Texas Public Health Association Legislative Advocacy Guide

Guidelines for Effective Public Health Advocacy

.

December 2005 About This Guide

This guide is for you- the public health advocate. It provides background on the Texas Public Health Association (TPHA), introduces advocacy and lobbying, information on the legislative process and provides you with tools and strategies for working and communicating effectively with policy makers.

Please use these materials in the work that you do as an individual or with your organization to meet your particular needs. If necessary, modify the information and resources provided.

TPHA would like to give special thanks to the following members of our organization who have been actively involved in developing this manual: . Terri Pali, TPHA Executive Director . Jacquelyn Dingley, TPHA President (2005 – 2006) . Katy Krottinger, Student Intern (2005) . Carol Lee Hamilton, Chair, Legislation/Government Affairs Committee . Doug Fabio, Member, Governing Council & Legislation/Government Affairs Committee . Elizabeth Treviño, Member, Legislation/Government Affairs Committee

TPHA would also like to thank the following organizations for their assistance in providing resources and information: . American Public Health Association . Research!America . Texas Public Health Training Center . Texas Association of Local Health Officials . Texas Association of Municipal Health Officials . Texas Institute for Health Policy Research . Tarrant County Public Health

2 TABLE OF CONTENTS

Page

I. What is the Texas Public Health Association ………………………………. 4  Vision  Mission Statement

II. What is Advocacy? Why Participate? …………………………………….. 5  Advocacy vs. Lobbying or Electioneering  Workplace Issues  Getting Started

III. How does the Legislative Process Work? ….……………………………... 6 - 11  How Does a Bill Become Law?  Basics Steps in the Texas Legislative Process  When & How to Advocate  Guidelines for Working with Legislators and Other Policy Makers

Available Resources through Workplace Do your Homework Writing to your policy makers Calling your policy maker Arranging a meeting Conducting a meeting Presenting Testimony

IV. What other Information is Available …...………………………………... 12- 14  Public Health Related Committees  Resources  Terminology

V. APPENDICES …………………………………………………………….. 15-18  Appendix A: Sample Letter to an Elected Official  Appendix B: Sample Testimonies TPHA, TALHO, TAMHO Local Public Health

3 WHAT IS THE TEXAS PUBLIC HEALTH ASSOCIATION?

The Texas Public Health Association is a non-profit, state association of public health professionals, organized in 1923. TPHA has also served as the Texas affiliate of the American Public Health Association since 1988.

Vision: The Texas Public Health Association envisions healthy Texans living in a safe environment.

Mission: As a leader of public health action in Texas, the Texas Public Health Association:

 Educates and empowers people to adopt healthy lifestyles  Develops and promotes policies and legislation  Explores new insights and innovative solutions to health and environmental problems  Fosters professionalism in a multi-disciplinary workforce  Brings together all individuals and organizations with an interest in public health under one umbrella

4 WHAT IS ADVOCACY? WHY PARTICIPATE?

An advocate is a person who educates and/or urges support for a particular issue or cause. Advocates can be individuals, non-profit groups, independent agencies or other organizations. A public health advocate attempts to influence the way the public and policy-makers think and act on public health policies. Advocacy efforts may be directed toward issues of general importance as well as specific issues that are currently under consideration by legislators and other policy makers.

It is important to make the distinction between advocacy, lobbying, and electioneering. The following table may be helpful in making this determination.

ADVOCACY LOBBYING ELECTIONEERING Educating legislators, Asking for a vote in favor Campaigning on behalf of urging support for a of or against a specific or voicing opposition to a particular issue or cause piece of legislation particular candidate

Workplace Issues

Most employers will have strict guidelines about whether and to what extent advocacy efforts can be conducted at the workplace. Lobbying is generally not allowed and electioneering is almost always prohibited. It is important to check with your employer’s government affairs or human resources office to obtain this information before you engage in any efforts of this sort during work time.

Getting Started

It is important to recognize that you can make a difference. Your policy-makers welcome your opinions and knowledge about issues affecting you, your community, and your state. Although working with legislators and other elected officials may at first seem intimidating, you can become an effective public health advocate by understanding the legislative process and following the guidelines provided in this document. The Texas Public Health Association is also available to assist you in every way possible. You can contact us by phone at: 512-336-2520 or by email at: [email protected]. You can also obtain information about current public health legislation/advocacy issues on our web site at http://texaspha.org.

5 HOW DOES THE LEGISLATIVE PROCESS WORK?

Understanding the legislative process is the first step to becoming an effective participant in the development and implementation of public health policy. For successful participation in the legislative process, timing is everything. The earlier in the process that you involve yourself the better chance you will have influencing the outcome.

The Texas State Legislature meets for 140 days every other year for its “Regular session.” The governor has the ability to call for “Special sessions.” Committee work is also done between sessions. The US Congress is in session every year, with a brief recess over the summer.

How Does a Bill Become a Law?

 A bill is introduced in the House or the Senate, and referred to the appropriate committee(s) that deals with that subject or issue  Often the bill will then be referred to a subcommittee  Then the full committee can hold hearings and make revisions. If the full committee approves the bill, it is “reported” to the full house. If the committee takes no action on the bill, it “dies.”  The bill is then debated on the House floor and may be amended. The full House votes on the bill and if it passes, it proceeds to the Senate to be considered. If it has already been passed in the Senate, both versions go to a Conference Committee to be “reconciled.”  Once the bill has been approved in identical form by both chambers, it goes to the President or Governor for signing.  After a bill has become law, it is assigned to the appropriate state or federal agency for implementation. Additional opportunities for advocacy occur during the agency rule and/or policy development process.

The diagram on the following page displays the sequential flow of a bill in the Texas Legislature from the time it is introduced in the House of Representatives to final passage and transmittal to the Governor. A bill introduced in the Senate would follow the same procedure in reverse. The process is essentially the same in the US Congress, with enrolled bills sent to the President for signature, refusal of signature, or veto.

6 Basics Steps in the Texas Legislative Process

Source: Basics Steps in the Texas Legislative Process. http://www.senate.state.tx.us/CHBook/Chart.htm

7 When and How to Advocate

Advocates can influence the legislative process at any time.  During the time of initial proposal, advocates can propose ideas and serve as useful resources.  When the bill is being introduced and referred to the appropriate committee(s), advocates should call, write, and visit legislators making them aware of your opinions.  When the bill reaches the subcommittee, advocates should provide verbal or written testimony before the committee. Advocates may also issue a press release or send letters to committee members supporting or opposing the bill.  When the bill is scheduled for floor action, contact your legislator by phone, fax, etc to indicate support or opposition.

Guidelines for Working with Legislators and Other Policy Makers

You will be more effective in your advocacy efforts with legislators and other policy makers when you know how to do it correctly. It is important to first make sure that you have the right contact person, as there are many issues that overlap across different agencies and different levels of government. Once you know where to start, you can find contact information on the Internet as follows: . State Legislators and US Congressmen: http://www.capitol.state.tx.us/fyi/fyi.htm. . State Agencies/elected officials: http://www.txdirectory.com . Federal Agencies/elected officials: http://www.firstgov.gov/

Use Resources Available Through Your Workplace Set up a meeting with your agency’s government affairs office. They can help you:  Learn institutional /organization policies and whether your advocacy efforts can be conducted during work time (Note: Even if there are workplace restrictions, you still have a First Amendment right to advocate during personal time, representing yourself as a concerned citizen with public health expertise).  Learn institutional/organizational programs already in place.  Identify appropriate legislators and/or their staff and set up meetings.  Invite legislators to tour your facility or attend an event at your institution or workplace.

Do Your Homework Learn about your legislators, their districts, constituents, and voting records. Take into consideration their experience, committee assignments, priorities, perspectives, advisors and allies when you strategize your approach. The more you know, the better you can tailor your message for that individual.

Acquaint yourself with staff members for legislators and their committees, as well as other resource officials with whom you will be working. These individuals are essential sources of information and have significant influence in some instances in the development of policy.

8 Use email communications and web-based resources available through the Texas Public Health Association to monitor legislation and identify key issues for advocacy. Work closely with other fellow advocates and partners in the public health community to better understand the process, identify common goals, and assess strengths and weaknesses. Identify those groups with whom you may need to negotiate/ally regarding specific issues. Do not dismiss anyone because of previous disagreements or because you lack a history of working together.

Keep on top of the issues and be aware of controversial or contentious areas.

Build Relationships  Meet with the legislative staff to introduce yourself, your organization, and the preventions and public health issues affecting your community.  Use personal information when possible. For example, if you grew up in the same town or went to the same university, make this connection.  Be brief, clear, accurate, persuasive, timely, persistent, grateful, and polite when presenting your position and what you need/want from the legislator or staff member. Be able to translate complex issues and scientific language into everyday terms.  Be honest, straightforward, and realistic. Do not make promises you cannot keep. Never mislead a legislator about the importance of an issue, the opposition’s position or strength, or other matters.  Be polite, remember names, and thank those who help you – both in the legislature and the public health advocacy community.  Be sure to follow-up with legislators and their staff. If you offer assistance or promise to provide additional information, do so in a timely and professional manner. This will help to ensure that they will perceive you as a reliable resource.

Writing To Your Policy-Maker

. Written communication can be via fax, email, or regular mail, although procedures to screen postal deliveries can slow down your input. . Always use the proper form of address and correct spelling of the policy maker’s name. (For example: The Honorable John Doe.) . Use the proper salutation. (For example: Dear Senator Doe or Dear Representative Doe.) . Identify yourself as a public health professional. . Confine your letter to one issue. Briefly state your purpose for writing and how the issue would affect you and other constituents. Include relevant data and research to support your position. . Make every effort to keep your letter to one page. . Be sure to include your name, professional degrees, and contact information at the close of the letter.

9 . Whenever possible and appropriate, use your agency/organization letterhead and your official title.

Calling Your Policy-Maker

. Prepare your phone message in advance. . Contact the office of the policy maker and state that you would like to leave a message. . Give your name and contact information and identify yourself as a public health professional. . Briefly state your purpose for writing and how the issue would affect you and other constituents. Include relevant data and research to support your position.

Arranging a Meeting

 Send a letter, fax, or email requesting an appointment.  Be sure to address the letter to the legislator and to the attention of the appointment scheduler. Include information about who you are, the nature of your visit, when you would like to meet, and the names of any friends or colleagues who may accompany you.  After a few days, call the office to which you sent the letter and ask to speak with the appointments scheduler or the administrative assistant who handles appointments.  Explain who you are and why you are calling. Refer to the letter you sent to the office. If the legislator is unavailable at that time or will not be in the area on the date you would like to meet, the scheduler may offer you another date/time or provide you the opportunity to meet with the legislative assistant who handles the issue you want to discuss.  Send a letter, fax, or email or make a phone call confirming the appointment.

Conducting a Meeting

 Arrive on time. If meeting with a staff member, be sure you have the correct contact name.  Bring two or three colleagues with you. Prior to the meeting, you should agree on what points will be made and which one each of you will cover.  Try to deliver your message in three minutes. Be sure to introduce yourself and your colleagues and explain why you are concerned about the issue. Be concise, polite, and professional.  Be prepared to answer questions.  When asked what you want, clearly explain what it is.  Offer your time and assistance if he or she wants to talk about your issues in the future.  Leave behind a business card and a one-page fact sheet summarizing your issue.  Follow up with a thank you letter. Be sure to include any additional information you may have promised or that may be relevant to the issue.

10 Presenting Testimony

. Secure an invitation to testify through the bill’s sponsors or committee members. . Provide a brief, concise written statement for testimony purposes, which will be part of the official record. . Be precise and concise in your oral statement, usually no more than five minutes. . Try to avoid scientific or professional jargon. . Be polite and address policy makers as “Madame Chairman, Senator __, Representative __, etc. . Concentrate your remarks on what can be done to improve the problem, suggest recommended action.

11 WHAT OTHER INFORMATION IS AVAILABLE?

PUBLIC HEALTH-RELATED COMMITTEES

TEXAS LEGISLATURE

See the Texas Legislature Online Web Site at http://www.capitol.state.tx.us/ for details regarding current committee membership and charges

House Committees Senate Committees * Agriculture & Livestock * Finance * Appropriations * Health & Human Services * Border & International Affairs * International Relations & Trade * Calendars * Transportation & Homeland Security * Environmental Regulation * Public Health * Rules & Resolutions * Ways & Means

UNITED STATES CONGRESS

See the House of Representatives Web Site at http://www.house.gov/ and the Senate Web Site at http://www.senate.gov/ for current committee membership and charges

House Committees Senate Committees * Appropriations * Agriculture * Budget * Appropriations * Education & the Workforce * Budget * Energy & Commerce * Commerce, Science & Transportation * Homeland Security * Environment & Public Works * International Relations * Finance * Transportation & Infrastructure * Health, Education, Labor & Pensions * Ways & Means * Homeland Security & Gov’t Affairs

12 OTHER RESOURCES

American Public Health Association http://www.apha.org

Federal Register http://www.access.gpo.gov/su_docs/aces/aces140.html

FirstGov, links to federal govt. info http://www.firstgov.gov

Library of Congress http://www.thomas.loc.gov/

National Institute of Health http://www.nih.gov/

Project Vote Smart http://www.vote-smart.org

Research!America http://www.researchamerica.org/advocacy

Texas House of Representatives http://house.state.tx.us

Texas Legislators & US Congressmen http://www.capitol.state.tx.us/fyi/fyi.htm

Texas Legislature http://www.capitol.state.tx.us/

Texas Public Health Association http://www.texaspha.org/

Texas Register http://www.sos.state.tx.us/texreg/index.shtml

Texas Senate http://www.senate.state.tx.us/

Texas State Directory http://www.txdirectory.com/

Thomas: Legislative Information on the Net http://Thomas.loc.gov/

U.S. House of Representatives http://www.house.gov/

U. S. Senate http://www.senate.gov/

13 TERMINOLOGY

ACT- The term for legislation that has passed both chambers of Congress and has become law.

AMENDMENT- A proposal to change or an actual change to a piece of legislation.

ADVOCACY- The act of pleading or arguing in favor of something such as a cause, idea; active support.

BILL- Legislation to create a new act. Must be passed by both chambers and signed by the President (Governor) before becoming law. This is how the legislature enacts a law.

CANVASS- Also referred to as "going door to door" to distribute literature ("lit drop"), gauge public opinion, gather signatures for petitions, etc.

COMMITTEE- Designated group of Members assigned the responsibility for holding hearings and consideration of measures within their jurisdiction and referred to them for this purpose.

CONFERENCE COMMITTEE- A committee of Members from both Chambers, usually from the originating committee, who are assigned the responsibility of reconciling differences in legislation that have been passed with differing language by each house.

GRASSROOTS- Activists or members of an organization or geographic area who are community residents. Grassroots are the sustaining force of activism.

GRASSTOPS- Activists or members of an organization or geographic area who have high professional and/or public profile and can raise public attention or influence decision-makers through established connections. An organization's board members and founders, community leaders, nationally recognized individuals (including elected and appointed officials, actors, etc.) are examples of grasstops. Grasstops can reinforce a grassroots action or move an issue independently (i.e., run their own advocacy campaign or initiative).

LOBBYING- To influence public officials on behalf of or against proposed legislation-'lobbied the bill through Congress; lobbied the bill to a negative vote.'

LOBBYIST- A person whose goal is pressing the views of a group, organization, or industry on issues under consideration.

PROPOSED RULES- Notices to the public of possible new rules and regulations, allowing interested parties an opportunity to participate in the rule-making prior to the adaptation of the final rules.

PUBLIC HEARING- A meeting of House or Senate committee or subcommittee during which public testimony may be heard and formal action may be taken on any measure or matter before the committee or subcommittee.

RULE- The methods of procedure agreed to by members of the body.

RULES AND REGULATIONS - Regulatory documents having general applicability and legal effect.

SELECT/SPECIAL COMMITTEE- Designated groups of Members created for a special purpose and often for a limited period of time.

SESSION- The period during which Congress meets. Each two-year congress is divided into two sessions.

14 APPENDIX A

Sample Letter to an Elected Official

[DATE]

The Honorable [ELECTED OFFICIAL NAME] [ADDRESS] Dear [TITLE & LAST NAME]:

Do you know that [XX NUMBER] of people [OR CHILDREN, TEENS, etc.] suffer needlessly from [RELEV ANT CAUSE] in [YOUR STATE] every year? Here at [YOUR ORGANIZATION], we are working to reduce [OR ELIMINATE] this pointless tragedy.

With sufficient resources, here are just a few of the accomplishments that are possible in [YOUR COMMUNITY, CITY, or STATE]: [MAKE 2-3 OF THESE TYPES OF POINTS, TAILORED TO STATE]

 We could prevent many of the devastating effects of the XX citizens struggling with diabetes not to mention sharply reduce the rising costs of managing this largely preventable disease;  We could reduce the XX unintentional injuries;  We could reduce the rates of children starting to use tobacco by XX;  We could reduce and one day eliminate the XX childhood poisonings from lead:  We could reduce the rates of obesity for children and adults;  We could lower the rates of asthma, heart disease, stroke and HIV.

Agencies such as the Centers for Disease Control and Prevention and the National Institutes of Health are leading the prevention effort and protecting the health of our nation. With your leadership, we can accomplish even more. Only about 1 cent of every health dollar in the United States is spent on prevention and public health research. This cannot meet even the most basic public health needs, much less meet the unpredictable health challenges that are now part of our everyday world. Increasing our investment in prevention can provide the answers for many of the health problems that we face today in [YOUR STATE]. We have made the choice with rubella, with polio, and with [RELEVANT EXAMPLE]. Our grandchildren deserve to reap the same type of benefits.

As concerned members of the community, we thank you for your commitment to [OFFICIAL'S HEAL TH CAUSE]. We are counting on your continued leadership and support for common sense involvement in the health and future of the citizens of [YOUR STATE].

Sincerely,

[NAME] [AFFILIATION]

15 APPENDIX B

Sample Testimony

. Joint Statement of TPHA, TALHO, TAMHO regarding the Consolidation of Health and Human Services Agencies; and Public Hearings for 2006 XXX Grant.

16

Texas Association of Texas Association of Texas Public Health Association Local Health Officials Municipal Health Officials

TO: Mr. Albert Hawkins, Executive Commissioner, Texas Health and Human Services Commission [HHSC] Dr. Eduardo Sanchez, Commissioner, Texas Department of State Health Services [DSHS]

FROM: Texas Public Health Association [TPHA] Texas Association of Local Health Officials [TALHO] Texas Association of Municipal Health Officials [TAMHO]

DATE: February 4, 2004

SUBJECT: Consolidation of Health and Human Services Agencies

As a united voice, the Texas Public Health Association [TPHA], Texas Association of Local Public Health Officials [TALHO] and the Texas Association of Municipal Health Officials [TAMHO] strive to achieve a strong public health infrastructure throughout the State. Our organizations have continued to monitor aspects of the reorganization related to public health and wish to offer the expertise of our respective memberships. We raise the following points for consideration:

 Regarding the Advisory Council, the Plan should specify additional qualifications for those appointed, and assure sufficient representation of public health issues. In previously submitted testimony we have recommended, for example, that at least four of the Council members represent the Sate/local public health system and that the Plan delineate training requirements for newly appointed members. We are available to you as you proceed to more closely examine the role and composition of the Advisory Council at the upcoming hearings.

 Because most public health happens at the local level and most services are delivered at the local level, it is paramount that the Plan assures a public health presence across the state. This presence is best achieved through a network of proactive, local health departments staffed with skilled professionals dedicated to providing services at the highest level possible. Where no local agencies exist, State support should be delivered through an integrated regional service model. Regions are able to offer flexibility and understanding of local needs not achievable through a centralized model. Establishment of designated roles and authority will assure locally-driven, rapid responses to public health threats.

 The proposed structures outlined as Option A and Option B do not provide strategic organizational placement of local public health. As currently proposed, local public health would be unable to coordinate effectively with programs and services across the DSHS. Our associations are in the process of finalizing an alternative model for your consideration.

Our organizations look forward to collaborating with you during the planning process to assure a strong statewide public health infrastructure.

Lee A. Lane Teri Pali Pat Fowler Executive Director, TALHO Executive Director, TPHA Executive Director, TAMHO Email: [email protected] Email: [email protected] Email: [email protected]

17 LOCAL PUBLIC HEALTH AGENCY

DATE: September 1, 2005

TO: Texas Commissioner of Health

FR: Local Public Health Director

RE: Public Hearings for FY 2006 XXX Grant

Mirroring Texas and the nation, our local health data confirm an alarming rise in obesity, diabetes and other chronic conditions. Local Public Health Agency has depended for many years on the funding of the XXX Grant funding to provide an array of prevention services. The XXX grant funding for fiscal year (FY) 2006 is critical for helping my agency to provide population based education and health promotion campaigns, and to support community collaborations that actively address pressing health issues. Effective targeting of preventive services is dependent upon results of timely community health status reports. Many of these reports are produced using the block grant funds. Our grant funds are entirely used to pay staff with expertise in health education, planning and community development, chronic disease prevention, and local epidemiologic research.

In FY 2005, the staff we funded with these funds provided the following essential services at the local level: Completed the 2004 Local BRFSS report, our first sub-county level examination of health behaviors and access to preventive health services. These results will enable us to plan cost- effective interventions to positively impact years of potential life lost and to reduce the burden of chronic disease.  Published the Eye on Epidemiology and AIDS Perspective quarterly newsletters to inform our health partners about communicable disease prevention and control.  Collaborated with 12 municipalities in our jurisdiction to establish the Hearts N’ Parks Program to promote healthier lifestyles.  Addressed health disparities by partnering with the annual Hispanic Wellness Fair and African- American Health Fairs. We reached over 23,000 community members.  Collaborated with other community groups e.g., American Heart Association-African American Task Force, Local Diabetes Coalition and the Area Health Collaboration to address cardiovascular disease and diabetes.  Coordinated the agency’s Speakers Bureau and Health Education Resource Center to link health educators with community groups that are able to deliver culturally appropriate prevention messages.

Among myriad grant funding sources, the XXX Grant is the only funding stream structured to assure a non- categorical and locally-driven response to changing health priorities. Our agency, our health system partners and the citizens we serve appreciate and rely upon every dollar of this funding to safeguard our community’s health.

18