Why is it Important to Me? OMAR A. CONTRERAS, DR.P.H., M.P.H. - - PDF document
6/12/2019 Public Policy Why is it Important to Me? OMAR A. CONTRERAS, DR.P.H., M.P.H. MEGHANNE BEARDEN, MPA MICHELLE BERMAN, MS, RDN, CDE, FAND, MODERATOR, SARAH KISER, MS, RD, CSO, CNSC ARIZONA STATE SENATOR TYLER PACE JUNE 7, 2019 FROM
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OMAR A. CONTRERAS, DR.P.H., M.P.H. MEGHANNE BEARDEN, MPA MICHELLE BERMAN, MS, RDN, CDE, FAND, MODERATOR, SARAH KISER, MS, RD, CSO, CNSC ARIZONA STATE SENATOR TYLER PACE
JUNE 7, 2019
FROM EVIDENCE- BASED RESEARCH TO POLICY ACTION
Omar A. Contreras, Dr.PH, M.P.H. Arizona Academy of Nutrition and Dietetics & Arizona Chapter of the American Association of Diabetes Educators June 7, 2019 Phoenix, AZ
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9.5% 10.6% 10.7% 10.0% 10.1% 10.80% 9.5% 9.7% 9.8% 10.1% 10.5% 10.50%
4.0% 6.0% 8.0% 10.0% 12.0% 2011 2012 2013 2014 2015 2016 Age-adjusted prevalence (%) Year Arizona National
Source: Arizona BRFSS (2017)
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Diabetes Age-Adjusted Mortality by Race and Ethnicity (2005-2015)
Source: Arizona Vital Statistics (2016)
Age-adjusted prevalence of prediabetes
* Error bars represent 95% confidence intervals. †In 2012 and 2015, the prediabetes module and questions were not administered by the Arizona BRFSS. NHANES data is representative of national prevalence of prediabetes data from 2011-2014 (n=5,179) No data was available for 2015 for BRFSS or NHANES to compare with SQL prevalence of prediabetes estimates.6.5 7.4 7.9 8.6 7.8 8.0 9.1 10.8 23.4 19.5 19.0 20.0 34.4
5 10 15 20 25 30 35 40 2011 2012 2013 2014 2016 2011-2014 Prediabetes Prevalence (%) National BRFSS Arizona BRFSS SQL NHANES
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Average direct medical costs per capita* Estimated direct costs for those NOT participating in the DPP who may convert to diabetes, 2017 Average indirect medical costs per capita* Estimated indirect costs if conversion to diabetes occurs for those NOT eligible to participate in the DPP Total medical costs (Direct and Indirect)
$9,601.00 $6,788,084,510.97 $3,640.00 $2,573,547,299.23 $9,361,631,810.20
Arizona diabetes projected direct and indirect costs, 2017
For a person with NO NO DPP intervention For a person with DPP intervention
Average direct medical costs per capita* Estimated direct costs for those eligible to participate in the DPP who may convert to diabetes, 2017 Average indirect medical costs per capita* Estimated indirect costs if conversion to diabetes occurs for those eligible to participate in the DPP Total medical costs (Direct and Indirect)
$9,601.00 $3,655,122,428.98 $3,640.00 $1,385,756,238.05 $5,040,878,667.03
* Average direct and indirect costs are based from theAmerican Diabetes Association, Economic Cost of Diabetes in the U.S., 2017 Source: Contreras, O (2019). Evidence-based research to inform diabetes prevention policy in Arizona. (Publishable doctoral dissertation) University of Arizona, Tucson, AZ.
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Cum Cumula lativ ive di difference be betw tween cos
in n the the "no no interv rvention" and and the the "interv rventio ion" gr grou
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Policy Advocacy Essential Steps
Analyze policies Plan of implementation Plan for monitoring and evaluation
Identify a policy issue Identify key partners/allies Define the strategy Identify key messages
Hasan Al Farooque SA. Policy Advocacy: Concepts, Strategies and Effective Communication. Asian South Pacific Association for Basic Adult Education – Civil Society Education Fund. http://www.aspbae.org/bldc/sites/default/files/ppt/Policy%20Advocacy.pptx. Accessed December 19, 2018.
The key to understanding the process…
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Lobbying Emails/Letters Briefings/Meetings Door-to-Door Phone Calls Social/Mainstream Media Marches or Protests Litigation
But All Politics Is Local – Ode to the States
Each legislature may establish its own rules
processes vary—from state to state, from chamber to chamber, and from session to session. In 2017, 17% of bills introduced in state legislatures passed, while only around 1% introduced in Congress passed States usually have a more direct impact on day-to-day lives Easier to meet your legislator Structure and nature of state legislatures allows you to be an expert and a strong voice
for dental education
6/12/2019 8 Advocate during the “down times” A lot of advocacy work is done before the start of a session Short sessions and full time jobs place constraints on legislators time The time to build relationships and educate lawmakers is before session starts, in many cases it is late to do anything proactive when session starts 24 states limit the number of bills a legislator may introduce
Additional Factors to Keep in Mind
crossover deadline
a specified date, the bill is usually dead
numbered years
from even years to odd years
Groups/individuals influential for supporting diabetes prevention policies in Arizona
10 20 30 40 50 60 1 2 3 4 5 6 7 8 9 10 11
Percentage Response Influential Scale (1 being the MOST, 11 being the LEAST influential)
Advocacy groups and coalitions Certified Diabetes Educators Researchers and Professors from Colleges and Universities (Academics) Constituents Governor Indian Health Services (IHS) Lay health leaders interested in diabetes health/care Legislative Leadership Local Health Departments State Health Department Medical Doctors, Nurses, Pharmacists, or other health care professionals Advocacy groups and coalitions include the American Diabetes Association, healthcare and disease specific coalitions, Tribal Coalitions, health foundations, etc. Percentages may not add up to 100% due to rounding. Source: Contreras, O (2019). Evidence-based research to inform diabetes prevention policy in
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Factors that influence the passage or failure of proposed diabetes prevention policies in the Arizona legislature
10 20 30 40 50 60 Not at all influential Slightly influential Somewhat influential Very influential Extremely influential
Percentage Response
Advocacy groups and coalitions Committee Chairs Constituents Disease burden data across the state Fiscal impact Governor Legislative Leadership Political party Timing relative to election Advocacy groups and coalitions include the American Diabetes Association, healthcare and disease specific coalitions, Tribal Coalitions, health foundations, etc. Percentages may not add up to 100% due to rounding. Source: Contreras, O (2019). Evidence-based research to inform diabetes prevention policy in
University of Arizona, Tucson, AZ.
Public policymaking for the coverage of the National Diabetes Prevention Program
Source: Contreras, O (2019). Evidence-based research to inform diabetes prevention policy in Arizona. (Publishable doctoral dissertation) University of Arizona, Tucson, AZ.
STRATEGIC PARTNERSHIPS FINANCIAL SUPPORT FOR PROGRAM IMPLEMENTATION INSTITUTIONAL LEADERSHIP HEALTHCARE AND REIMBURSEMENT PAYMENT MODELS
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Final thoughts…
Prediabetes and diabetes continue to be major public health problems in Arizona. Diabetes prevention efforts may help to alleviate the cost burden. Data are powerful to initiating policy, systems, and environmental changes. State level diabetes prevention policy can be informed and influenced through a cadre of stakeholders (CDEs, constituents, advocacy/coalition groups, and legislative leadership). Being an effective policymaker constitutes understanding the intersection of policy, politics, and advocacy. Advocacy should be an ongoing process and it begins NOW!
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WeArePublicHealth.org @MaricopaHealth /MCDPH
Meghanne Bearden, MPA
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– Governor
– House and Senate
– Courts
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– Equal in population – Redistrict every 10 years
– 60 Members (2/District)
– 30 Members (1\District)
How is a bill created?
with an idea to address a problem.
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Committee Hearings
committee, and the Rules committee
Crossing the Courtyard
(House + Senate)
Committee/Final Vote
» Sign into Law » Veto (Legislature can override) » Not signed, becomes law
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school meals; water
Language of the bill
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the importance of all nutrition professionals
– become the go-to as elected officials make decisions that impact nutrition policy
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azleg.gov
the first time you use the RTS system.
about the process
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lobbying
guidelines regarding advocacy and lobbying
– Use your personal time to advocate and/or lobbying for issues you’re passionate about
Meghanne Bearden, MPA
Health Policy Analyst @ MCDPH Meghanne.Bearden@Maricopa.gov 602-359-6861
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June 7, 2019 AZAND/AADE Annual Conference Michelle Berman, MS, RDN, CDE, FAND AZAND Advocacy Director
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Three Focus Areas:
1.Prevention and Well-being 2.Health Care and Health System 3.Food and Nutrition Safety and Security
Successful Public Policies:
National Provider Identifier
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Farm Bill Reauthorization Agriculture Improvement Act of 2018
National School Lunch Program WIC, Commodity Supplemental Foods Medicare Medicaid (AHCCCS) Kid’s Care
Federal Nutrition Programs are Public Health Programs
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S.B. 1089: insurance; telemedicine S.B. 1353; AHCCCS services; diabetes management
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https://www.eatrightpro.org/media/multimedia-news- center/videos/andpac https://www.eatrightpro.org/media/multimedia-news- center/videos/andpac
Michelle@nutritionpro.net Advocacy@eatrightarizona.org