussant at conferences. Wiggle your way into the hiring or promotion committee. If you want to improve, evaluate your options – then start evaluating.

After the dust settles…the aftermath of Haiti

As a Public Administration practitioner, I know for a fact that my PA colleagues have been watching the news and stories of the relief efforts in Haiti and shaking their heads.  It’s natural.  As employees in the public sector, this is what we do; we develop, plan, implement, lead, assess, evaluate and revise.  This is definitely what we do.

I personally kept stating that there is a need for a logistics team to lead the efforts because of all of the bottlenecking and missed efforts that are over compensated.  However, as I have moved along from the current relief and on-going search efforts, my concern is with the aftermath.

We have seen it before, after the dust settles and nothing more can be done “on the ground” the efforts turn towards rebuilding.  However, I have found that some of the very entities that need assistance are often forgotten.  For instance, homes, schools and government buildings will become priority of course and rightfully so, but what about the small businesses and nonprofit organizations.

There are organizations that are in Haiti providing wonderful services; however, if you think about it they have been hit twice.  First, the organizations’ leaders, workers and volunteers have been hit individually in which they will have to recover, but then they will have to rebuild the organizations in which they work and regain stature so that they can begin to continue to provide much needed services.  This part is often forgotten.  The organizations that provide services to those in need are now in need themselves.

Although donating money is the big need right now, I feel that I am not doing enough.  The question for me is, what can I do to assist those organizations that are in need after the dust settles?  As a practitioner along with my colleagues, we should be able to come up with an answer to this question.  We are public administrators.  We should be able to propose a solution.  I am seeking answers and action.  What do you think?

Vanessa S. O’Neal PhD Candidate

Founder:  Families 4 Life, Inc.

www.families4lifeinc.org

The Concept of the Globalization of Public Administration in Disaster Relief: The Case of Haiti

Introduction

The print and electronic media have been supersaturated with information pertaining to the calamities surrounding the aftermath of the devastating earthquake that occurred in Haiti on January 12th, 2010. This type of frenzied coverage of natural disasters, especially, has been commonplace in United States media circles. For example, the 2004 Indian Ocean Tsunami which plagued certain countries in Asia; and Hurricane Katrina, which plagued the Gulf Coast area of the United States in 2005, have all been covered in about the same journalistic vein. In this regard, the mass media succeeded in bringing the plight of these affected places into the international forum for observation, discussion and analyses. In the case of the Haitian earthquake, this exposure has set the stage for countries within the international system to make the attempt at mustering the needed resources designed to assist Haiti, not only effectively address the short-term impact of the earthquake, but also to emerge from the ruins of that catastrophe in the long run. In as much as such efforts are helpful in providing some measure of relief for the affected populations of that state, history has shown that they are nevertheless usually fraught with tremendous political (the actual provision of resources), and logistical (coordination) difficulties both of which in turn contribute extensively to operational delays and as a result the apparent ineffectiveness of the goals espoused by such missions.

For all intents and purposes, this international effort is tantamount to a globalization of public administration, defined as the “attempt” by other state governments, the United Nations, and non-governmental organizations (NGO’s) to assume the governmental functions of another state, perhaps temporarily, in an effort to govern the affairs of that state. However, because there are inherent political and practical problems of the provision of adequate resources, in addition to very acute problems of the coordination or the logistics of relief efforts, achieving the goal of effective disaster relief has been demonstrated to be extremely difficult. In this exercise the view will be espoused that, as a result of the political and coordination difficulties encountered, the globalization of public administration in disaster relief efforts such as the one in Haiti will largely be ineffective. This difficulty is further highlighted by a comparison between Katrina and the Haitian earthquake experiences.

 Comparative Analyses: Katrina and the Haitian Earthquake

Although one disaster took place in an advanced country with a tremendous amount of resources and technological capabilities, while the other took place in a third world country that is widely regarded as a failed state, Katrina and the Haitian earthquake nevertheless share similarities and dissimilarities as it regards disaster relief efforts, from a public administration perspective.

(1) Generating the needed resources for the purpose of addressing effectively a catastrophic aftermath the magnitude of which had not been expected and as a result, for which there had been no concrete plan, proved to be extremely difficult even for the United States and rather practically impossible for the impoverished and fragile state of Haiti. This fragility explains the reason that Haiti, unlike the United States, has had no choice but to acquiesce to an international donor force, at the price of the loss of a significant measure of its sovereignty.

 (2) The coordination of the relief effort among donors, in the case of Haiti, and policy coordination among the three levels of government, in the case of the United States, also manifested extreme difficulties. In the United States, despite the stipulations in the federal constitution pertaining to the relations that govern the two levels of government under federalism, all three jurisdictions (the National Government, Louisiana, and New Orleans) held each other culpable as to which level was supposed to have been responsible for performing certain functions in addressing the aftermath of that catastrophe. This is proof that disaster relief efforts, without regard to where they may occur, will be challenging undertakings for political and/or coordination reasons. These difficulties are compounded when the international status of Haiti is observed from two major perspectives: first, that Haiti is an impoverished society; and second, that the coordination of relief efforts was made much more complicated by the involvement of states world-wide in a globalization of public administration effort.

The Globalization of Public Administration: A General Theory

Because the globalization of public administration exacerbates the issues of resource availability and coordination, a number of positions are being posited in the form of a general theory. (1) That the long-term effectiveness of the globalization of public administration in disaster relief efforts, whether man-made or nature-made, is actually unattainable. Resources will be inadequate and relief efforts may not be coordinated effectively. (2) That any measure of success by such efforts will be temporary at best (a band aid) and will not necessarily, serve the long-term needs or interests of the populations in that particular state or country. The state would not have possessed the infrastructure that would enable it to address such problems on its own. (3) That the “disempowered” (unable to resolve its own domestic problems) state will continue to need such assistance in the future, thereby placing in jeopardy its sovereignty within the international system, and also placing a strain on the scarce resources of donor countries. Because the state will continue to be very dependent on foreign assistance, foreign donors will be returning to provide aid on a repeated basis. (4) That allowing disempowered states to remain disempowered, and as a result absolutely dependent on other states for the welfare of their populations, may cause serious disturbances within the international system of continued political competition among donor states; and even wars, if such problems are to become really intractable.

POLITICS OF THE ALLOCATION OF RESOURCES

Addressed below are a number of reasons which are responsible for the politicization of the provision of resources to a country that may be in need of them. The reasons are rooted in economic and political theories as regard the behavior of states or the “games nations play” within the international system.

 Global Competition

There is competition among some donor countries whose primary goal may simply be the creation of a “sphere of influence” or hegemony in that particular state, for the fulfillment of their own national political, economic and/or security interests. Because the world is decentralized (no world government), international relations are rife with this type of tacit “deal-making”, implying that such donor countries may have an ulterior motive other than the articulated humanitarian gesture. When this becomes the case, the emphasis is shifted away from humanitarianism to a quid pro quo strategy which may have the effect of diluting that type of aid, or making it somewhat ineffective or unappreciated once the recipient state discovers that there are strings attached to it. Further, it is also possible that when state “A” discovers that it has successfully “out-bidded” (given more aid) than its competitor state “B”, it may then decide to end its allocations having satisfied perhaps one of its own national interests (the “out-bidding” of competitors), even though more aid may still be needed by the recipient state, and even though state “A” may still have more resources at its disposal. To elaborate, a number of examples involving the relief efforts in Haiti will be enunciated.

Scarce Resources

Since economics teaches that resources are scarce relative to the demand for them, the decision-making process as to “who gets what when and how”, according to Harold Lasswell, will be conducted on a political basis rather than on the basis of actual need. David Easton agreed with this assessment when he defined politics as “the authoritative allocation of values or scarce resources”. For example, donor states often decide to allocate scarce resources to countries primarily on the basis of a vital national interest. Any other condition such as, where the national interests are either too minimal or simply non-existent, may not be considered seriously. The rational basis of this principle is premised on costs and benefits, whereby “returns” are expected for the donor country’s “investments” in order that the effort be regarded as having been tantamount to rational decision-making. In colloquial terms, a potential donor state will aspire, as individuals do in societies, to “put its money where its mouth is” in the international system.

 Further, this phenomenon can be appreciated when one observes the ideological composition of the list of countries and organizations that are involved in the Haitian earthquake relief efforts. Primarily, the countries consist of allies, enemies, and non-aligned states. The non-aligned states are themselves not absolutely non-aligned, since some are dependent on other states, occasionally, for assistance. Even some of the NGO’s, sometimes regarded as not having any ideological orientation, are said to actually be representatives of their respective state governments and/or multinational corporations. Multinational corporations have also been known to have vested interests in other states.

 PRACTICAL PROBLEMS OF COORDINATION

After having examined the politics underlying decision-making in international resource allocation, the technical issue of coordination will also be examined in terms of the practical problems posed in international relief efforts.

 Because of the limitations imposed by political considerations, as has already been demonstrated above, it will simply be impossible to assemble donor countries, whose national interests are at variance with each other, to agree to coordinate their functions for the purpose of increased effectiveness in relief efforts.

 Another major obstacle, even under the assumption that coordination could have been possible, is the differences in the personnel systems of the states that are involved in the process. It may be possible, in a typical country, to assemble firefighters from various local jurisdictions to train them in anticipation of a terrorist attack, as has been done in parts of the United States. But, how can such a complicated enterprise be conducted at the international realm where there is decentralization? The United Nations could have been, perhaps, the most ideal organization to conduct such an initiative, but the organizational membership still consists of the same states that seek their individual national interests within the international arena. This makes the United Nations somewhat ineffective; especially, when it is considered that the permanent members the Security Council are global hegemons within the international system, each with its own vested interests. Most of the organization’s funding emanates from these major powers, with the United States at the top. This would imply that, as an organization, the United Nations may not be able to promulgate policies that run counter to the vested interests of the permanent states in the National Security Council, without the agreement of such states. To some extent, this explains the reasons international disaster relief efforts have been so handicapped.

 Conclusion

What should be done in the case of Haiti to help it be more self-sustaining into the distant future? This becomes a valid question because it has been very clear for decades that the state is unable to sustain its sovereign status in the international community. In the United States President Clinton, certain members of Congress, and former bureaucrats in the national government, have all attempted to address this issue. But has not this same issue been addressed in the past?

 Since it is not possible to engage in effective global public administration, the only other approach to take is to empower Haiti so that it may be able to maintain its sovereignty in the western hemisphere. Among other positive factors, this will assist greatly in stabilizing the region, a concern of the United States for over one hundred years.

 

By:  Mordu Serry-Kamal, Ph.D.

Haiti and Emergency Management

Members of ASPA’s Section on Emergency and Crisis Management have been following Hurricane Katrina and trying to understand the limitations of disaster response, and what might be done to get help to victims and survivors faster.

Haiti now adds another layer of study for us. What factors are present in a disaster requiring international aid? How can these avoided becoming barriers to needed assistance?

The Section will sponsor a session on Haiti in April at the annual conference in San Jose where section members and ASPA members can have an open conversation on this public administration challenge for 2010 and beyond!

Disasters requiring international aid have occured with distressing frequency in the recent past. The January 2010 Natural Hazards Observer just featured a pair of invited comments on international aid, reflecting on Cyclone Nargis, and in one George Kent leads off with the challenge of the hour: “The rights and obligations of different parties in humanitarian assistance need to be clarified.”

Bruce Binder, long time Veterans Administration emergency manager, FEMA disaster responder and EIIP Board member, just circulated a document on Friday, January22 showing that the Red Cross tried to bring the Unified Command structure to bear on Haiti, to no avail. In my own recent article in Journal of Contingency and Crisis Management, I raise some of the concerns with the delivery of cross-border aid, especially international challenges.

The day of the earthquake the President of Haiti said that his home and his palace had both collapsed, and that he had no place to sleep, “but I have plenty of time to look for a bed.” Since then the airport has become the defacto seat of government, while coordination of aid operations seems limited to the US government assets - mainly military and DHS- as they provide air traffic control and airport logistics management. The US military reports on using GPS to track US assets in the field, but who is coordinating the multi-national relief efforts going on all over the disaster area?

The New York Times’ daily photos show fear and shock changing to anger, with pre-disaster gang activity again on the rise. The UN and its Brazilian peacekeepers, present before the earthquake, became disaster victims along with the Haitians they were trying to protect.

Does the US have a special responsibility as a neighbor? As a hemisphere leader through OAS? What should be expected of the Dominican Republic? Of other Carribbean neighbors? Should the UN and International Red Cross be the lead agencies? Who is responsible once life safety issues (e.g. rescue and immediate medical care) have been addressed? Will the nation’s central government be able to provide any command and control functions?

The total national disaster is a new disaster model that will need some new strategies.  While the southeast Asian tsunami and Cyclone Nargis were devastating, the national capitals were spared and national government functions continued. In Haiti the capital was the site of  the worst of the shaking, taking down ministry buildings with their public servants inside. How does the loss of a country’s trained administrators impact its ability to respond to and recover from such devastation?

On Friday, January 22, the second week after the earthquake, 500,000 Port-au-Prince residents were being evacuated from the carnage and wreckage to tent cities outside the urban area. While this may be good from a public health perspective, what are the mental health impacts of the loss of community and sense of place? How will people cope with their grief in a new environment without the succor of long time neighbors and parish priest?

Another question is where will the money come from to rebuild a  country, where one third of the population is victim/survivor? Government facilities are gone. The port is gone. The airport has one usable runway. The water and sewer plants, hospitals, schools and churches are all damaged or destroyed in the quake area. Lacking building codes, the built environment has crumbled, and now has become a second layer of disaster: debris management.

We can give  money to the Red Cross or Unicef. We can engage in prayer or whatever religious or philosophical activities we believe will help. We, however, are not just concerned by-standers, but public administrators. What can we give of ourselves, our knowledge, our capability to ensure that such a disaster is not repeated in Haiti? That is the real challenge to ASPA.

Frannie Edwards, past chair (2006-2009), SECM

Safety or Privacy?

It happened again. Our privacy and freedom of rights are at stake. As per the Government imposed air security measures, there will be installation of full-body scanners at major U.S. airports. Public opinion is divided. Whether safety or privacy comes first is a question that many are asking now. To safeguard the nation is of utmost importance when the country is in war against the world’s terrorists, but trading in privacy for ensuring that safety is not desired at all. What Government is saying and doing is unclear when it proposed for body-scanners, add-ons to the total safety security package available to air travelers these days. No wonder distrust in Government is at its peak when double standards continue to define Washington’s actions.

Indeed, a false sense of security is looming large everywhere. Security experts explained that body scanners could not have rightly detected explosive device used in the attempted terrorist attack on a Detroit-bound plane.  However, Washington is not hesitant to push for a controversial security measure which pose tremendous threats to personal privacy and freedom of rights. History shows that surrendering our liberties out of fear and panic ends up restricting our freedoms. There is no guarantee body scanners will make us any extra safer if that is the goal of investing millions of dollars in these expensive machines. Moreover, no one is clear about where this money is coming from. At a time of recession, this kind of drastic and dramatic security measure is odd.

In the absence of a detailed plan (whether scanned photos are to be stored, how it will be stored, and for how long, etc.),  there is always the danger of misuse and abuse of images. During this sensitive moment, Government needs to enact procedures that pose least threat to our civil liberties and are also proven to be effective. At least that is what we hoped for when the new Administration came to power a year ago. We cannot repeat this error of breaching our freedom of rights. Safety cannot win over privacy and if it does it will be unconstitutional and violation of American values.

By: Reefa Mahboob

An irony of Our Times

One would be hard pressed to argue that these are difficult economic times. Record numbers of people are unemployed while costs of necessities like food and fuel continue to increase.  The “have’s” are morphing into the “have nots” as my sister lamented recently, “It is expensive just to live.”

Our country has relied upon the compassion and effectiveness of social service nonprofits to help our communities get through difficult times. Food banks feed the hungry. Shelters provide warms beds for the homeless. Rape crisis centers provide support to victims of sexual violence.  Job training programs help individuals become self-sufficient.

Sadly, many of the very organizations that have served as safety nets in our communities are now struggling to keep their doors open. For years, nonprofits have experienced level funding. This means that despite an increased cost of living, nonprofits have been asked to continue providing the same level and quality of services without an increased revenue. While this trend continues, a new trend is emerging: Funding cuts, particularly at the state and local levels, is evaporating.  Consider the irony: At a time when more of our friends and neighbors are in need of help, the nonprofit organizations designed to be of service are at a decreased capacity to do so.

As I begin to plan for the next fiscal year, I will join my colleagues in evaluating the benefits of strategic alliances. I will explore every cost saving measure possible. And I will ensure, as far as I am able, that my organization remains available to help those in need.

This is the work of the nonprofit manager. Serving the community. Empowering individuals. And motivating staff to do more with less. And more with less. And then, even more with less.

Robyn-Jay Bage, M.P.A.

Policy is an essential service function which is a challenge to fulfill

    In The Future of Public Health (2002) and later, Healthy People 2010,  three basic core functions for public health were developed to assist in understanding the role and needs of public health. These functions, states Dr. Lloyd Novick (DVD, 2008), became 10 Essential Services that define public health. These functions, Assessment, Policy, and Assurance are critical to the well being of a quality health care system.  Policy is an essential service function which is a challenge to fulfill.

           Presently our healthcare science has advanced far beyond the scope of our legislators, and often times, policy advocates.  Typically, this is couched in terms such as: “Not enough funds”, or “They just don’t care”.  However, such uncaring is unlikely. It is  also not that the funds are unavailable; rather it is about the way we use these funds.  This is evident. In the book Who Killed Healthcare (2007), Herzinger states that the U.S. spends 2 trillion dollars a year in healthcare, more than China’s entire economy, while enjoying a lower quality of care than they. Additionally, Cuba has made strides in healthcare to the point that they are models for outsourcing healthcare and healthcare education. (Salud!, 2006) And yet, as we see in the recent Congressional debates, we have an unnerving unwillingness to break from our brokenness to move towards what research has shown is more effective.  Why don’t we get it? The cost of healthcare has been crippling us financially, and consequently strangling high quality medical services.

             While this policy stumbling block is a challenge to healthcare, there are stages to change; these come with time, thought, and awareness.  Miller and Rollnick (2006) in their work on Stages of Change names these as Pre-Contemplation, Contemplation, Preparation, Action, and Maintenance.  They basically move a person from not knowing there is a problem (Pre-Contemplation), knowing there is one but not knowing if we will do anything about it (Contemplation); to considering the options (Preparation); to trying some of the options, fine-tuning, etc (Action); and finally, to integration of this change into every day life (Maintenance).

             Now, granted, these were written about how people work through problems to become motivated and begin problem-solving. And, admittedly, these were written in regards to mental health and addictions treatment.  But when exploring policies and their general acceptance by the general public, legislators, policymakers, ”stages of change” fit.  In addictions treatment, counselors would historically tell a client s/he was in denial, refusing to understand. Over time, treatment has changed to incorporate Miller’s work in their best practices, understanding that when a client was in the Pre-Contemplation Stage of Change: S/he just did not know she had a problem. 

             Perhaps we do not know yet fully understand our problem with healthcare. Perhaps it is not that we don’t want to get it, but that we truly do not understand the fullness of our dilemma.  As in addictions treatment programs, perhaps we have been caught in insanity, thinking we can keep doing the same things over and over, expecting different results.  And now, as before, perhaps we are only able to move forward in small incremental steps, not because policies are good or bad, but because we are simply not that far in the stages of change; we want to get, but we just aren’t there yet.

             Like Miller and Rollnick’s work suggest, the answers lie in continuing the discussions, entertaining new information and considering new ideas, allowing the media to create a forum for lively debate.  It is a nerve-wracking and long process.  It is also the way to change.  Open discussions, complaints and quarrels, in all we move along in our growth path.  Each step a step closer to the planning and programs which will improve the effectiveness and efficiency of our nation’s healthcare. 

References

 CDC, Healthy People 2010. As retrieved January 12, 2010 from www.healthypeople.gov

 CSAT (1999). TIP 35: Enhancing Motivation for Change in Substance Abuse Treatment.   SAMHSA: MD

 Field, C. and Reed, G. (2006) Salud! (DVD)

Herzinger, R. (2007). Who Killed Healthcare? McGraw-Hill: NY

Miller, W.R. and Rollnick, S. Motivational Interviewing: Preparing People for Change.     NY: Guilford Press, 2002.

Novick, L. 2008. Health Policy & Management, DVD. Laureate Education, Inc: MD.

Novick, L, Morrow, C. and Mays, G. (2008). Public Health Management: Principles for   Population-Based Management. Jones and Bartlett: MD.

 Shroeder, S. A. (2007). We can do better—improving the health of the American     people. New England Journal of Medicine,        357(12), 1221–1228.