Share Public Health Transcript: Advocacy, Change Comes Through Relationships

Season 2 Episode 5

Deborah Thompson: Welcome to Share Public Health, the Midwestern public health training centers podcast, connecting you to topics, issues, and colleagues throughout our region and the country that highlight what we all share in public health. Thank you for tuning into this series that focuses on public health advocacy. Hey, public healthers, thank you for tuning in to this episode of share public health. My name is Debra Thompson. I’m a public health advocate. And for eight years, I was the point of contact for legislators at Iowa State Health Department. These days, I spend my time as an advocacy consultant and as a volunteer for the Iowa Public Health Association’s advocacy committee with my dear friend, Hannah Schultz. Hannah’s the producer for this podcast series and I’m your host.

This is the final installment of four episodes about advocacy. In this series, we’ll explore the motivations, public healthers all over the Midwest feel about advocating for their craft. They’ll give us advice on how to be successful, and they’ll ask that you consider finding your voice to aid in our collective efforts to promote and improve the health of the Heartland. Thanks for listening. Today, we’re talking about the importance of coalitions. In public policy, a coalition can develop a coordinated response to an issue, increase the efficiency of service delivery, pull community resources, create and launch community-wide initiatives, build and wield political clout to influence policy and work effectively toward long-term social change. Our guests today, are Linda Rallo, vice-president of Aligned. Aligned is a nonprofit nonpartisan coalition of business leaders committed to improving education in Kansas and Missouri. We’ll also be speaking with Dr. Nafissa Cisse-Egbuonye, who is the administrator for Black Hawk County public health in Iowa and Reverend Dr. Mary Robinson, who’s a long serving member and the current chair of the local board of health in Black Hawk County. We’ll start off today’s episode talking with Linda.

Linda Rallo: Hi, I’m Linda Rallo. I work for Aligned, we’re a nonprofit organization that is made up of business leaders who are interested in improving education outcomes for students so that they can enter the workforce ready to go. We’re based out of Kansas City and we work on basically state level policymaking in Missouri and Kansas.

Deborah Thompson: Linda is a highly successful advocate. She breaks it down in this next part, know the policy process, so you can use it to create change, understand the politics surrounding your ask. Pool your resources, find like-minded people in organizations because coalitions are all about a power in numbers approach – many people in organizations singing to the same tune to make a beautiful chorus calling for change. Linda also gives a helpful advocacy survival tip, do not focus on the larger picture without celebrating the small steps to getting there.

Linda Rallo: It’s really about being strategic. I mean, first, you have a goal, whatever it is you’re trying to change and then really setting the strategy about how to go about doing that. And so, one of the things that you can do is leverage resources of associations, councils and other advocates that share your values. You have to learn the language of politics, policymaking, and lawmaking. And then really like this is the most important thing – it’s just understanding what is politically feasible and also taking the time to celebrate incremental wins. I think a lot of advocates get really fixed on a big goal, for example, Medicaid expansion, and that is a herculean task. And you might want to go get it one year and you’ll fail. And so you’ve got to figure out how to celebrate those incremental wins. So we have an organization in Missouri called Kids Win Missouri, and it’s really open to anyone that has children at the center of their policymaking. So, we represent the business community. So we come in as that branch, but we have hospitals in our coalition. We have afterschool programs. We have nurses and parents, and teachers and early childhood providers. So it’s really … even like juvenile justice type things, anything that touches kids. And so, we have built a really broad coalition and it’s gotten so big now that we have broken off into work groups. And so we’ve got the safety and security work group, there’s the youth development work group, early childhood education work group. And so these groups get together and then they set the agenda of what are the priorities that we’re going to go after in the next year? The reason why we’ve been so successful is because when we’d say we’re Kids Win Missouri, I mean, there’s a depth there. And then everybody in the coalition brings talents to the table. One of my things that I can bring is that I’ve developed really good relationships with members of the press. So I can use those relationships if we want to get a story out and time it properly. Others have great relationships with healthcare coalitions, others have great relationships with the network of early childcare providers across the state. And so we can all… it’s basically, we just are a team and we leverage our talents. And so having a coalition is really just having an arsenal of so many skills and intellect and talent that when it’s time to make a change, it’s like a beehive, we jump on and then we just buzz through it and get it done. And so, I think coalitions are the most important thing you can do in advocacy.

Deborah Thompson: Linda’s decades of success in advancing policy has made her really savvy. My takeaway here was to think of coalition members like a cast of characters in a scripted play. We’ve all seen Hamilton, right? Each player has a strength, a key relationship or a skill and when it’s time to tap that gift, they could step up and shine.

Linda Rallo: I think it’s just the ability to react strategically at the right time to influence policy and to be able to bring in a multitude of actors. nd to leverage all of the connections we have, the resources, the knowledge and to bring that in and then to actually apply pressure where it needs to be applied. And then obviously to change policy.

Deborah Thompson: Linda continues to share her insight by explaining how to be sure your cast of characters are filled with the right kinds of actors. In other words, there are a couple of things to consider as you assemble your coalitions membership to give it strength. She ends this part with another good tip. Don’t let perfect be the enemy of the good.

Linda Rallo: Looking at like, who are the winners and losers? That’s a big thing in policymaking. Someone wins, someone loses. Hopefully, we wish that everyone would win. But figuring out who’s going to benefit the most from that policy change and then figuring out who those folks are and then inviting them into your coalition. I will give you an example of something I worked on a few years ago. There was an effort in Missouri to raise the age of adult prosecution. So in Missouri, 17-year-olds were being prosecuted as adults. And we wanted to raise that to 18. And there were lots of reasons. It’s really not safe, obviously, for a 17-year-old to be put in the adult system. And we had to bring in the counties who had opposed it for years and years and years, because it was going to put an unfunded mandate on them if they started to have an increased case load at the County level of more juvenile offenders, and they didn’t have the resources to take care of them the proper way. And then there was the juvenile justice association that, they were against the County. And so we brought everybody into one room and we basically … I always use this analogy, it reminds me of Apollo 13 when they don’t follow the parts on the table. And they’re like, “This is what you have work with. Figure it out. You’ve got to get these guys back from space.” And so we sat in this room and I wouldn’t let them leave until everybody came up with like, “What can we live with?” And it was the big problem. And you’re going to find this in most policy – it’s about the money. There was no money to fund this policy change. And so, we worked through with everyone in the room and came up with a solution. So I think it’s even getting the people that may have opposed you in the past and just sitting them down and figuring out what’s workable. And so we had to come up with a new revenue stream. And so, we just went through every possible thing. Could you raise taxes? Could you assess fees? What could you do? And we really needed some seed money to get into an account so that it could accumulate and then have enough money at least to offset the initial costs. And then we figured over time it kind of would all work out. And so we ended up coming up with a dollar court fee on civil cases at the city level and then some other fee, I can’t think of the top of my head what it was, but we were just very – not to say nickel and dime – but we just picked a little pockets where there was a little opportunity for a fee to come together. And then we knew, we needed a few years for this to come to fund. And while that wasn’t like, we wanted that change today and get it done, it was a good compromise because if we had waited for perfect, we would never have gotten there and we’d still be talking about where are we going to get this money and let’s say, we’re now in year three, where we pretty much accumulated the funds that we need. If we had still been stuck we would be maybe now three years later going, “Okay, maybe we need to incrementally assess these fees.” And now we’ve already arrived at the solution. So you’ve got to really be willing to compromise and maybe not let the perfect be the enemy of the good.

Deborah Thompson: Over time, you’ll build stronger and stronger relationships with different members of your coalition. We’ve talked about the importance of relationship-building several times over the course of this advocacy series. Why? Because relationships make the world go round. Getting to know the members of your coalition means getting to know what they’re good at. You’ve experienced their strengths and weaknesses. And so, you know when to give them their solo and even when to maybe just keep them behind the scenes. I know listeners, I am really leaning into this play metaphor. Don’t hate me. Just keep listening to Linda.

Linda Rallo: I think that’s what’s really exciting about coalitions is because you feel really empowered when you have built something that can sustain over time and it’s just there ready when you need it. So I think we’ve just done it naturally, we kind of know who our go-to people are on different things. I have a friend who leads an organization and he is not a salesman-type of a personality. He’s not somebody I would bring down to have the first meeting with a legislator, but he has so much knowledge and he’s very well-respected, and because of the years and years of work that he’s done in the legislature, he’s trusted. So, I would bring him in after maybe the third meeting, when you really want to get into the weeds and explain the policy, when you’ve already built that relationship and it’s not about those first impressions, and then use those kinds of people strategically at that time. So it’s kind of like who are your great faces, who are the folks that might have a little bit of charisma that can go out initially and get the doors open, and then you just bring in the experts afterwards instead of bringing in an expert in at that first meeting, when they’re going to throw all those facts up and someone’s going to be like, “Yeah, whatever.”

Deborah Thompson: I appreciate so much the vulnerability Linda shares in her story about her favorite loss. Yup. That’s what I said. Her favorite loss. Here’s more.

Linda Rallo: I would say, one of my biggest failures in life is probably one of the best successes for me personally, just from the things that I learned and the scars that I got. So, we wanted to raise the tobacco tax in Missouri. It’s the lowest in the nation. And we wanted to use those funds to invest in early childhood health and education. And so we worked for four years to build a group. And we met with every person we could think of that would be either for or against it. We had hundreds of meetings and we wanted to get buy-in from everybody. And so, we did community conversations across the state where we went out and talked to local leaders and got their perspectives, which really helped shape the policy. We were going to do a policy where all the funds would be distributed by County based on population, and then we were going to let the county-level government figure out how they wanted to invest it. And the first thing, when we went to talk to counties people were like, “Well, one, we don’t trust our county people. Two, the counties didn’t want to have to deal with that.” And so we had to go back to the drawing board and figure out something different. But we built this amazing coalition and then we ended up having a funding issue because we needed to collect signatures, it’s very expensive. So we partnered with Big Tobacco which sounds horrible, but we have a weird thing in Missouri where there’s two tobacco markets and they sort of compete, so we were trying to change the policy so there wouldn’t be this small tobacco, cheap cigarette market and just make all cigarettes sort of have to play by the same rules. And so Big Tobacco wanted that. So we partnered with R. J. Reynolds. We had learned from past attempts that the pro-life community would come out and say, “You’re going to use this money for abortions.” And so we thought, well, we will go partner up with the Right to Life community and say, “We’re going to put protections in there. So it will be ironclad that none of this money will go to fund abortions.” And so we got them on board. Well, then what we did with all of that is we really ticked off the scientific community because then they thought we were messing with embryonic stem cell and it just got out of control. And then bit by bit the big science – I call it the big science, but that was just me being snarky – but what they did is they hired lobbyists who then looked at our coalition. They literally went on our website and they started calling them bit by bit and pressuring them and getting them to say, “We’re not supporting this anymore.” And so, it all disintegrated and we had our true believers that stayed with us when they understood that this language was just prophylactic. It wasn’t going to really affect science. It wasn’t going to do anything bad. It was just basically saying, “This pot of money can’t be spent on abortions and embryonic stem cell.” So we did have the ones that stayed with us, but we went from 58% support in our polling to election day only getting 40% of the vote. So it just imploded and I will tell you pretty much everybody was against us by that point. And when we failed in November, I had to go back to the Capitol, to do my regular job starting in January. And all the people, the lobbyists that assassinated our effort were in the building, people that were against me were in there and it was just like, I’d walk around feeling like I had a big loser sign over my head. And I was just really dejected and embarrassed, but I had to keep doing my job. And I went up to one of the guys who was against us from the small tobacco coalition. And he said, “You did an amazing job,” he’s like, “you have nothing to be ashamed of and you better hold your head up high. You’re a wonderful person. And I don’t want to see you sad anymore.” And I was just like, “Okay, I’m going to get through this.” I think at that point you realize it is a bit of a game and people are hired to fight for their causes and it’s not personal. And I was taking everything really personally. And so I think in advocacy you’ve got to be able to at the end of the day be confident in that you’re doing your best job and things just might not go your way, but don’t take it personally. And remember these were relationships that you had maybe with somebody that opposed you, may end up being on your side a little later.

Deborah Thompson: Linda just made a great point that someone you oppose in one advocacy campaign, may be on your side on the next one. This is also true of lawmakers. Conservative lawmakers may support progressive policy on occasion and liberal lawmakers are often quite conservative on some issues. Be open-minded and listen to what someone is saying. I mean, really listen without trying to find a place to judge. It’ll be refreshing to hear that more often than not, they care about the same issues impacting their community that you do. With the power of shared purpose, you’ll work out the kinks.

Linda Rallo: I think in our state, we call them the [inaudible 00:18:37], you know, Kansas City and St. Louis where they’re more liberal and then the middle is more conservative. And sometimes in St. Louis, they get really dejected about the conservatives. They don’t see eye to eye and so they kind of disparage them a lot. And I’m always like, “You guys need to chill and understand that there are conservative lawmakers that share some of your same values. They care about education. They care about child safety. If you’re constantly saying how terrible they are, then they’re not going to want to work with you.” so it’s hard though, because they’re just so different, their values are so different. But that’s the thing like too with Medicaid expansion, which was really genius strategy, is to be able to show rural lawmakers the impact on hospital closures to their community and why we needed to expand Medicaid in our state, really identify their pain points, even though they didn’t want more government in healthcare. But when they realized “it’s hurting my community, the person next door might not be able to get healthcare because of it”. It does help to change their perspective. So you just got to constantly make it relatable to everybody.

Deborah Thompson: If not you then who? Linda explains that one of the most important functions of a network of advocates in a coalition is to simply monitor an issue. It’s not always about pushing for change. Sometimes it’s more important to protect the status quo. Coalitions also play an important role in keeping bad things from happening. And as Linda puts it: protect the henhouse because the fox is always looking for an opportunity to pounce.

Linda Rallo: In Missouri, there was a group called Partnership for Children and they were the child advocate in the building and they were around and then they lost funding and they went away. And then there was a year where there were no child advocates in the building. And in that year, a legislator passed a law that banned quality rating systems for early care and education, so it made it illegal to rate quality for childcare centers and that caused us to not be eligible to win a national grant. It closed a lot of doors on federal funding opportunities. So then the next year after we got the Kids Win – well, they changed their name, but it was called the Missouri Children’s Leadership Council. So they came back that next year and then started putting the pieces back together. My group and Kids Win, we worked to get that language that banned quality out of statute and established a pilot project for our quality rating system. And then we went around and told lawmakers, we were like, “If you get rid of this language and put it in this pilot, then we’re going to be much more competitive when we go for federal grants.” Well, then we got that done. And then the next year, there was this big preschool development grant opportunity and Missouri won it. And we were able to go back to the legislators and say, “Thank you, because of your work, we now are going to have $33 million coming into our state over the next three years for early care and education, quality improvement and all of that.” And I love to tell that story because it, the bad thing happened the one year there weren’t advocates in the building. And so sometimes you don’t always get the things that you want done, but a lot of bad things can happen. So you’ve got to have a presence all the time, somebody watching the hen house to make sure the fox doesn’t come in and steal the chickens. And so, that to me is the number one reason why you’ve got to have a coalition, so you can make sure that your children or whatever it is that you’re advocating for are protected even in the years that nothing gets done, at least nothing bad gets done.

Deborah Thompson: Thank you.

Linda Rallo: for making the benefits of a coalition crystal clear. A strong coalition can move mountains. Now we’re going to turn our attention to Black Hawk County, Iowa, to talk with Dr. Nafissa Cisse-Egbuonye and the Reverend Dr. Mary Robinson about their experiences with coalitions. A few years ago, Black Hawk County was named the worst place in America to be black. This report will come up in the conversation as a catalyzing moment for the health department and the community. We start with Reverend Mary, just be ready to be inspired. That’s really all I need to say.

Mary Robinson: Well, I am Reverend Dr. Mary Robinson. I am currently a pastor of All Nations Community Church. I’m also a part-time chaplain at Tyson Food, but probably the most important thing of course, is the church and then the next thing is really the community activism. It has been a part of my life. I remember even as a child laying up in my bed, looking at the moon, and then I would be somehow thinking about people who were in trouble or thinking about ways to help people get out of trouble. And so you really don’t know your calling because it didn’t feel like a calling. It just felt like I was night dreaming or daydreaming. And then as things evolved, it seemed like you would notice, as a child, the difference. You would notice when the teachers treated you different. You would notice when people looked at you different and it had a lasting impact upon you. And then as you become an adult and you see your children going through some of the same things that you went through, and it’s like, when is enough, enough? And so what drove me into really becoming a lot more vocal … and the most amazing thing is that no matter where I’ve been, when I was at work or college we had to [inaudible 00:25:24]. When I was at the law school, we had to [inaudible 00:25:27]. When I was at the seminary, we had to deal with issues. It never ever stops. And so, I was very active in, I can’t say the civil rights movement because we’ve had so many, but very active in the civil rights movement of the late ’60s early ’70s in Waterloo. And I learned the extent to which law enforcement, the extent to which society, the extent to which those who are privileged, the extent of which they will go to keep our voices not heard, our voices silent. And I became familiar with Zora Neale Hurston. And she said, “If you keep quiet or silent about your pain, they will kill you and say you enjoyed it.” And I thought, I can’t keep silent anymore because I don’t want anybody to say I enjoy so many of the injustices that you have to go through daily if you are a person of color. And so as I came into the ministry, I became driven by not just the giantsb- Dr. Nafissa is correct – we stand on the shoulders of so many giants, too numerous to name. And even those not just nationally known, but those right here in Waterloo that we never [inaudible 00:27:15]. But then I thought about Dr. Martin Luther King, right from scripture, where the scripture says that God has showed us what is good and what does he require? And that is to love, to do justice, and to love mercy in addition to walking with him. And then I thought about the model of Jesus and that he came to be a servant, that he came to lift people, to make them better than what they were. And so that has always driven me. But the other thing that probably drives me the most is that no parent likes to see their children hurt. And you would do anything to take that pain of your child. And when I saw my children going through some of the same things that I had gone through in the school system and with jobs and whatever. Enough is enough. And so, I was president of the state NAACP for over 10 years, I’ve served two terms on the state board of education. It’s just the number of things I help put in place. I helped write the legislation for the state commission on the status of blacks. It’s just been so many things and so I decided I was tired and I needed rest. So, I pulled back and then the 24/7 report came out a few years ago, showing that we were number 10 as the worst place to be in America. And I thought, now that can’t be, that cannot be. Somebody is making a mistake. And I remember I was sitting at a board of health meeting, and I was thinking about that. And I thought about, as I looked around the department and I thought about the staff, and I thought about just there I was sitting on a board that we weren’t really dealing with some of the issues. And I thought could that report really be true? And then three years later, it came out that we had moved from number 10 – Des Moines had been number nine – but we had moved from number 10 to number 1. And then it hit me, wait a minute, I can’t retire. I want to retire, I want to travel, I wanted to go back to Israel, I want to go back to Maui. I want to go back to Italy. I know this is my time, I’m old enough now I need to really, really have fun stuff to do, but I didn’t see anybody addressing that report. And I thought, “Wait, wait, wait, nothing?” And I kept saying to the Lord, “Lord, nobody is saying anything about this report.” And then He said, “Well, you’re somebody.” And I thought, “No, I don’t want to do this.” I really seriously did not want to start addressing the issues again. I was tired, I really was tired. But I did. I went before the city council to talk about the issues in that report and then the rest is kind of history. I’ve gotten back involved again in a big way.

Deborah Thompson: I told you guys, Reverend Mary is a role model in public service, but what I appreciated most in what she just said is her candidness about her feeling of burden. I feel this way too sometimes. I wonder if you guys do too. Why do I have to be the one to care so much? Why do I have to notice what’s wrong and feel so compelled to help? I also want to go to Hawaii too and maybe even with Reverend Mary, if she’d have me. That’s why we’re the strongest advocates though, listeners, our passion carries us and fuels us. And at times this is despite us, especially when we feel so exhausted by it, but that’s the dual nature of the calling to serve. So really thank you for your service, public healthers, sincerely. In this next part, Reverend Mary explains how her calling to serve led her to her membership and leadership on the Black Hawk County board of health and how rewarding that journey has been.

Mary Robinson: I’m not even sure now who asked me if I would be interested, it had to be someone who was on the board of supervisors at that time, because they appoint. I had not really been involved with the board of health. We had been involved with a lot of issues with health disparities, that’s for sure. And so I said, “Well, yeah, I will consider it.” And I was interviewed. And so I went on and I think I chaired, I served two terms as chair, or at least for sure another term before this one. It spoke to my passion for making sure that there was quality health care that I was not seeing. And as the other thing that drove me, was that when I looked at every single major chronic disease that we have, it seemed like that people of color were always at the top of that risk. And that concerned me. We didn’t seriously … we knew that there was a board of health, but it wasn’t something that played into our everyday kind of thinking like it is today. It was like, well, that’s just bureaucracy, that’s just one of those agencies, without really thinking that no, that’s an agency that’s supposed to be serving everyone in the county. And it was good. I mean, the people were awesome, don’t get me wrong, but there was not the connection that needed to be to our community. And so I was excited about being able to help make that connection.

Deborah Thompson: So Reverend Mary has lived in Black Hawk County her whole life but Dr. Egbuonye traveled quite a ways to get here. Of all the places to wind up, man is Black Hawk County lucky to get to claim her. What I love about this next part is how Nafissa connects her origin and upbringing to her work in public health and how she perceives her role as a public healther in her community. It’s something to think about. Where did your public health roots grow from and how do they inform the perspective you bring to your role?

Nafissa Cisse-Egbuonye: I am Dr. Nafissa Cisse-Egbuonye and the public health director for Black Hawk County. I’m originally from West Africa, from Niger. One of the things that I think people find fascinating – and I’m starting now to recognize that, that was an important piece of my journey – is the fact that I came to the US in 1989, and I was six years old, I believe. I landed in JFK, but my mom was living in Illinois. So my US story started in the Midwest. It was the journey that I took alone. I will never forget that day where my great aunt just woke me up and put me on a plane and said “you are heading to go see your mother”. So, I got on the plane and crossed the Atlantic Ocean I mean, it was just… I’m a woman of faith, so God took care of me on this journey. I didn’t speak the language. I remember sitting next to a stranger, did not know how to cut my bread. But it was such an intense journey that I remember it pretty clear. I landed at JFK and I look around and I just see my mom’s open arms, just screaming, “Nafissa.” And so I just ran to her. And so from that, we got on the bus because she was a student and didn’t have enough money for the plane ride to Illinois. So we got on the bus and headed to Illinois. My elementary school is in Springfield, Illinois and it was the Martin Luther King Elementary School. And it was a school that was very, very diverse. It was right next to the campus where my mom studied at the University of Illinois. So that’s where I think my journey really started. My parents very early on instilled in me the importance of social justice, the importance of thinking about your neighbor, your brother, your sister. And one of the things that my mother ensured is really this understanding that African history is African American history. African-American history is African history. And so she would take me to Black Beauties salon for friends who were African-American. I didn’t realize until now later that we would navigate low-income neighborhoods and housing. That’s where I was with babysitters. That’s where I learned to double Dutch. Really, I mean, I didn’t know what my mother was doing. But there is a deep connection and we would always do that when we moved to other places. The first thing my mother did was to find the African-American community regardless of where we were. And that was a way for her to also connect us with our culture, our heritage and just provided a sense of the long game. So when I read books on equity, I just think about my upbringing and I’d say, equity and advocacy is really a value base. It’s something that you have to value within yourself, not something that you learn and it’s not like a curriculum, it’s something you have to value. And so, I think my journey in terms of my education was always being in a field in which I can serve. I believe that advocacy is about servant leadership. As the health department, there’s a lot of times that public health, some of the damages that we’ve done is always making assumptions that we know what’s best for people, even in programming, instead of saying that we are here to support, we are here to be a partner. We are here to actually be informed. And so, I don’t believe in just making assumptions about us being experts. It’s just those that are in need of the services that are actually the experts because they can tell us what will work and what will not work. And so as a health department, I think it’s public health’s responsibility to really be very clear about these issues. I think in the past, we have been that invisible field and now I’m pushing and saying, no, I don’t like to hear that statement anymore because we shouldn’t be that invisible field. Public health has the responsibility because we know that the health disparities are due to the social and economic conditions of people. Those are the root causes of the problem. And public health has a role and public health needs to acknowledge also the role that they play in creating harm as well. And so I think it’s not just about moving forward, but it’s also public health to say, “Wait a minute, we’ve done this in the past. This did not work and here’s why it didn’t work. And here’s the reason why we have to figure out how to be more strategic.”

Deborah Thompson: When you’re a public facing presence in the community, how important is it to be authentic? Experts on leadership will tell you that authenticity is critical to gaining buy in that advances your goals. As an expert in advocacy, I will also tell you that authenticity is critical to advancing your goals. Shedding your armor, accepting you for you, strengths and weaknesses alike, is what will make your passion attractive to others. They will follow you because they trust that you’re trying to do right by your community, even when you have setbacks and even when you make mistakes. Trust yourself first, and then trust Dr. Egbuonye and I, on this point.

Nafissa Cisse-Egbuonye: The most important thing is being authentic and I try my best to present myself in the most authentic matter. And so, I think as a new leader, the board of health has charged me with the restructuring, with the accreditation. And so the first couple of years were very difficult because community leader’s understanding of public health was direct services-oriented. What we were known for was the school nursing program. And so, having to be placed in a role where they’re seeing layoffs occurring and we were no longer offering those nursing contracts. One of the conversations was, well, we were taught that this is public health and I’m here saying, “Wait, public health is a bit different. It’s not just for nursing. We do more than that.” And so I think there was a lot of suspicion at first about me and what my plans were for the division, for the health department. But I think it’s important as a leader to not go in with this idea of forcing that buy-in. You have to build buy-in, you have to allow people to go through their journey to see that transformation. And for us, it was step-by-step that people were starting to see that. And actually it didn’t take me, it was more community leaders informing each other. And so I think that that really helped where it wasn’t the newcomer trying to sell this new vision or idea. It was community leaders that started to see where the health department was going, like “aha”. So when they were running it to people that had a negative perceptions, they were informing those individuals. Some of the feedback they were sharing with me, they would say you have to seek community leaders that are willing to understand your vision and let them do the education. If you charge yourself up always being the one to lead, there’s so many opportunities for leadership. I think it’s more effective when people that already have those skills and relationships. For me as a public health director, I have to be in the community. I have to be able to participate in community events and if community members have an issue I have to be available. I think that is my responsibility. So very often programming staff have the interaction, but as a public health director, I want the community to always know I’m a phone call away. I think that’s one of the things that’s really important in terms of advocacy, because now when you look at how the way things are changing, it’s really grassroots movements that are going to change the system. It’s building from underneath that’s going to change the system, not from a top-down approach. No, it’s really… and so, I like to see grassroots organizations and what they’re doing, and I think public health’s responsibility is to give them the data, is to give them the resources to help them also move the needle forward. So, oftentimes equity work becomes … actually, it is personal, but there’s finger pointing that happens or I say this, members of the white community don’t say much. And so, we wanted to have an approach where everybody is engaged. Everybody sees themselves within the system as part of the solution. We sat down and we really built the coalition based on the social determinants of health. And so we went through that whole list and then we kept asking ourselves who’s missing, who’s missing, who’s missing? The church members, I mean, the local public health system, elected officials, school administrators, K through 12, higher ed, economic development. I mean, we really wanted to reference the social determinants of health. One of the things with bringing people at the table, I realized through coalition-building is that, Ilene provided me with the latitude to have coffee with people. So she was managing the day-to-day operations because email isn’t good enough for relationship-building. Never make assumptions that, oh, I’m going to send this email. And then people are going to RSVP. Why would they? What is in it for them? I would do daily check-ins to see how many people would RSVP. I’ve learned that some people prefer a phone call. I’ve learned that some people prefer texts. I’ve learned that some people need that face-to-face coffee, 30-minute lunch, 30-minute face-to-face pump. And so I did all those things. I said, “What’s the best method of communication?” “Oh, let’s have lunch.” “Okay, when?” I head there, “Okay, just send me a text, just text me.” When is it? Okay, text me. Let’s have a phone conversation. Okay. And so people have different methods of communication. And so when you want to bring others along, you have to respect that. And so that’s how we were able to… by the time it was… and we had a very short window, I remember I was so nervous. I was like, “Oh my God, nobody’s going to show up.” And we sent 50 invitations and 47 responded, 47 people. The same 47 people were consistent in the workshops. And when they couldn’t, they would send long emails or long voicemails apologizing for not being able to attend. And so that to me was the biggest win. So I think for the non-traditional partners, I think foundations have been… Foundations fund, I was always intentional about building that closer relationship with foundations, I think because I think they play a key role with funding and also with the business community. And so I think that was one of the biggest wins of just having foundations saying, “Okay, we get that something is wrong.” And the acknowledgement in itself, I think is a win. It’s not the solution yet, but having foundations saying, “We get that we have to do something different.” But I also learned through the process of foundations, even if CEOs are on board and the board of directors are not, that can be problematic. The business community … I think through this work I was invited to be a board member of the Grow Cedar Valley, which is our Chamber of Alliance here, which is very non-traditional from public health. Again, we’ve seen with the outbreak here and COVID how it is important for the business community to have a relationship with public health.

Deborah Thompson: Again, we hear about the importance of relationships. One of the main themes of this podcast series on advocacy. This time Nafissa discusses, the integral part that trust plays in relationship- building and how to gain trust by simply listening.

Nafissa Cisse-Egbuonye: I think when you go into a meeting with an agenda, that’s where the problem starts already. I think that authentic relationships starts with understanding each other, it’s the same with equity work. Tell me about yourself, tell me where you’re from, what you like, because it’s a personal thing. Like I said, it’s not like something you should learn. It’s not just a curriculum and you just try to apply it. But as the person is talking, you learn about their values. And so in learning about their values you can understand better the approach to take to bring them to the table. But if you go in with the agenda, there’s a lot of assumptions and you’ll be surprised how quickly people get put off by that because they see through the agenda. So to be honest, I go in with, “Hey, Black Hawk County, Waterloo, Cedar Falls was labeled the worst place for African-Americans to live. What’s your take on that? Let’s have a conversation. I just want to know what’s your take? How did you feel about it?” And even if some of the responses are not responses that you want to hear, you have to be willing to be uncomfortable. For me, it’s just been that part of the work where I’ve been in spaces where, “oh my goodness, this is uncomfortable”, but I have to zoom in on what the person is saying. And it will also help me determine whether, is this actually the ideal person to be at the table or not? I’m very also intentional if I do see individuals that can be barriers. I don’t spend a lot of energy on that because that also can delay the process. So you have to be willing to move on and say, “Okay, this person doesn’t recognize that this is a problem. And it is what it is, but I have to find somebody that will help me push some of the solutions that need to happen.”

Deborah Thompson: Reverend Mary, returns with some extremely important thoughts to consider about maintaining focus despite feeling angry and frustrated. None of the topics that public health will be tackling in the 21st century are easy. They’re just undeniably necessary to address. Finding your allies and building your coalition will disperse some of the weight of the burden and frankly, some of the emotions. We are better together.

Mary Robinson: Well, you can get angry but you don’t allow it to affect your outward action. But to say that I never get angry, clearly, it’s almost like daily and Dr. Nafissa knows this. But then I have to think about, okay, what is the goal? And no matter how angry I might get, I cannot allow that to stop me from reaching that goal. And so I get it. In fact, I get mad every single day. Sometimes when I think about things, it just happens. And another emotion just as dangerous as anger is you may have an affinity for someone. You may like someone, and maybe they’re doing something that is clearly racist, but you don’t want to say anything or you don’t want to move forward because you think it might hurt them. That’s just as dangerous because it stops you from reaching whatever goal you had set to reach. And so we have to find a way to get around our emotions. Defensiveness, that’s another one. We’ve got to find a way to get around those. So then that’s what this coalition-building does because people, when they come on board they sign onboard that they know there needs to be change and that they are willing and want to be a part.

Deborah Thompson: A final thought from Reverend Mary, is that you just have to start somewhere. Think of what your story could be. Once upon a time, you knew no one, and you had no influence. Then one day, you stepped out of your comfort zone and had a conversation about public health. Then you had another and another. Then from those conversations came relationships with people who were compelled by your conversations. And from those relationships, a coalition was built and then a call to action declared. And from that call to action, change came. That change felt good and so more conversations came next and more relationships and more coalition-led advocacy until one day, you look back and you can marvel at the light you left behind for others to come. As Reverend Mary and Nafissa both said, “We have to show the way, and then we have to lead the way.”

Mary Robinson: Really seriously, I think we’ve been sold a bill of goods, that oh you’ve got your senator there, you’ve got your representative. Are you letting them know what you really think? If any of the people that we’re talking about that we have to work with are not within the sphere of influence with many of our legislators. And so I found out that in order to get the grassroots involved, you have to really work with people within your sphere of influence. And then they work with others in their sphere of influence. And then that’s where the change comes. I’ve gone the route of just when I was a nobody and you get in touch with [inaudible 00:57:23] you have no influence there, but as you work with each group, each person, as you make the friends that Dr. Nafissa was talking about, as you develop the relationships, that is where the change comes. And I think she’s absolutely right that we have to show the way and then we also have to lead the way.

Deborah Thompson: Thank you so much to Reverend Dr. Mary Robinson and Dr. Nafissa Cisse-Egbuonye, for sharing your wisdom and your experiences with us today. I’ll end with a quote from Dr. Margaret Mead that I think is fitting for the episode on public health coalitions. “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it is the only thing that ever has.” Dr. Mead was an American cultural anthropologist who was notable in the 1960s and ’70s and she was really, really smart. As this podcast closes, so does this four-part series on advocacy. Hannah Schultz, the producer, and I sincerely want to thank you all for listening to this series.

If you’ve made it through all four episodes, congratulations, you now have the knowledge you need to get started advocating for your craft alongside the very notable guests we’ve had today and throughout our series. You’ll be in great company and they will absolutely welcome you as an ally. If you haven’t heard all four episodes go back and listen to what you’ve missed. It’s well worth your time. Thank you all for the work you do to promote, improve and protect the places where people live, learn, work, play, and worship. Thank you so much for being a public healther. I’m Debra Thompson. Thank you so much for listening.

Thank you for tuning into this episode of Share Public Health. Thank you too Sonja Armbruster, Brandon Grimm, Jeanine Moody, Hannah Schultz, and Kristin Wilson for helping to plan and produce the series. Thank you to Melissa Richlen, for audio production and support. This podcast is supported by a grant from the Health Resources and Services Administration. A transcript and evaluation for this episode is available at and in the podcast notes.

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