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August 01, 2020

Health Law Connections

CEO Corner—Administrative Advocacy: A Tool to Aid Social Justice Reforms

  • August 01, 2020
  • David S. Cade , American Health Law Association

History teaches us that significant social changes generally follow periods of civil unrest, protest, and disruption. The Civil War preceded the 13th Amendment to abolish slavery in the United States. The Women’s Suffrage movement ran for almost 100 years before the 19th Amendment was ratified to give women the right to vote. The Civil Rights movement prompted Congress to support a constitutional amendment to grant the District of Columbia electoral votes. These movements were the product of persistent pressure by the oppressed people and those who join and support the cause for the liberation, equality, and dignity being sought.

The shocking image of George Floyd’s murder so unsettled, angered, and frustrated the people of the United States and communities around the world that civil unrest and protests erupted. This cultural inflection point refocused us on the systemic racism and indifference rooted in American culture, which has yet to address its history of slavery and is still racially divided.

We are experiencing another people’s movement to change systemic social and racial problems that have festered in this country for centuries. Mr. Floyd’s murder focused immediate attention on police reform. It brought to light again how racism is perpetuated by stereotypes and that the cries for change united with economic pressure is prompting reforms many thought would never happen.

Mr. Floyd’s murder and the impact of COVID-19 have also underscored the nation’s health care disparities. CDC reports that African Americans contract the Coronavirus at a rate approximately five times that of Whites. Health disparities among racial groups and the impact of social determinate factors on health outcomes and educational and economic successes and opportunities are not new. In 1966, Martin Luther King, Jr. stated that “[o]f all the forms of inequality, injustice in health care is the most shocking and inhumane.”

As you consider the role you and your organizations can play in social justice reforms, it is important to have an Administrative Advocacy strategy as part of that effort. Organizations often have a Legislative Strategy that focuses on Congress or a state legislature. Administrative Advocacy, however, is a focused engagement with Executive Branch agencies, the equivalent state health department, or the local county or political district. Focused engagement means submitting comments to proposed rules and proactively informing agency officials about the challenges encountered as you administer and support programs within the regulatory environment.

Engagement also includes attending public hearings and submitting position papers. The goal is to humanize your cause and advocacy position. During my years in practice, including several years as a senior federal government policy official, Deputy General Counsel, and Acting General Counsel, I would often say that people need to see the problem. All too often individuals are regulating behaviors and industry practices without having spent time with the individuals or in the industry or community settings. I have often urged officials to visit nursing homes, clinics, and homeless shelters to better understand these operations and the individuals served before developing policies that impact them. Never assume that the regulators understand all the issues or have substantial familiarity with the individuals and industries being regulated. Your goal is to put a face on the issue. Let them see what life is like as a homeless vet. Let them see a child with high blood-lead levels. Let them hear from the family that has been victimized by discrimination and racial hatred. The voices of the oppressed are strong and impactful. Humanizing the problem is an effective way to tear down the barriers that exist between the regulators and the regulated and makes the problem harder to ignore. Let the officials see what they do not see or what they have chosen to ignore.

Change sometimes comes slowly and requires persistence. I have seen senior policy officials moved to tears and change positions when hearing the stories of young mothers moving through recovery and education programs trying hard to overcome economic, health, and education barriers that cultural racism erected. People are impacted by what they see and experience.

What is demonstrated by persuasive pressure is that change happens when people give voice to what needs to change. An effective Administrative Advocacy strategy can help amplify that voice for change.

 

“Not everything that is faced can be changed, but nothing can be changed until it is faced.”
James Baldwin, 1962