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 Management Minute

Advocacy = Educate + Urge Action 

Last week I traveled to Chicago to speak to a group of MCH leaders attending the University of Chicago-Illinois’ Maternal and Child Health Leadership Retreat. The topic of my presentation, “Advocating for MCH in Challenging Times,” was a chance to share some thinking about the larger forces and issues impacting AMCHP’s advocacy for state maternal and child health programs. In my talk I used a pretty standard definition of advocacy: advocacy involves education (sharing the facts) with urging action (doing something about them). I thought sharing some of the major themes from the presentation might be good for us all to consider as we move forward our MCH advocacy agenda. While the final outcome of federal deficit reduction and budget cut negotiations remains cloudy, it is very clear that the coming year’s appropriations season will require the tremendous need for all of us to redouble our efforts in support of the Title V MCH Services Block Grant and other critical MCH programs. 

The State and Federal Roles in Promoting Health
The debate over the constitutionality of the Affordable Care Act (ACA) has kept many states from fully implementing new opportunities to support maternal and child health programs. For example, an AMCHP member recently shared with me that her state has been prohibited from implementing the new home visitation program and left millions of new dollars for moms and kids on the table in the process. The debate over ACA is a classic debate about the rights of states and the role of the federal government. Ironically, this debate is not new for MCH. The early days of the Children’s Bureau and MCH legislation in the 1920’s were filled with controversy about the federal government’s role in protecting and promoting the health of women and children versus states’ rights to determine what and how MCH services will be provided. How will this play out? We are all waiting with bated breath for state lawsuits to make their way through the judicial process and pretty much everyone agrees that the Supreme Court will need to decide on the crucial question as to whether or not the federal government can require all Americans to have health insurance. What does this mean for state MCH leaders? There will continue to be varied approaches to ACA implementation for the foreseeable future – Plan A is full ACA implementation, Plan B is what we’ll do without it. One of the main sources of new resource for MCH programs is ACA funding. This makes ACA implementation critical. 

Deficit Reduction and Budget Constrictions
As if ACA implementation was not enough of a challenge, the continued negative economic environment has led to a shrinking of state resources, including resources to support maternal and child health programs. We all have friends who have been furloughed, downsized, laid off, or re-organized within their agencies. In a time of shrinking budgets MCH programs are being asked to do more with less: more program administration, support more partnership, and provide more leadership on MCH issues with less people and less resources. Indeed, the challenges of leading in tough economic times are overwhelming. What does this mean? In an environment of scarce resources, MCH advocacy is all the more important especially considering the competition for funding within a state. It also calls on our ability to prioritize: what is most important or core to our programs and how can we continue to provide these services in light of cuts to state MCH programs? 

The Impact of Cuts
AMCHP has collected a variety of data on the impact of budget cuts to state MCH programs. Quantitatively we can estimate how reductions in MCH funding will result in an increased number of bad outcomes for our nation’s women, children and families. What we also need now are stories of how critical the Title V MCH Services Block Grant program is in the lives of individual families. These qualitative data make the data “real” to policy makers. AMCHP needs your help in showing how your state’s residents will be impacted by the decisions your representatives are making here in Washington. 

Anti-Government Sentiment
I think it is fair to say that now is not a great time to work in government: anti-government sentiment is at an all-time high. A recent Washington Post-ABC News poll found that 80 percent of people surveyed are “angry” or “dissatisfied” with the way Washington works, the highest in 20 years, and that anger is directed at all levels of government. Voter anger is squarely on the minds of all members of Congress and the president. State government employees are often demonized in anti-government rhetoric, and act as pawns in larger political battles. Morale is comprised by this anti-government sentiment, as is your ability to recruit and retain effective staff. Despite the anti-government sentiment there is an urgent need for the services that government provides. If not Title V, who else will assure that the health needs of women and children are taken into account in these trying fiscal times? Who else has the responsibility for assuring that policies and programs are in place to address the most critical state MCH needs? What does this mean for advocacy? We need to continue to make the case that Title V is essential to protecting and promoting the health of women, children and families. And we have to be resilient MCH leaders in the face of tough times. If not us, who else will carry the water for state maternal and child health? 

All of these themes resonated with the group I spoke to in Chicago. I hope they resonate with you as you consider your role in advocacy during challenging times. I look forward to hearing from you about this and other ways that AMCHP can help you in the states.