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Influencing Public Policy – a High Priority for SBM

The news from the doctor's office hit Mrs. Stevens* hard. Tests showed that sugar levels for her 16-year-old son Joey had reached a disturbingly high 124. The doctor painted a scary picture: "The range for what we call 'pre-diabetes' is 100-125," she told Mrs. Stevens. "Joey is two points away from having type 2 diabetes."

Mrs. Stevens immediately felt guilty. She had allowed her son to indulge in too many cheeseburgers and other fast foods. She felt overwhelmed. She really didn't know what kind of diet her son should be on or how to help him stick to it. In addition to working full time as a supermarket cashier and caring for Joey, Mrs. Stevens also cared for two pre-teen daughters and her diabetic mother, all on her own. Her husband was in Afghanistan, deployed for another 3 months.

Mrs. Stevens' mother encouraged her to call the doctor back and ask about options. The doctor recommended a nutritionist. After the first visit with the nutritionist, Mrs. Stevens felt encouraged. The nutritionist had spent an entire hour going over Joey's diet, including all his many food allergies. She explained that it would be important to meet weekly for three to four months so they could develop a healthy diet tailored around Joey's allergies, get his weight down, and start an exercise plan. Mrs. Stevens sighed with relief, knowing she had found an ally and an expert who could help get Joey on track. Her husband's military service provided health insurance and when she handed the insurance card to the receptionist, Mrs. Stevens fully expected costs for the appointment and ongoing nutritional counseling would be covered. She was wrong. "Joey does not have a qualifying diagnosis," noted the receptionist. "If he had type 2 diabetes, insurance would cover. How would you care to pay for today's appointment, cash or check?" The charge for the appointment was $100 and Mrs. Stevens quickly calculated the cost over three to four months and immediately knew it was beyond reach.

The Advocacy Strategy

Nutritional and obesity counseling, cancer screenings, evidence-based smoking cessation, exercise and physical activity interventions, and strategies for increasing medication adherence all have the capacity to reduce suffering, save money, and improve the health of hundreds of thousands of Americans. Policy makers, however, weigh costs against benefits and in the current deficit reduction-driven economy, the scales can tip toward cost-containment or cost-cutting. As in the case of Mrs. Stevens (a story relayed by SBM member Sherry L. Pagoto, PhD), such realities can mean that effective, evidence-based interventions are not available to those who could most benefit from them. Advocacy - influencing public policy makers through education and outreach - can increase the chances that behavioral medicine evidence finds its way into funded programs and initiatives, thereby helping to improve the health of the nation.

Beginning in 2010 the SBM Board recognized that healthcare reform signaled a propitious time for expanding SBM's health policy work.

SBM's Advocacy Activities

1) Policy Briefs
Recognizing the importance of advocacy, SBM has been active on the health policy front for several years. SBM's Health Policy Committee members began publishing evidence-based policy briefs as early as 2004, which placed SBM on the health policy landscape. In the past year, two new briefs were developed:

The Public Health Need for Patient-Reported Measures and Health Behaviors in Electronic Health Records, advocating for inclusion of behavioral and psychosocial measures in electronic health records, recommended domains and provided example measures.

SBM and SRNT Urge Increased Funding of Quitlines and Research to Maximize Public Health Benefits of 1-800-QUIT-NOW on Cigarette Packs, advocating for planned, proactive research to maximize the public health impact of these new policies when they go into effect.

2) Making the behavioral medicine case and giving SBM a stronger voice
Board members visited 33 legislative offices in 2011, sharing policy briefs and highlighting members' research and practice areas. Legislators welcomed the scientific evidence but asked for "stories" or compelling examples demonstrating how behavioral medicine interventions improve the health and lives of their constituents.

SBM President Abby C. King, PhD, took the legislators' request seriously (see her article in this issue of Outlook), encouraging members to embrace the art and power of story-telling. ". . . All of us," she writes, "have compelling scientific stories that can be told in a convincing and engaging fashion."

The visits also made it clear that the policy landscape shifts quickly and SBM needs to stand ready to respond. In order to provide a rapid response mechanism, the Board formed the Public Policy Leadership Group (PPLG), led by Karen M. Emmons, PhD. The PPLG sets strategic directions, and its several action teams in several high-priority areas scan the health policy environment for open comment periods, endorsements, and sign-ons. Action teams include the obesity and diabetes team, led by Sherry Pagoto, PhD; the veterans' health action team, led by Sara J. Knight, PhD; and the congressional communications team, led by Karen M. Emmons, PhD.

PPLG members develop case statements for use in congressional visits, including "School-based Physical Activity: Essential for Children's Health," which supports policies designed to increase evidence-based PA activities in schools. A second case statement demonstrating the effectiveness of evidence-based, community-focused behavioral interventions is under development.

Taking their cue from Dr. King, team members imbue case statements with outcome "stories" or examples that show how interventions make a positive difference in peoples' lives.

Throughout the 2011-2012 SBM year, the policy action teams also:

3) Reviewed and recommended endorsement of:

  • The Healthy Lifestyles and Prevention America Act (S. 174) introduced by Senator Tom Harkin (D-Iowa)
  • New and emerging weight management strategies for busy ambulatory settings: a scientific statement from the American Heart Association
  • The Elementary and Secondary Education Reauthorization Act of 2011, in particular the provisions promoting student physical health and well-being, nutrition and fitness

4) Advocated for:

  • Continued support for the Prevention and Public Health Fund and Community Transformation Grants
  • Funding and sustained federal investment in National Institutes of Health/Office of Behavioral and Social Sciences Research

5) Reviewed and recommended SBM participation in multi-organizational letters:

  • Supporting Healthy Kids from Day One, legislation introduced by Senator Tom Udall (D-Iowa) that would create a 3-year pilot program in 5 states to support child care collaboratives that focus on combating obesity among very young children;
  • Encouraging the Patient-Centered Outcomes Research Institute to support the development of infrastructure and capacity building for active partnerships between community-based patient advocacy and service provider groups and research (including academic) institutions; and
  • Recommending that the U.S. Department of Health and Human Services require state Medicaid plans require coverage of all A and B-rated preventive services.

6) Provided comments to the Centers for Medicare and Medicaid Services (CMS):

  1. urging that psychologists be included in the definition of providers for CMS-reimbursed obesity behavioral counseling; and,
  2. endorsing the CMS initiative for Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse.
Your Role: Become Engaged and Take Action!

Increasing SBM's impact in the health policy arena depends, in large part, on SBM member engagement. Members can take actions - such as those recommended below - that extend the SBM reach and increase the visibility and importance of behavioral medicine research.

Listservs, blogs, magazines, newspapers, and radio stations feature health policy news, analyses, opinion pieces, and editorials.

  1. If you spot an issue that you believe warrants an SBM response, email the national office: astone@sbm.org. Recommend a course of action (if you care to), but it's not necessary.
  2. Check out the Supporting Policy page on SBM's website. SBM's weekly broadcast emails often invite members to contact their federal legislators about a relevant policy issue. The website allows members to easily identify legislators and send an SBM message to them.
  3. Encourage your SIG chair to involve members in identifying health policy issues related to SIG members' interests.
    1. If issues warrant a policy brief, the Health Policy Committee could well be interested in co-developing such briefs with SIG members.

*This story was inspired by real events but names and details have been changed.