Share Public Health Transcript: Advocacy, Overcoming Public Health’s Humility

Season 2 Episode 2

Deborah Thompson:Welcome to Share Public Health, the Midwestern Public Health Training Center’s 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 in to this series that focuses on public health advocacy.

Hey Public Healthers, thank you for tuning into this episode of Share Public Health. My name is Deborah 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 volunteering for the Iowa Public Health Association’s Advocacy committee with my dear friend Hannah Shultz who’s the producer for this podcast series and I’m your host. This is the first 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. Thank you for listening and of course, your feedback is welcomed. We’re going to start today’s episode with Jaci McReynolds. Like many Public Healthers, Jaci’s path to public health has not been direct. But the skills she’s picked up along her path has enabled her to tell the public health story in Missouri so she can build relationships that will propel her state’s local public health system forward. Let’s hear what Jaci has to say about the current wake up call that the pandemic has been.

Jaci McReynolds: My name is Jaci McReynolds, I have been in public health for about 20 years. I started right after 9/11 and came on board as a Regional Public Health Information Administrator for about 18 counties in southwest Missouri. And then my territory was expanded to 35 counties in southwest and South Central Missouri. So that was my introduction to public health. My background prior to that was in film and television news. I worked there for about seven years and then I moved on to become a local public health administrator in rural Missouri for about four years. And then left that to start my own business, really had such a passion for public health, but became very frustrated by the red tape, and the bureaucracy that sometimes holds us back in certain positions. And so I wanted to get out into an area where I could work more on a contract basis, supporting local public health agencies across the state of Missouri with projects as needed just to kind of help them stretch their budgets and give them an extra set of hands when they really didn’t have the money to hire a full-time person. So I’m currently doing emergency planning for 11 counties, I work on MCH, Maternal Child Health contract with a county, I do a lot of marketing and public relations, social media management, website design, just kind of whatever they need, a little extra set of hands. And then the main project that I’m working on now is communications coordinator for the grassroots initiative called Healthier MO. And that’s a statewide initiative here in Missouri to really transform our public health system into one that’s a little bit more current, more culturally relevant, more cohesive. And it’s really following more of a foundational public health services model than the fragmented system that we currently have. I think COVID has been a huge eye-opener for all of us because sometimes I think we get the idea that people understand what public health does every day. And because surely, everyone else must understand it. And I think COVID has really shown us that that is just not the case that unless we are more clearly describing what we do in detail in a way that people can relate to, they truly don’t have a good sense of what we do. Again, they do think we just provide shots to poor people and do WIC, and it’s so much more than that. If we’re not the ones talking about public health, the ones who understand it and live it every day, then we’re actually creating a silence, a void of silence that other voices will fill and we’ve seen through the COVID situation how other voices can very quickly start talking about what they perceive public health to be or not to be or should be or shouldn’t be. So we really have to do a better job of being assertive with our storytelling and assertive with describing what our work is and how it does impact every person every day.

Deborah Thompson: Jaci was not the only person we interviewed that stressed the need for Public Healthers to talk about what we do. We’re not exempt from the age old adage, out of sight, out of mind.

Jaci McReynolds: I think it’s important to remember that people … In our society today, we are so immediate. If it doesn’t affect me at this moment, it’s probably not on my mind. And so if we are not talking about public health, we’re not putting ourselves continually in front of people and telling our stories, it’s very easy for us to be ignored. And I don’t mean intentionally ignore it, we’re just going to fall to the wayside. We have to keep ourselves front and present in the story of life. You can see very quickly just looking at social media, if you don’t see a news post, or if you don’t see a post as it comes up, it’s going to be buried within seconds. And I think that’s the story of public health as well. We’re not every moment putting ourselves out there with good information and good storytelling, it’s very easy for us just to get pushed to the side in the influx of information.

Deborah Thompson: But if so many Public Healthers see the lack of understanding of what we do is a barrier to their success. Why is it that we don’t speak up more? Jaci had some insight to share into this problem.

Jaci McReynolds: Some of the barriers that we see in Missouri specifically are a misunderstanding about the difference between advocacy and lobbying. I think there’s a lot of concern that people don’t want to cross the line and get themselves in trouble individually or as an organization. So we have worked with partners like Missouri Foundation for Health to bring in advocacy training, and to help people understand that there are things that are permissible, even with lobbying, but there are certainly things permissible with advocacy for all of us as public health professionals to participate in. Another thing that I think I see is we’ve talked already about humility, that public health in my opinion, is just a very humble field. And like you said, we wear that silent … If things are going well, we’re doing our jobs well, we have worn than that as a badge of honor that we don’t need to stand up and say, “This is what we do because we know that what we’re doing is important, and it’s achieving results.” And so maybe there’s the misperception of why do we need to talk about that, it’s working well. And COVID is showing us that we do need to do a better job of talking about that. And so I think the first challenge is the misunderstanding between advocacy and lobbying.The second challenge maybe is the humility that prevents us from talking about our work. And a third challenge is probably that people just really don’t know what to say. We have such a misperception of how people think about public health and we assume oftentimes that they understand what public health is and the richness of what we do. And so it’s difficult for many people to know what are the words to speak when you’re giving advocacy messages. Thankfully, we have some great new tools that have just recently come out, the PHRASES toolkit from De Beaumont Foundation based on research by FrameWorks Institute, that really boils it down to some simple messaging that people can use to become strong advocates for public health and for their organization in particular.

Deborah Thompson: Yes, the PHRASES project guys. Be sure to check it out at phrases.org. It’s chock-full of neatly packaged, easy to access, easy to read and easy to use information for messaging public health across sectors. It’ll prove an invaluable investment of your time, trust me, phrases.org. Now, let’s go on a myth debunking mission and hear Jaci’s thoughts on what advocacy is, and isn’t.

Jaci McReynolds: I think a lot of people when they think about advocacy, the first thing that comes to their mind is, “Oh no, I have to have a conversation with the legislator and I’m scared to death to do that, because I don’t want to say the wrong thing.” And I think that we need to reconsider advocacy as a much broader opportunity. Advocacy can be a one-on-one conversation that you have at the grocery store. When somebody sees you and knows that you’re a public health nurse and asks you a question about their daughter’s immunization schedule, you have an opportunity for advocacy. You are the best ambassador for public health because you live it every day. It’s your field, it’s your world, it’s your passion. And so as public health professionals, it can be as simple as a one-on-one conversation. You can go on your social media page, on your individual private social media page, and you can talk about public health. You’re not restricted by your employer about what you say as long as it doesn’t criticize your employer or create a bad light for them. You can talk about public health. I do it on my page all the time. My family probably gets sick of me saying things like you need to be wearing your mask during COVID. You can advocate on your personal page. You can also amplify social media posts and I think this one is probably where we can really make the most gain because we have a lot of health departments who are getting on board with social media especially now because of COVID. They are putting out great content, but as you know, there’s so much information on social media that that post is gone in a heartbeat. But if we all as public health professionals will amplify those with a like or a comment, it will bump them up in Facebook’s algorithm where they will be seen more widely and we can grow our audience very, very quickly. We can get good information out broadly and it costs us absolutely nothing. Public Health is such a broad field, it’s very difficult to boil it down into some succinct messages that are easy to deliver. And so we really have to do a good job of finding those nuggets of connecting the work that we do to what’s relevant to people, what they value, what they’re thinking about in the moment. And then telling the stories that they can relate to. COVID has been a public health nightmare, but it’s also given us a great opportunity. The spotlight is on public health, we have everyone’s attention and this is a great opportunity to be very thoughtful, and very intentional about the stories that we’re telling and connecting with people and helping them to understand how we play such a vital role in their life. Not just because we’re asking them to wear a mask, not just because we’re asking them to limit or restrict their movements, but because the things that we do in public health really helped to build stronger communities, really helped to give people the opportunities they need to thrive, to reach their full potential, and to really live the healthiest life that they can live. I just think there’s a lot of misperception about the role of public health. And if our partners don’t understand what it is that we do everyday and what it is we have to offer, then they may not understand the value of that partnership, and the value of collaboration, and getting all of those ships online. It’s not just about the public health ships aligning and moving in a single direction, it’s about every single organization, nonprofit, private, public, every entity that has a vested interest in people getting on board, moving together in a direction, deciding what can I bring to the table that’s going to help this entire movement move forward in a solid direction. And until we can talk clearly about the role and reach and value of public health in that collaborative effort, we are not going to be successful. We have to be able to do that advocacy and do it well. It’s very, very important.

Deborah Thompson: We have to be able to advocate and we have to be able to do that well. What a great point. What’s exciting, listeners, is that it’s as simple as telling people about the amazing things you do everyday just by showing up for work. That’s what Jaci hears when you talk about what you do in her presence. Remember, she has a background in broadcast journalism, and she knows a thing or two.

Jaci McReynolds: The longer I’ve been in public health, the more amazing stories I hear. And I’m always surprised when I attend a meeting, most commonly, they’ll do a round table and people will talk about the programs that they’re doing or the experiences that they’ve had. And they never seem to think of that as being a great story. But just sitting there as a communications person, I will be taking crazy notes because I want to circle back around to them and learn more about each of those stories. I think that in public health, we don’t always do a good job of telling our story. I don’t know whether that we don’t think it’s anything special because we do it every day, or whether we just don’t think people are interested. But I really feel like we have some incredible stories we can share about public health primarily because it affects every single one of us in a community. Whether or not you’re directly participating in a program like WIC or immunizations, you are still impacted by the work that public health agencies are doing all over the state of Missouri and around the region. The clean air that we breathe, the clean water that we drink, the fact that we can through proven public health methods actually stop the spread of a disease, those things impact every single person in our communities everyday. And we just have to learn how to do a better job of telling those stories. When I started in my career in public health about 20 years ago, I wanted to find out what people knew about our specific public health agency. And so whenever I was at a meeting or out in town or shopping, I would ask people, “What do you think the health department is? Or what do you think they do?” And the most common response that I got from almost every person I talked to was they give shots to poor people, and they do WIC. And I think that we have created that massive misperception, if you will, because those are two programs that are very visible and it’s easy when you think about public health, it’s easy just to put the icon of a syringe on the screen to show public health. It’s a lot more difficult to explain all of the rich nuances that public health does and how we integrate it into every single part of life. It’s tough to explain that. And so I think we have done ourselves a disservice over the years by focusing on the stories that maybe were easier to tell instead of really doing a more descriptive job of explaining the wealth of what public health has to offer, and how it really does impact every single person every day. In order to tell good stories, we have to get beyond thinking about “I’m telling a story.” I think we have to step outside of the actual building of that story and just be real. Just talk about what it is that we’re doing everyday, talk about the things that we’re passionate about. If you ask any public health professional in the state of Missouri, what they love about their job, most of them are going to say, “I love my work, I love helping people.” If we could just tell our stories with that framing about those contacts that they have every day and how they’re able to pour into someone’s life, how they’re able to help people make better decisions, or find resources, or improve their own health, set goals, all of those things. If we can just talk about them as if you were talking to a neighbor, or sharing your story on social media, I think that would be a good solution, but we’ve got to get comfortable doing that. We’re not very good in public health at talking about ourselves. And maybe that’s because a lot of public health professionals are caregivers, their other-oriented if you will, they’re thinking more about what they can do to help others as opposed to talking about themselves. But it takes maybe a trained person who is a storyteller to come along and find those nuggets and help them flush those out into real stories that they can share. We’re not good about bragging and it doesn’t have to be bragging, it just needs to be lived experience. Like I said when I attend these meetings, and people will talk about the different programs that they’re doing and exciting things that happen, those are the types of stories people will relate to. Not some overproduced massive project that takes a lot of time, just talking to people, just telling your story just like you would on social media or with a friend.

Deborah Thompson: Have you heard the quote, above all else show the data? Maybe not, but the sentiment probably resonates. Public Healthers like to talk about evidence and data, but we’re missing a big connection, values and shared purpose. Moral values are integral to the lives we serve and through this connection, we can shed light to what we do. As Jaci says, we have to speak to values, it’s the way we connect with people.

Jaci McReynolds: I think we absolutely have to speak to the values. That’s the only way you’re going to connect with people in any kind of storytelling. And there are so many values that we have in common as people regardless of our our background, or where we live or what we’re involved in. We all love, we all have family, we all want to be healthy. So we have some real serious shared values that we can definitely connect with. It definitely takes all kinds of personalities to tell the story of public health, the data is really important because we have to show with numbers the work that we’re doing. And we haven’t done a good job historically of sharing our data, we haven’t done a good job historically even collecting data. So when we say there’s a need in our community for this type of program, it’s difficult to back that up if we don’t have the data to show it. So I certainly think there’s an important connection between collecting, analyzing and sharing the data and the way that we do that because it does have to connect with the values that people have. And this is not a mystery. You see this done in the news media every single day. The story doesn’t start with “56,000 people die of flu every year, so we need to get our flu shots”. The story starts with, “Here’s Helen, she’s 83 years old.” And it tells the story of Helen and why she got a flu shot. Storytelling is not a complicated model and it’s demonstrated for us every day in the media. We just have to do a better job of making sure as public health professionals, we can follow that pattern. I think there are probably three main values that we can really work around with public health. The first would be that shared value that everybody should have the opportunity to reach their full potential. And you can see that playing out through the Black Lives Matter Movement, definitely everyone should have the right to have a voice and the opportunity to reach their full potential. Another shared value would be one of having a strong foundation or a community to really thrive. So community is huge across our nation and especially where I am in southwest Missouri. People who may be just destitute and below poverty level will go to a fundraiser and give $20, $50, $100 to help their neighbor who’s in a crisis. And we see it over and over and over. And it’s because of that shared value of wanting to help one another and have a strong and resilient community. And then the third one is just being – I guess I’ve already touched on it but – being a good neighbor. We all have people that we care about in our lives, whether it’s a small group, whether it’s a family, or whether you’re someone who loves people broadly. We all have that shared value of trying to love on people and care about people and wanting to be loved in return. If we can connect with these three values, giving people the opportunity to succeed, building up our communities, and caring for one another, I think public health touches all three of those in so many ways that we would have so much better opportunity about how to advocate for our field and how to share our story better. One of the things we talked about too is in the Healthier MO project because it’s a grassroots project, we’re trying to build support for public health from the ground level. And helping people to understand how public health really is a part of everything they do. Not only just clean air, and clean water and immunizations and some of those more visible things, but to know that you can walk through your community and have access to parks, to know that you can bicycle, to know that you don’t have to be afraid that you’re going to get a contagious disease because those things are being monitored, and there’s contact-tracing happening. And I know that sounds difficult right now in COVID because the pandemic is so widespread, it’s not a typical public health situation by any means. But for hundreds of years, public health has controlled tuberculosis. It controlled sexually transmitted diseases, it controlled vaccine-preventable diseases through the work that’s done every day in public health [inaudible 00:22:13] that we have to do a better job [inaudible 00:22:19] those proven public health methods that have been protecting our communities for years.

Deborah Thompson: Wow. Jaci McReynolds is a strong advocate for public health. I am so glad she’s on our team. Thank you Jaci for sharing your expertise and encouragement. We look forward to hearing more good things from your efforts with the HealthierMO.org project. Our next conversation was with Iowa State Senator Joe Bolkcom. Senator Bolkcom has long been a strong public health champion in our state and getting to work with him closely was a real treat. Not every legislator comes from a public health background like he does. Here’s more.

Joe Bolkcom: Well, I started my career actually organizing senior citizens around health care issues back in the ’80s and then had an opportunity, decided to go back to school for a graduate degree at the University of Iowa. And I was working on a graduate degree in Public Affairs and had an opportunity to do an internship at the Johnson County Health Department at the time, and worked on environmental health issues and on community education around tobacco cessation and encouraging kids not to start smoking. And at that time, HIV/AIDS was an emerging issue and did some public education work on that as well. Then I had an opportunity to run for the Johnson County Board of Supervisors. Once I completed my graduate work and won a seat on the Johnson County Board of Supervisors where I served for six years and then had the State Senate seat open up and the person that was in that seat came to me and said “you should run for this”. And I initially thought, “Geez, I really like being a county supervisor. You get to work on all sorts of different issues that really directly impact folks.” But ultimately decided to run for the State Senate and I’ve been serving there for the last 22 years. I was really interested in public and environmental health as part of my graduate degree and decided to do this internship at the health department. I was lucky enough to have an opportunity to do that. I actually went on to be hired in a part-time position, doing really community education around tobacco cessation and HIV/AIDS prevention and awareness.

Deborah Thompson: Now, full disclosure, Hannah the broadcast producer and I are proud members and volunteers of the Iowa Public Health Association. We couldn’t resist leaving in the senator’s plug for IPHA. If you’re not part of your state’s Public Health Association, shame. Public health takes a village and advocacy is no different. It’s a power in numbers approach and these associations need your support. This goes for public employees too. Listen closely to Senator Bolkcom’s advice on this point.

Joe Bolkcom: Well, at first I think I want to dispel the myth that people that work for local government whether it’s County Health Department or City Health Department are not allowed to express their views to their elected officials, they certainly are and I encourage them to do that. I have good relations with folks in my health department in Johnson County, and I rely on them for expert advice on public policy issues that might come before the legislature. I’d also say that the Iowa Public Health Association is the organizing entity in Iowa for public health professionals to share their advocacy work and to establish an agenda around public health issues that affect folks in Iowa. And they are actually quite effective in bringing people together to create an agenda around public health. And also, they have good relations with public policymakers at the state level, both with the state health department as well as legislators to advocate for good strong public health programs. So in that regard, I would encourage people to get active and number one, join the Iowa Public Health Association. I think the role of the Iowa Public Health Association has never been more important. I think local health leaders are overwhelmed on a day-to-day basis with managing COVID-19 and the public health of their communities in their counties. And I think trying to find time to do advocacy and do public policy work during this pandemic is just nearly impossible for folks on the frontlines of fighting the pandemic, our local public health professionals. But it couldn’t … I think the pandemic has also made clear that the investment we’ve made in public health is completely insufficient to deal with the kinds of problems that a pandemic brings, and that advocacy going forward from the grassroots through the Public Health Association, it’s imperative to bring that message to state policymakers, federal policymakers. If the pandemic taught us anything, it taught us a couple things around you should follow the science and pay attention to what our epidemiologists say, and our public health professionals say, and that it also showed us that we were not prepared. And when the rubber meets the road, it’s not some federal program necessarily coming in from afar. It’s who’s your health department director? Who are your staff? Do you have the right people? Do you have the resources? And I think this pandemic has laid bare the fact that public health across the country was really … has been under invested in and was struggling to keep up with all the demands. So I think our public health professionals on the front lines are worn down right now, I think they’re tired. This pandemic shows no signs of letting up. And I think we’re asking them to do a lot and I hope as they catch their breath coming into 2021 – hopefully we’re going to catch our breath – we’ll be hearing from them on what their needs are to strengthen our public health infrastructure.

Deborah Thompson: The 21st century is showing us a new game of whack-a-mole when it comes to keeping people healthy. Chronic conditions, social determinants of health, health equity, racism, poverty, no one sector will be able to tackle these complex issues alone. But only one sector has the mission and vision to bring all the influential community leaders together to try. The senator definitely gets the public health role here, but he’s only one of a handful that do. We need to cultivate more champions like him, don’t you think?

Joe Bolkcom: First and foremost, we look to our public health community to keep everybody healthy, right? An idea of we need policies to promote population-based health. And we have several leading causes of illness and sickness in the country, tobacco, heart disease, lung disease, hypertension, diabetes. We have these risk factors that people have problems with, and I think we look to our public health professionals to help broad-based groups in the community be healthy, right? So we have a campaign around encouraging kids not to smoke, or we have a campaign around encouraging people that do smoke, we want to help you stop smoking. Tobacco is still the leading cause of death in the country and in Iowa. So that’s number one I think, promoting healthy living, and then I think then it goes to well, if I’m not healthy, what are the resources to me in my community to get more healthy? I think the health department has a role to play in advocating for more outdoor recreation opportunities, more physical activity opportunities, better diet habits, those kinds of things that create healthy people through exercise and good eating. And then I think the final thing I’d say is we need an active advocacy effort from our public health professionals. People that are on the frontlines of these fights likely have the best ideas on how to be effective, and I think we need to listen to our public health professionals and take their advice on what works best. Another maybe a fourth thing and this is tangential to the question, but I think it’s imperative right now. At the University of Iowa, we have a strong public health program. And we really want to encourage public health professionals to be involved in state government work and local government, we want to recruit, have a pipeline of new professionals especially in state government, but certainly local level to make sure that people that are graduating from our public health programs here in Iowa see opportunities here in Iowa as a workforce and the professional workforce for future.

Deborah Thompson: Listeners, would you help a stranger move? Be honest now. Throughout the whole podcast series, the theme of building relationships has dominated in our interviews. And that’s because changing the status quo even for the better is a really heavy lift. Knowing your elected officials prior to an ask is key to accomplishing your goals before you even know you have them. It’s reciprocal, though. We’re a resource for them too. We know things that they don’t know about the health of their community. We have the power to help them be better public servants too. Senator Bolkcom explains how to get started and why relationships make the world go round.

Joe Bolkcom: Well, I think advocacy in an Iowa-specific context is really quite simple. And because we all have one state senator, and we all have one state representative, no matter where you live in Iowa, you’re stuck with one of each. And you can go to the legislature’s website and type your address in if you don’t know who they are, and you can find out who they are. You can get their email address and their phone number, you can see where they live and you can try and make make a connection with them. The world works on the basis of relationship. It’s how people get introduced to their future-to-be husband. It’s how we get help when our muffler falls off our car and we ask a friend, where do you get your muffler fixed. It’s how we get information when we’re sick about who should we see as a specialist. It’s based on our relationships with people. And public policy is also based on relationships with people, not only policymaker to policymaker, but constituent to a policymaker. And if you don’t have relationships with your state senator and your state representative, you don’t really have the ability to be involved in that conversation about what makes good … your views on what we ought to do as a state or to address public policy. In Iowa, the state representatives, state senators are very accessible. I get emails all the time from people that want to meet and I meet, pre-pandemic, I would have coffee with somebody. Now it’s either a Zoom or a phone call. But it’s introducing yourself, talking to your legislator about your expertise or your area of concern. And frankly, try to be, as a public health professional or public health advocate, try to be a resource to your policymaker who may not have a lot of background in the topic that you do. So I think it’s reaching out and introducing yourself, being friendly, sharing the information you care about, being polite, listening to responses, and basically begin to develop what you can hope to have is an ongoing working relationship, potentially a friendship with that policymaker. So that when topics of public health interests come up, and I get an email from somebody I know who I’ve already met, who I trust is a smart person who has good objective information, I get that email and say, “This is helpful.” And I use the example of you’re walking down the street of your hometown and you pass your state senator, your state representative, that you’re able to say, “Hi Joe.” And I’m able to say, “Hi Hannah, good to see you.” that you’ve developed the rapport that you know who each other are and you have that kind of relationship. I think at the end of the day, it is how the world works, it is how policy is made. So I think you’ll find it very fruitful to do outreach to your legislators, and try and develop a relationship.

Deborah Thompson: So we’ve heard from Jaci McReynolds, her advocacy will improve the local public health system in Missouri. And we’ve heard from Senator Bolkcom, he writes and votes on public health policy in Iowa. Our last guest for this podcast is one of my favorite local Public Healthers, Christine Estle. Chris has a powerful perspective and gives us great insight into the importance of advocating for public health at the community level. Keep listening.

Chris Estle: I am Christine Estle, I am the public health administrator for Jefferson County which the county seat of Jefferson is Fairfield, Iowa. It’s a county of about 18,200 I think, close. I’ve been a registered nurse for 26 years, 13 years of my career has been as the public health administrator.

Deborah Thompson: Chris is a fierce advocate for public health. We asked her where this passion came from.

Chris Estle: I’m the oldest of four children. So there you have it, the oldest of four children, one of which, my sister, my only sister has special needs. She is intellectually disabled, and her diagnosis at the time in the late ’60s would have been profound mental retardation. That’s politically incorrect today, but that was her diagnosis at the time. She’s five years younger than I am. So I think from a very early age, I’ve been put in that role of being a voice for those people, those individuals that can’t be a voice for themselves. And I think that’s very, very important. And I think that’s something that you’re just sometimes born into, or that’s the cards that you’re dealt, and then you do the best you can with that hand and you should consider helping others that can’t help themselves. So I think that’s part of where that came from. My mom is the oldest of six children, and my dad was the third of six. And they always said until my sister was born that they were going to have six kids themselves. I’m like, “Oh my god, I don’t want to be the oldest of six kids.” But yeah, my dad was a member of the board of supervisors, he had his own dirt contracting company, third generation grading contractor. So I think so, I think that’s just how I grew up. And I think being put into that role with somebody that has special needs makes a huge difference.

Deborah Thompson: We wondered if anyone she’s asked to meet with has ever told her no? And if so, was that common?

Chris Estle: I have. Just because maybe it didn’t work with their timeframe, they give you that rationale that, “I’m sorry, it’s just not going to work now.” And then it’s like, “Oh, that’s fine, we can meet another time. Please get back with me with whatever works with your schedule, or drop me an email or whatever.” And then sometimes it’s like crickets, you don’t hear anything from that person. So you give them the opportunity to get back with you but unfortunately, sometimes they don’t get back with you, but I’m pretty lucky having worked in this community and lived in this community a long time. I know most of the people. Sometimes that’s a good thing and sometimes that’s not a good thing. There’s pros and cons both ways. So I’m very approachable. I’m very forward. If I need something from a department manager, elected official, if it’s the sheriff or somebody at the hospital, or whoever, I just pick up the phone and I call them. I don’t wait for an invitation. I just say, “Hey, this is what public health is looking at or working on, do you want to be a part of it?” Or, “Do you want to help? Or can you help?” You can’t be shy, and be a public health administrator. You can’t be quiet and be a public health administrator. I think the thing that I always go about when I try to have a conversation with somebody or I want to have a conversation, or I need somebody to help me with a community project whether it’s a Community Health Needs Assessment, or whatever the situation is, I always put my hat on that says, “greater good”. I don’t have my own agenda, I have an agenda for the health of our public, for our entire county. And I think that that is something that I try to do, and I try to not get lost in that. Sometimes it’s hard because I am trained as a nurse, so I think like a nurse and sometimes it’s hard to pull that nursing training back and see it a little bit differently. Sometimes I just keep saying it’s for the greater good, it’s for all of us as a community. We live here, we work here, we raise children here. We want our community to be better, we want it to be safe and sometimes if you spin it like that, you’ll get more than, “Oh geez, here comes Chris again, she wants me to be involved in another project.” Or, “What does she want from me?” And the other thing that I try to do a lot – I don’t always get it done – but I try really hard to send somebody a quick little email or text or something after the meeting like, “Hey, thanks for participating in our meeting today.” Or, “Thanks for the feedback.” Or, “I know that that wasn’t easy to bring out, but thank you for being that advocate.” And I think that helps people. It is all about being connected in relationships. It is, it truly is. And sometimes I’m much more politically correct than others. And you have to be true to yourself, I’m not going to talk to you guys one way and then talk to somebody else another way. This is the authentic Chris and sometimes my language is more colorful than other times. But I’m not going to say one thing to one person and then go say something else to somebody else. This is who I am at the end of the day for the greater good.

Deborah Thompson: Public service and public servants have lost the Kennedy shine and twinkle from the early 1960s. Remember, ask not what your country can do for you, ask what you can do for your country. Well, listeners, be proud that you’ve answered the call to serve your communities. Politics is our minefield, a worthy opponent to our success in fact, but as Chris explains, we all need public health. And that’s hard to argue with and certainly worth fighting for. I think that after hearing this next part, you’ll appreciate the sheer drive to help as the motivating factor for Public Healthers like Chris to keep showing up to work during this pandemic.

Chris Estle: I started my nursing career at the hospital, we had an inpatient psych unit so I worked inpatient psych, I worked in the emergency department, I worked overnight, I was a house supervisor, education manager, lots of different roles. But the one thing that was consistent throughout my tenure at the hospital was I would talk to everybody, try to remember their name, didn’t matter what department they worked in or what job they did. But I’ll never forget this. I had given my resignation and I was going to start as a public health administrator, and I had one of the physicians come up to me. I ran into him at one of the stores uptown and he’s like, “Chris.” He goes, “I just heard that you’re leaving the hospital and you’re going to go to public health.” And he goes, “I can’t believe you’re leaving the hospital and you’re going to public health.” Like it was a bad word. And I looked at him and I’m like, “I’m sorry, why are you shocked I’m going to public health?” He goes, “I can’t even believe you’re going to public health, you’re leaving a hospital?” And I looked at him and I called him by name and I said, “You do realize that all of us receive service from public health, whether you are physician, a nurse or an inpatient at the hospital.” And he looked at me and he goes, “Well, I guess you’re right.” And he just went on about his business. And I thought, “What the heck does that mean?” I just was got by that. He said public health like it was a bad thing. “Public health.” I’m like, “Wow, thanks.” I’m telling you what, when I applied for this job, it didn’t say political landmine on the job description. It was like, “Okay, nursing, Bachelor of Science in Nursing, da-da-da-da-da.” Great. I have these qualifications. I bring a lot of emergency preparedness with me because of from the hospital side of things, point of dispensing, incident command, and all that stuff. But the political … this is the first job in my nursing profession that I’ve had that has been so political, to this level of politics. Like I said, we had politics at the hospital, you have a hospital board, or you have interdepartmental politics, or they got picked first for the team or whatever. They got the snack and I didn’t, that kind of stuff. But it’s very, interesting and that’s why I always encourage people to go vote in the primary. Get your person on the ballot because sometimes, people assume that that person is going to move forward to that election in November and that’s not always the case. It’s like, “Oh, don’t talk about religion, politics and abortion.” Dude, we need to talk about those things because if we don’t talk about it, then you’re not going to learn how to navigate those difficult conversations when you are in a position to have a vote or make a difference. You have to look at it from the other side. I see things like a nurse because I am a nurse, but if you want somebody that’s a CFO, then you need to ask the CFO, not the nurse, but if we are not allowed to communicate and disagree and move forward, then we’re doing ourselves a disservice. It’s one of those things where our elected officials or our boards or governing entities cannot make it better for us if they don’t know where we’re currently at. And in my board too, my local board of health only knows what I provide them. So I could give them this Pollyanna little version of life in the local public health. Well, right now it’s not so fun, but we’re getting through it. But it’s my responsibility to communicate that up the chain, whatever that chain looks like. So then they have a true picture of what it really is like on the ground and as a frontline local public health department dealing with whatever situation we’re dealing with. And it is exciting. It’s like, “Hey, I remember working with Dr. Miller-Meeks, when she came to our hospital, she’s a ophthalmologist. So I worked with her and took care of the same patients and stuff.” So it is, it’s like a sigh of relief. It’s like, “Oh thank God I got that off my chest. Now I can move on to the next project.” Because they needed to hear that. And if we don’t be honest or authentic with them, we’re not doing ourselves any good. We’re just getting more and more angry internally. And it’s like, “Who cares, nobody’s listening.” They’re not listening because we’re not telling them what they need to hear and what they need to hear sometimes might not be the popular or fun conversation to have. That’s why we’re tired sometimes too because it’s like, “Oh God, here comes Chris, she’s going to be negative again, she’s going to blow us all out of the water with her negativity.” I think sometimes we overanalyze everything. And again, you heard me say I worked ER. I can’t form a committee and worry about what’s going … I have to make a decision like that, in seconds sometimes. So you have to be able to move forward, process what you’re dealing with, and then move on, triage it. You have to move forward. You can’t get stuck in a perpetual state of, “Oh gosh, I don’t know what to say.” Or, “I should have said this.” That’s why you have to be honest with your own self and comfortable with your own self. You know what? It might not be the exact way I should have said it, but they got the message. It might not be flowery, but they got the message. Well, I think if I am like the teacher on the Peanuts cartoon, the teacher that you always hear go “wha wha wha”, nobody’s going to listen to you because nobody cares. If you don’t feel passionate about your job, your goal, your role and your capacity that you can make a difference, nobody’s going to listen to you because if they don’t feel that you don’t care, then they’re not going to care about your issues. So that’s why sometimes I do get a little wound up. Some people might think I’m going off on the handle or I’m going off on a rant, I’m going off on a rant because it’s like, “Dammit, this is important, and I need you to pay attention.” And I can’t say, “Dammit, this is important. I need you to pay attention.” It’s like if you’re looking at a toddler, you want to get down on their level and look them right in the eye. So you want them to pay attention because this is important, also tiring sometimes. It is. We’ve seen that this year, but you know what? You just got to keep doing it. I don’t want to be one of those people that’s close to retirement in the next decade and be like coasting out right now. “Dude, get out of here, get out of my way. Quit coasting, get out of my space.” It is exhausting. You have to find some kind of rejuvenation somewhere. So you have to learn to categorize stuff and know that it’s okay to walk away from it and then go do your thing away from work and then come back to work. That’s really hard to do. I still struggle with it. That’s why I don’t get my email on my phone. I don’t. I refuse to and I think that’s something that we need to set boundaries with. A lot of people have my cell phone number. So if it’s something that they need to get ahold of me for, they can call me, but I’m not going to get sucked down the rabbit hole of I got to email people back at two o’clock in the morning. No dude, you should be sleeping.

Deborah Thompson: Chris has previously worked with Dr. Mariannette Miller-Meeks, her state senator in Iowa. So we asked if that previous relationship has made it easier for her to reach out in her administrator role.

Chris Estle: I think it helps, I think it helps open that doorway so to speak. But even if I hadn’t worked with her previously, I still would have reached out to her locally. I think it’s important to be involved with your elected officials and your appointed officials and really, anybody that’s in any kind of business or industry role in your community as public health. We need to work with all resources and everyone that I mentioned is a resource to public health. And everybody under that umbrella also uses the services of public health in some way, shape or form. So I think that’s important. Plus, it’s fun to meet new people. We’ve had a lot of supervisor changes in the 13 years I’ve been here. We have two seats open in this election, who knows what will happen? Historically, I will tell you Jefferson County has had three male Republican supervisors. So it’s been interesting and we had our first female supervisor, not this last time, but the time before. So Dee is actually our second female supervisor and it’s very refreshing to see a female in that role and just see some changes and some growth, so it’s good, it’s important.

Deborah Thompson: Chris explains that she often feels frustrated that local administrators don’t have the respect and autonomy necessary to do their jobs. Public Healthers have a lot of insight and power, and they need to realize it. In her view, if we don’t speak up for ourselves, who will?

Chris Estle: I think it’s very difficult for us because as local public health administrators, I don’t feel as though we maybe have the respect or the autonomy sometimes that we need. And that doesn’t mean that people don’t respect our jobs, it’s sometimes we get lost in the layers of we have a local board of health, that’s our governing entity, and that appoints us and then the Board of Health is appointed by the Board of Supervisors. So you don’t realize sometimes those political connections, but I think we have a lot of insight and a lot of power amongst us as health advocates that we don’t realize. And I think that as public health administrators, we need to work on that collectively. Even though I know every county’s health department looks different and we offer different services, the core functions of public health remain the same. And we struggle with that sometimes because we do look different, but then we look similar. And funding is always a challenge. And I said this the other day too, you don’t work in public health or public service to get rich or to make a lot of money. And that’s a concerning statement too when you look at the workforce because you can … sometimes people, we want to go make a lot of money, and then they don’t have to work as many years or whatever. But it is true, you can make more money working in a hospital setting. We don’t have that flexibility sometimes. So I think we need advocacy, I think people need to show up for public health, speak up for public health and I think we need to tell our stories. We hear about teachers, and none of us would be where we are if it wasn’t for teachers, I get that. But there’s going to be a huge nursing shortage in the next few years on the last year, the baby boomers. So there’s going to be a huge shortage, not only with people retiring, but actually nurses coming up through the ranks so to speak. Who’s going to take care of us when we get sick? Are we even going to be admitted to a hospital for an inpatient stay? Is it going to continue to be six days of observation? Is every county going to have a hospital? Who’s going to take care of me when I can’t take care of myself? I broke my wrist a couple of years ago, and being a single person with no children at home or adults at home. It’s like, “Man, this is not an easy thing.” So there’s those things to think about and we have to … If we don’t speak up for ourselves, and we don’t do it, nobody’s going to do it for us. And then we get frustrated when people make decisions. When decision makers make decisions based on information that they might not have, it’s our responsibility to give them that information. Sometimes they don’t want to hear it. Sometimes we don’t feel comfortable saying it, but we have to say it.

Deborah Thompson: Well, public service is hard work and definitely not for sissies. Chris recommends celebrating the small wins and remembering why even the work that doesn’t seem like fun is important to the community and therefore worthwhile.

Chris Estle: I think the thing is, it can be something very small. I’m the co-chairman of our safety committee in our county, sometimes that’s a struggle. Government is definitely ran differently than private business and industry and I’ve seen that time and time again, since I’ve been in this position. So a small win for me was to actually organize a hands-on fire extinguisher training, okay? You think that’s not a big deal, but to try to get all these different departments to the fire department so they can actually pull, aim, squeeze and sweep and put out a real fire with a fire extinguisher, that was huge. I was so excited. I’m like, “Now, do I get an immediate return on my investment?” No, I clap my hands because I was happy because they went to the training. But here’s the other side to that. If they ever have a fire or a boat catches on fire, or a kitchen catches on fire, something, they’ve actually had hands-on training, okay? So it could make a huge difference later. I taught CPR for years and the thing is when I was teaching classes, I always asked at the beginning of my class, “Has anybody in this class ever done CPR on a real person?” Because sometimes that can really be a trigger point for people because statistics show that we’re going to do CPR on somebody that we know, a co-worker or a family member, it’s not going to be the stranger at the grocery store. Sometimes people would raise their hand and say, “Yes, I have.” So it’s important to know where you’re at and to make sure that you do look at little things as a win.

Deborah Thompson: As they say, all politics is local, and for Public Healthers at the local level, the people who run the towns, cities and counties can have a lot of impact on their work. Don’t complain though if you didn’t vote.

Chris Estle: So politics are everywhere. It doesn’t matter who you are, what you do, they impact everything in our daily life when you really start to think about it. I’ve learned this a lot in my 13 years of being a public health administrator. I very rarely would ever go vote in a primary election and I’m like, “I learned the importance of voting in a primary election.” And especially at the local level. To me, it’s not a political debate. Healthcare is one of those things that it’s a people issue, we need to figure out how we can work at it together. But I always tell people when they start to complain about something, I’m like, “Well, did you go vote?” That’s the first thing I ask them, “Did you go vote?” “No, I didn’t go vote. My vote wouldn’t matter anyway.” And I’m like, “Seriously? People have died for the right to vote. People continue to die for our right to vote and for our right to exercise that power at the poll and if you didn’t go vote, then I don’t want to hear you complain.” And then it’s just like, “God, she’s grouchy.” It’s like, “Dude, if you didn’t go vote, then I don’t want to hear it. Have you volunteered for a board? Have you tried to run for political office? What are you trying to bring to the table that’s going to help solve a problem?” And again, it goes back to what I said earlier where I don’t have my own political agenda, I have an agenda to do the best I can as the public health administrator.

Deborah Thompson: Bring it home Chris, who’s an advocate?

Chris Estle: I think we’re all advocates. If you’re in any kind of health and human services field, you are automatically an advocate whether you realize you’re one or not. And we are constantly doing quality improvement process and we just don’t call it quality improvement process because we’re constantly doing something and then reassessing or re-evaluating our actions, our reactions and then the next step. I think the thing is to become involved in as many things as you need to or are asked to at the local level. There’s a lot of things that I’m involved in as far as community organizations and different advisory boards just like the safety committee. Did I really want to do that? No, I did not. I’m like, “I don’t have time for this.” But I’m like, “Seriously, I do have time for this because it’s directly related to health occupation, safety with our employees, our insurance premiums, keeping people safe, making sure they’re following the guidance.” So yeah, the assistant county attorney and I are the co-chairs and you just have to show up and you have to be willing to step out of your comfort zone. You just have to be there and say, “Hey, I’ll volunteer to do this. I might not know what I need to do, but you guys will lead me and guide me.”

Deborah Thompson: As this podcast episode comes to a close, a big thank you to Jaci McReynolds, Senator Joe Bolkcom, and Christine Estle for sharing their stories, expertise, and passion for public health advocacy. Be sure to listen to the other episodes of this podcast series on public health advocacy. Now, go on, go tell somebody your public health story for the good of the cause. This is Deborah Thompson and thanks so much for listening.

Thank you for tuning in to this episode of Share Public Health. Thank you to Sonja Armbruster, Brandon Grimm, Jeneane Moody, Hannah Shultz 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 mphtc.org and in the podcast notes.

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