Public Health Policy: A Landscape of Possibilities
This article was first published in Outlook on Women's Health, a news magazine previously distributed through the Cincinnati Herald Newspaper's Sunday Edition
Webster's Collegiate Dictionary
defines "public law" as follows: "a legislative enactment affecting the
public at large." Sets of national public law, such as the body of federal
laws that govern certain aspects of American life, such as healthcare,
childcare, retirement benefits, are examples of federal public policy. Policy
decisions are made every day at all levels of government, and each decision may
represent a life-and-death dilemma to individual women or groups of women. For
this reason, governmental policies are critical to Women's Health. This article
encourages women to take a more active role in the development of effective
Women's Health policies. For those of us who are not policymakers, this is one
way we can enhance or expand beneficial health services and possibilities, such
as high quality professional health services, safe places to exercise, access
to high-quality foods, freedom from physical and psychological abuse in our
homes, workplaces, educational institutions, and all other public spheres.
Unless otherwise mentioned, this article is based upon (1) my observations of women dealing with health challenges, (2) related archival study, and (3) many discussions with women living in disadvantaged rural and urban communities all over the USA. The range of health and safety crises I have observed include awe-inspiring births, as well as street violence, domestic violence, accidental death, food shortages, lack of housing, lack of heating fuel, unsafe housing (e.g. asbestos, rats, at risk locations), predators, sexual assault, child abuse and the aftermath of homicide. All such circumstances and issues are matters of great concern for Women's Health.
The general public seems to expect women to intervene in and resolve complex community-based crises on their own. Often working with meager resources and in the midst of what Shakespeare would call “the slings and arrows of outrageous fortune," women often do produce workable and enduring solutions. I contend that many professional policymakers lack the life experiences necessary to facilitate a serviceable understanding of the complexities faced by many of these women. Just last week, international radio broadcast, I heard one member of Congress say that he now realizes that more than 1/5 of all American children are living below the federal poverty level. It was heartening to know that his awareness had been elevated. But does he also know that the established definitions of the “poverty level" are so low that people making twice that amount are still very poor by most regional standards? Does he realize that most of the nation's homeless are women and their young children? It sounds to me that there is an information vacuum here, and it will take many more experienced women to fill that vacuum.
Which Laws Matter Most?
Determining which policies to address, those most likely to impact Women's Health in a big way, may seem a complicated matter. My contention, however, is that every American law impacts the health and well-being of women to some extent, so opportunities for public policy to impact our well-being abound. To begin, pick any law or body of law that catches your attention and start your own personal research into how it will affect you and other women over time. Of course, some laws exert more impact than others, and laws are not the only factors affecting Women's Health. But, certainly, federal policies have pervasive impacts. Domestic policies reverberate through our lives in ways that sometimes enhance, and sometimes interfere, with our best efforts to live safe and healthful lives. Foreign policies also affect women in one way or another. Over recent months, I have talked with several women whose children are now in Iraq; they all tell stories of sleepless nights and distracted days; that's part of the short-term impact and the long-term impact will become more obvious over time.
Words and Wording: Titles May Not Tell the Whole Story
Titles of proposed or enacted laws can be confusing; they don't always reflect the content or projected benefits of that law. Ambiguous or misleading titles can sometimes influence the way legislators think about the content of a proposal and their votes affect our lives. Even accurately titled legislative acts may not be as beneficial as they might appear, due to limits (often funding or time limits) written into the language of the act. For example, during the 1970s, if you were looking for a way to ease the high unemployment rates of reservation communities and were called on to vote for an "Indian Employment Act," you might think it would result in some good news for a specific population of job seekers. That would seem to be a reasonable assumption. In actuality, when the bill was introduced to Congress in 1979, all at authorized was retirement benefits for top ranking federal staff (Feraca 1990:178; Public Papers of the Presidents, Gerald R. Ford, 1976:2319). It was first vetoed (Castile 1998:166) for being "discriminatory and costly" before making it through Congress on a second try. The title notwithstanding, it offered no benefit for the proposed "target populations." And the appearance that an employment initiative had already been enacted may have prevented any later attempts to do just that.
During earlier years of this New Millennium, one bill tried to work its way through Congress under this title: "Healthy Mothers and Healthy Babies Act." That sounds like a fine goal to me. However, anyone who read the proposed bill would see that the beneficiaries were neither women nor babies; the proposed outcomes, in fact, would have further limited any medical liability in the case of medical malpractice lawsuits (for example, medical mistakes that caused brain injury to an infant or the death of the birthing mother).
Public policies can save women's lives. Here are two examples of federal policy outcomes supportive of Women's Health. During an interview with a young mother in who lives in the American Northwest, she told me that she is alive today because of her infant’s involvement in a federal child development program. She entertained the radiant six-month-old child as she told me about more troubled times of spousal abuse that began with the news of her pregnancy, and then escalated over a period of months. She credited her survival to her access to program staff and other parents she had come to know through her engagement with the program; she said they intervened in her crisis “just-in-time" to give her the information she needed, and the support of a team of volunteers who helped her move her son and their belongings into a much safer residential situation. And from North Carolina comes this story. A report on outcomes of a nutrition project administered by the University of North Carolina in Chapel Hill, NC, during the first few years of the New Millennium, stated the following: “From … 1995 through 1997, more than 2100 women in 31 North Carolina counties were screened for risk factors for heart disease and stroke… In 17 counties, women received minimal counseling on diet and physical activity; in 14 counties, women participated in the New Leaf program. After one year, lipid and blood pressure values improved and the risk for death due to heart disease and stroke declined among women in all counties. In addition, women who participated in the New Leaf program improved their diet much more than women who received only minimal dietary and physical activity counseling.”
Go Beyond the Surface: Ask Solid Questions
Lawmakers need our questions. It's our health and well-being they are talking about, after all, and the wisest legislators know they can benefit from the insights, perspectives and experiences of the people they serve. We have the right – and the responsibility – to question and seek answers about the details of proposed legislation. Today's proposal's become laws that we will live with for decades to come. We need to look beyond policy titles and decipher what the actual projected outcomes of the law will be. To do this, we need each question to take us deeper into the layers of policy initiatives. Remember, our goal is the identification of the actual projected outcomes (e.g., will women's lives be saved or put into increased danger).
Specific words really matter, as policy language must be precise in order to limit and control its meaning in law. Be sure to assume nothing when you consider what legislation is really all about. Ask questions that can take you to a fuller truth. Let answers to your first question springboard you toward your second question. Leap beyond the headings and into the actual potentials, the benefits and/or risks embedded within the legaleee. For example:
A. Who gets the money? This is a reasonable first question, as all legislation leads to the distribution of federal dollars. Someone is going to receive those funds. This is always an interesting place to begin.
B. Is personal freedom limited or expanded? If it is, to what extent and which American households are primarily affected?
C. How will this policy – or how did this historic policy – impact the health of women? For example does it change anything about whether or not women have access to necessary or beneficial services, and if it does, are specified services adequate and quantity and accessibility in terms of the realities of everyday life? Does it enhance the personal safety of women? Does it give women quality information?
Can We Agree to Agree?
May I assume that most of us envision healthful life for one and all as a value that lies somewhere in the mixed up catalog of American Values? After all, what could possibly be more fundamental to our nation's well-being and community health at the local, state and national levels? Perhaps becoming excellent students of public policy might be one way to enhance the status of Women's Health. Good public policy requires ample public implant; policymakers need our input in order to create relevant Women's Health initiatives. Let's get more involved in that process. Why? Because policy matters … to all of us.