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Publication: Journal of Environmental Health
Date published:
Language: English
PMID: 23855
ISSN: 00220892
Journal code: PENV

Warning: This column is not for public health purists.

Warning: This column is not for ideologues who have difficulty exploring ideas that lie outside of their ideological comfort zone.

Two columns ago, I talked about how crucial it is that we (the environmental health profession) become energized about the possibilities that the future holds for us. I contrasted this optimism with the more prevalent and morose pining away for the good old days that I see in too many corners of environmental health today.

In my last column, I offered that we could achieve greater traction with our messaging if we would tune into the language that our target authences speak and learn how to use their words (and not ours) to advance our cause and case.

Now in this column, I will take these ideas that final step by explaining how we've made them the centerpiece of our strategy to advance environmental health, which is the mission that drives this organization. I begin by recapping the story of our new Center for Priority Based Budgeting (CPBB).

Our new Center program was devised to help NEHA (and through NEHA, our profession) better connect with the policy makers who control our budgets and determine our roles. Through this program, we have found our way to the very table that mayors, county administrators, county executives, city managers, chief financial officers, and the like all sit at. In fact, in many cities and counties throughout America, we are now sitting down right next to them.

More to the point, we are now guiding many of these local leaders in the development of what is arguably the single most important and powerful policy document that local governments produce - that being their budgets.

The process that we use (a values-based method of priority based budgeting) forces a government to think through why they even exist. We boldly ask, "Why do you exist and what exactly does this community expect from its government?"

Hold that thought for a second while I talk about why learning a new language is more important than yelling through a bullhorn when it comes to having an impact on public policy.

As I argued in my previous column, if all we do to safeguard our work and our future is stand on a street corner and yell about the importance of environmental health (which is metaphorically what so many professions are doing today), it's hard to imagine any other outcome than a sore throat! The 19% cut in the local public health workforce over the last three years stands as some pretty compelling evidence for how effective that tactic has been.

We need a different way. Using bullhorns to preach our case (or simply wishing for a magical journey back to the good old days) isn't going to enable us to achieve the standing that so many of us seek.

In my last column, I strenuously pressed the point that Stephen R. Covey made so elegantly in his book, The 7 Habits of Highly Effective People: "Seek first to understand and only then to be understood." I also pressed the point that we need to understand the language that policy makers speak and then talk to them in their language, not ours, if we have any hope of them hearing us.

OK - back to my main thread - by getting a seat at the policy maker's table, we have been able to learn why these governments (that so many NEHA members work for) exist and what the language of local policy makers sounds like.

When asked why do you exist, two issues utterly dominate the conversation. Local policy makers tell us in the most unequivocal of terms that their governments exist to

1. Provide a safe community and

2. Foster economic health and vitality.

In fact, in just a little over a year of our successful Center program, we've now amassed enough experience and data to catalog the answers that we have been getting to this most crucial of all questions - Why do you exist? The complete listing looks as follows:

* Safe Community

* Economic Health and Vitality

* Sustainable, Healthy Attractive Environment

* Cultural, Learning, and Recreational Opportunity

* Effective Transportation Systems

* Quality of Life Communities and Neighborhoods

* Ecological Stewardship

* Thoughtful Growth Management

* Reliable Urban Infrastructure

* Effective and Authentic Communication with Citizenry

* Nurturing, Connected Communities

* Sound Fiscal Management

* Responsiveness and Customer Service

Once we get local officials (and often citizens as well - through a strong public participation component that we have built into our process) to identify why their governments exist, we don't then allow the discussion to end. Instead, we next insist that they tell us what they mean by public safety or economic health, etc. This is where the process gets even more fascinating.

What we have learned is that "public safety" - the overwhelmingly number one reason for why communities exist - means much more than just police and fire. Among other things, it also encompasses emergency response capability, enforcing environmental regulations, well-planned communities, providing for physical and mental well-being, healthy communities, and structurally sound built environments to cite but a handful of elaborations as to what policy makers mean by public safety.

When we looked more closely at economic health and vitality, we found similar enlightenments. This concept includes wellplanned community development, sound land use planning, quality of life, sound and efficient urban infrastructure (think drinking water, recreational facilities, wastewater disposal, etc.), attractive environments, energy efficiency, green industries, ecological stewardship, and natural resource renewal.

Going down this list of "reasons for being," we see numerous other priorities that have environmental health written all over them - sustainability, healthy environments, recreational opportunities, quality of life, quality neighborhoods, ecological stewardship, smart growth, etc.

Let's take a step back and think about what we've learned.

When we listen to and then absorb the language of the very people we're trying to communicate with and influence, we discover that in fact, environmental health is nearly as important to them as it is to us! In fact, environmental health is embedded in the most important considerations holding sway in our communities today.

The challenge is that most policy makers don't realize that they are talking about environmental health and we haven't exactly been helping them to understand that. This has therefore become a priority area for NEHA. We are moving forward with strategies that enable policy makers to more easily see the environmental health threads that are woven into many of their primary interests. (As but one example, we've made arrangements to have published in the ICMA [International City/County Management Association] journal a stirring paper that details why local governments should be using their environmental health staff to help them with their sustainability programs and goals.)

But beyond enlightening local officials, we also need to have more environmental health people adopt (or at least become fluent in) the language used by policy makers. If public safety is the unbridled top concern of policy makers and if within this issue we can find many environmental health considerations, then why wouldn't we approach policy makers to tell them that we can help them meet their public safety goals? If we instead stay on that street corner with our bullhorns and demand that policy makers (and even the public) respect and appreciate public and environmental health, does anyone really believe that we would get anyone to even listen?

If we can extend our opportunities to protect the public we serve from threats to their health, simply by tuning into and using the language of the policy makers who oversee our programs (and budgets), then why wouldn't we do this?

Over my 40+ year career in environmental health, I've never seen the unsettledness that I see today in our economy and in even the way our government works (or should I say, doesn't work!). Things are different. But the methods being employed by advocacy groups for change continue to look much like those used in past worlds, which were different from this new and fascinating new world of uncertain budgets, unpredictable energy costs, unsustainable energy consumption patterns, structural unemployment, etc., etc., etc.

The premium today is on innovation, experimentation, speed, and an openness to seeing complex issues from multiple points of view.

NEHA well understands its mission to advance this profession and its capabilities. But what gives that sentence meaning is that we're open to the possibility that there are new and different ways to realize our mission. The bullhorn approach (and the marketing approach that held currency for years within NEHA), just hasn't gotten us anywhere. So we've dared to be different. We've been experimenting and we've been innovating.

Who would have thought that someday an "environmental" organization would be helping major American cities like Cincinnati, Sacramento, and San Jose - to name just a few - develop and finalize their budgets?! Who would have thought that we could attach environmental health as justifiably to public safety as we attach this discipline to public health? But if it works and if these different methods of advocacy end up helping us to carry out our work in this new world with greater policy and financial support, then why not?

As we venture onto some of these new paths, we are also building new friendships, just as we continue to maintain our existing friendships within the public and environmental health community.

We count among our new friends the likes of ICMA and the Alliance for Innovation - professional societies that represent the leadership of local governments throughout the nation (and our bosses' bosses!). Just recently, in a conversation I was having with the leadership of ICMA, a most interesting comment was made. That professional society believes that this next decade will be "the decade of local government." They observe that the federal government is broke and dysfunctional. The same can be said for many states.

At the local level of government, however, the housing crash and its taxation consequences have forced local leaders to both change and innovate. From the bottom up, fascinating things are happening. And NEHA is there and in the process, we are telling local leaders how environmental health can help them to build healthier, more sustainable, and more economically viable communities.

No one is proposing that we decouple environmental health from our public health heritage. We are open, however, to the idea that environmental health can also be coupled to public safety - for after all, doesn't our work serve to protect the public from threats to their health? And isn't that public safety?

If this concept makes some uncomfortable, we ask only that you judge us by our results, which we're confident will surpass any that arise from the use of the street corner bullhorn.

Author affiliation:

Nelson E. Fabian

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