Why is it Important to Me? OMAR A. CONTRERAS, DR.P.H., M.P.H. - PDF document

6/12/2019 Public Policy Why is it Important to Me? OMAR A. CONTRERAS, DR.P.H., M.P.H. MEGHANNE BEARDEN, MPA MICHELLE BERMAN, MS, RDN, CDE, FAND, MODERATOR, SARAH KISER, MS, RD, CSO, CNSC ARIZONA STATE SENATOR TYLER PACE JUNE 7, 2019 FROM EVIDENCE- BASED RESEARCH TO POLICY ACTION Omar A. Contreras, Dr.PH, M.P.H. Arizona Academy of Nutrition and Dietetics & Arizona Chapter of the American Association of Diabetes Educators June 7, 2019 Phoenix, AZ 1

6/12/2019 Burden of diabetes in Arizona 12.0% Age-adjusted prevalence (%) 10.80% 10.7% 10.6% 10.5% 10.1% 10.50% 10.0% 10.0% 9.5% 10.1% 9.8% 9.7% 9.5% Percentage of 8.0% Adults that Have 6.0% Been Told by a Doctor That They 4.0% 2011 2012 2013 2014 2015 2016 Have Diabetes, Year 2011-2016 Arizona National Source: Arizona BRFSS (2017) 2

6/12/2019 Diabetes Age-Adjusted Mortality by Race and Ethnicity (2005-2015) Source: Arizona Vital Statistics (2016) 40 34.4 35 30 Age-adjusted Prediabetes Prevalence (%) 25 prevalence of 23.4 20.0 prediabetes 19.5 20 19.0 15 10.8 10 9.1 8.6 8.0 7.8 7.9 7.4 6.5 5 0 * Error bars represent 95% confidence intervals. 2011 2012 2013 2014 2016 2011-2014 † In 2012 and 2015, the prediabetes module and questions were not administered by the Arizona BRFSS. NHANES data is representative of national prevalence of prediabetes data from 2011-2014 (n=5,179) National BRFSS Arizona BRFSS SQL NHANES No data was available for 2015 for BRFSS or NHANES to compare with SQL prevalence of prediabetes estimates. 3

6/12/2019 Diabetes costs Arizona diabetes projected direct and indirect costs, 2017 For a person with NO NO DPP intervention Average direct Estimated direct costs Average indirect Estimated indirect costs if conversion Total medical costs medical costs for those NOT medical costs per to diabetes occurs for those NOT (Direct and Indirect) per capita * participating in the DPP capita * eligible to participate in the DPP who may convert to diabetes, 2017 $9,601.00 $6,788,084,510.97 $3,640.00 $2,573,547,299.23 $9,361,631,810.20 For a person with DPP intervention Average direct Estimated direct costs Average indirect Estimated indirect costs if conversion Total medical costs medical costs for those eligible to medical costs per to diabetes occurs for those eligible to (Direct and Indirect) per capita * participate in the DPP capita * participate in the DPP who may convert to diabetes, 2017 $9,601.00 $3,655,122,428.98 $3,640.00 $1,385,756,238.05 $5,040,878,667.03 * Average direct and indirect costs are based from the Source: Contreras, O (2019). Evidence-based research to inform diabetes American Diabetes Association, Economic Cost of Diabetes prevention policy in Arizona. (Publishable doctoral dissertation) University of in the U.S., 2017 Arizona, Tucson, AZ. 4

6/12/2019 Medical Savings Cum Cumula lativ ive di difference be betw tween cos osts in n the the "no no interv rvention" and and the the "interv rventio ion" gr grou oup $4.3 .3 BIL BILLION 5

6/12/2019 Analyze policies Plan for monitoring and Identify a policy issue evaluation - Set a policy goal Policy Advocacy - Desired outcomes Plan of implementation Essential Steps - Define the target Identify key messages Define the strategy Identify key partners/allies Hasan Al Farooque SA. Policy Advocacy: Concepts, Strategies and Effective Communication. Asian South Pacific Association for Basic Adult Education – Civil Society Education Fund. http://www.aspbae.org/bldc/sites/default/files/ppt/Policy%20Advocacy.pptx. Accessed December 19, 2018. The key to understanding the process… Advocacy Politics Policy 6

6/12/2019 Types of Advocacy Lobbying Emails/Letters Litigation Phone Calls Marches or Door-to-Door Protests Social/Mainstream Briefings/Meetings Media But All Politics Is Local – Ode to the States Each legislature may establish its own rules of procedure. As a result, legislative processes vary — from state to state, from chamber to chamber, and from session to session. In 2017, 17% of bills introduced in state legislatures passed, while only around 1% introduced in Congress passed States usually have a more direct impact on day-to-day lives Easier to meet your legislator Structure and nature of state legislatures allows you to be an expert and a strong voice for dental education 7

6/12/2019 Advocacy In the States Advocate during the “down times” Additional Factors to Keep in Mind • At least 24 states place a deadline A lot of advocacy work is done before on bill introduction the start of a session • At least 22 states impose a Short sessions and full time jobs place crossover deadline constraints on legislators time • If a bill hasn’t passed a chamber by a specified date, the bill is usually The time to build relationships and dead educate lawmakers is before session • 24 states carryover legislation from starts, in many cases it is late to do odd numbered years to even anything proactive when session starts numbered years 24 states limit the number of bills a • NJ and VA carryover legislation legislator may introduce from even years to odd years Groups/individuals influential for supporting diabetes prevention policies in Arizona 60 50 Percentage Response 40 30 20 10 0 1 2 3 4 5 6 7 8 9 10 11 Influential Scale (1 being the MOST, 11 being the LEAST influential) Advocacy groups and coalitions include the American Diabetes Association, healthcare and disease specific coalitions, Tribal Coalitions, health foundations, etc. Advocacy groups and coalitions Certified Diabetes Educators Percentages may not add up to 100% due to rounding. Researchers and Professors from Colleges and Universities (Academics) Constituents Governor Indian Health Services (IHS) Lay health leaders interested in diabetes health/care Legislative Leadership Source: Contreras, O (2019). Evidence-based research to inform diabetes prevention policy in Local Health Departments State Health Department Arizona. (Publishable doctoral dissertation) University Medical Doctors, Nurses, Pharmacists, or other health care professionals of Arizona, Tucson, AZ. 8

6/12/2019 Factors that influence the passage or failure of proposed diabetes prevention policies in the Arizona legislature 60 50 Percentage Response 40 30 20 10 0 Not at all influential Slightly influential Somewhat influential Very influential Extremely influential Advocacy groups and coalitions Committee Chairs Constituents Source: Contreras, O (2019). Evidence-based Advocacy groups and coalitions include the American Diabetes research to inform diabetes prevention policy in Disease burden data across the state Fiscal impact Governor Association, healthcare and disease specific coalitions, Tribal Arizona. (Publishable doctoral dissertation) Coalitions, health foundations, etc. Legislative Leadership Political party Timing relative to election University of Arizona, Tucson, AZ. Percentages may not add up to 100% due to rounding. Public policymaking for the coverage of the National Diabetes Prevention Program STRATEGIC PARTNERSHIPS FINANCIAL SUPPORT FOR INSTITUTIONAL LEADERSHIP HEALTHCARE AND PROGRAM REIMBURSEMENT PAYMENT IMPLEMENTATION MODELS Source: Contreras, O (2019). Evidence-based research to inform diabetes prevention policy in Arizona. (Publishable doctoral dissertation) University of Arizona, Tucson, AZ. 9

6/12/2019 Not As Complicated As it Looks! Prediabetes and diabetes continue to be major public health problems in Arizona. Diabetes prevention efforts may help to alleviate the cost burden. Data are powerful to initiating policy, systems, and environmental changes. Final thoughts… State level diabetes prevention policy can be informed and influenced through a cadre of stakeholders (CDEs, constituents, advocacy/coalition groups, and legislative leadership). Being an effective policymaker constitutes understanding the intersection of policy, politics, and advocacy. Advocacy should be an ongoing process and it begins NOW! 10

6/12/2019 Thank you! Review of the Arizona State Legislature + The Role of RDs in Advocacy Meghanne Bearden, MPA WeArePublicHealth.org @MaricopaHealth /MCDPH 11

6/12/2019 Three Branches of Government • Executive – Governor • Legislative – House and Senate • Judicial – Courts 12

6/12/2019 AZ Legislative Districts 30 Districts • – Equal in population – Redistrict every 10 years House of Representatives • – 60 Members (2/District) • 31 Republicans • 29 Democrats Senate • – 30 Members (1\District) • 17 Republicans • 13 Democrats Legislative Process How is a bill created? • Someone (lobbyist, organization, citizen) comes up with an idea to address a problem. • Research, best practices, model policy, etc. • Find a legislator to sponsor the bill • House Bills – HB 2xxx • Senate Bills – SB 1xxx 13

6/12/2019 Legislative Process Committee Hearings • Chairperson makes agenda • Public testimony • Amendments • Strike-everything • Vote • Do Pass • Hold • Failed to Pass • All Bills will go through at least one committee, and the Rules committee Legislative Process Crossing the Courtyard Bills must be approved by both chambers • (House + Senate) If Amended - Possible Conference • Committee/Final Vote Transmitted to Governor • » Sign into Law » Veto (Legislature can override) » Not signed, becomes law 14