Outlook: Newsletter of the Society of Behavorial Medicine

Winter 2020-21

Taking Behavioral Medicine to Capitol Hill: An Interview with Dr. Reginald Tucker-Seeley

Rachel C. Shelton, ScD, MPH‚úČ; SBM Member Delegate

Reginald Tucker-Seeley, MA, ScM, ScD

Dr. Reginald Tucker-Seeley, MA, ScM, ScD, is the inaugural Edward L. Schneider Chair in Gerontology and Assistant Professor in the Leonard Davis School of Gerontology at the University of Southern California (USC). He completed master and doctoral degrees in public health (social and behavioral sciences) at the Harvard T.H. Chan School of Public Health (HSPH) and a postdoctoral fellowship in cancer prevention and control at HSPH and the Dana-Farber Cancer Institute (DFCI). His research has focused primarily on social determinants of health across the life course and on individual-level socioeconomic determinants of health. Dr. Tucker-Seeley has a longstanding interest in the impact of health and social policy on racial/ethnic minorities and across socioeconomic groups. He has experience working on local and state-level health disparities policies, and in the measuring and reporting of health disparities at the state level. Dr. Tucker-Seeley has been a member of SBM since 2008 and has served as the Chair of the Aging SIG, member of the Health Policy Committee, and Co-Chair for multiple sessions at SBM Annual Scientific Meetings and Scientific Sessions. Dr. Tucker-Seeley was recently in the 2017-2018 cohort of the Robert Wood Johnson Foundation (RWJF) Health Policy Fellowship Program.

Tell me why you chose to apply to the RWJF Health Policy Fellowship Program?

I used to teach a course at the Harvard T.H. Chan School of Public Health called “Measuring and Reporting Health Disparities.” In that course, I used my experience in state level policy, having worked on the Commission for Health Advocacy and Equity in Rhode Island, to develop a case study that took students through the process of having to write a state level health disparities report that I included in that course (note: the case study is available for educators here: https://store.hbr.org/product/the-rhode-island-commission-of-health-advocacy-and-equity-developing-a-report-on-health-disparities-part-a/PH9015). I remember in an evaluation of the course, a student wrote, “this is a great course, but there's nothing on the federal level.” Well, that was because I knew very little about health disparities policy at the Federal level. So I started looking for opportunities that would give me exposure to health disparities policy at the Federal level. I found two fellowship opportunities that seemed most appropriate. One was the White House Fellowship, and another was the Robert Wood Johnson Foundation Health Policy Fellowship. I then reached out to a couple of mentors to discuss and was fortunate to be connected to folks who had been accepted to both programs. After hearing about the RWJF Health Policy Fellowship program’s three-month orientation, with training on how federal health policy gets made, I knew that that program was exactly what I was looking for. I really approached it as a way to think about what are some of the tools that I could learn and train students to better engage in health disparities policy, from a federal perspective.

So can you do the fellowship while you're in a full time faculty position?

Yes, interestingly, the fellowship functions like a grant. And so the grant goes to your institution, and it's two years of funding with one year in residency in Washington, DC. While the program is funded by RWJF, it is managed by the National Academy of Medicine (NAM). For those first three months of orientation, the fellowship cohort is housed at the NAM offices in Washington, DC. During that time the cohort meets with leaders across a range of health policy topics learning how federal health policy gets made and how the branches of the federal government work. Next, each fellow interviews for a fellowship placement in either the executive or legislative branch where the fellow will work for eight to 12 months.

What do you think surprised you the most about the fellowship in terms of your expectations?

Yeah, so I think oftentimes at the start of these kinds of programs, people assume that they're going to take whatever their area of expertise is and advise policy makers (legislative or executive branch offices) only on that topic; however, it is important to note that legislative and executive branch offices have their own priorities and agendas. And, with federal politics, you know, things can change at the drop of a hat. So I think as a fellow working in that context, you really have to pull out all of the skills you learned in graduate school related to reading large amounts of material and synthesizing that material really quickly. I think the part that is new, is learning how to then to write succinctly about that synthesis. We as academics are pretty good at synthesizing, but many of us struggle with doing so succinctly. That was something that that I definitely struggled with initially in the fellowship program and in my placement.

And how did you decide on your placement?

Right before accepting the RWJF Health Policy Fellowship, I was recruited to the Leonard Davis School of Gerontology at the University of Southern California (USC). So, my first year on the faculty at USC was spent in Washington, DC. I knew very little about California, and I wanted a placement that would give me an opportunity to learn more about the state where I had just moved my family. Fortunately, Senator Dianne Feinstein’s office was accepting health policy fellows. I submitted my resume and was interviewed by Senator Feinstein's health policy staff. Although she wasn’t on the two primary committees with jurisdiction over healthcare (Health, Education, Labor and Pensions or Finance), she is the senior senator from the largest state with a long history in the Senate and her office staff looked like California; that is, it was racially/ethnically diverse. When I met with her Legislative Director during the interview process, who is an African American man [you don’t see many folks who look like me in leadership positions in the Senate], I knew that I wanted the placement in that office.

What was that like? What was your favorite part? And what was unexpected?

I’m not sure if this was my favorite part, but what was surprising was watching the Senator and her staff manage so many different topics. In our weekly staff meetings, the Senator would go from talking about defense topics to security topics to health and health care topics. It was truly impressive to watch that process!

I would say my favorite part was meeting with constituents. About 25% of my job as a fellow was meeting with folks that wanted to inform/discuss with the Senator a specific health/healthcare related issue. So for those of you that have participated in, a “Congressional Hill Day” where you meet with a congressional staff member, I was that staff member! Hearing about health/health care related issues from California constituents was a great introduction to my new state home and also provided me with insight into how issues are managed in a Senate office. 

I think one of my least favorite aspects was the pace. The phrase “drinking from a firehose” is often used to describe what working in Congress feels like and I completely agree with that description! It often felt like time moved fast and slow at the same time in DC. For example, there are so many issues that move in and out of federal policy maker attention and the pace of that process can sometimes feel overwhelming; and managing that process while trying to move one’s policy priorities forward can feel like pushing an elephant up a flight of stairs.

What was a day in the life like?

It could be a bit unpredictable. In some congressional offices, the health policy fellow might be the primary “health” staff member. I knew I didn’t want that experience. I wanted the opportunity to work and watch! That is, I wanted the opportunity to watch how ideas made their way to legislation in a Senate office. I was fortunate to work in an office with a “health policy team” so many of the tasks were divided among multiple people. For me, each day generally started with meetings with constituents. The day could also consist of writing talking points for the Senator on a health/healthcare related topic, working with the health policy team on writing a memo to an Executive branch or Congress member office on the behalf of the Senator on a health/healthcare related topic, and by meeting with/talking to potential co-sponsors of legislation to move the legislative health policy agenda of the office forward.

During my time in her office, Senator Feinstein was on the Senate Cancer Coalition and she was very interested in racial and ethnic diversity in clinical trials. The health policy team worked on writing a letter related to that topic to either HHS or FDA to improve racial/ethnic diversity in clinical trials participation. The memo we wrote to NIH is available here.

I also helped to supervise some of the summer interns. One of the tasks that the summer interns had to do was to write a policy memo and present it to the staff as if they were presenting it to the Senator. I incorporated that task into my Aging and Social Policy course here at USC.

How has this shaped either your personal research or your perception of research?

One of the biggest lessons learned from this experience, was that it helped me to situate what I do (my research agenda) within the larger Federal health policy agenda and the larger Federal policy agenda generally. I think within our own research communities we may rarely think or talk about how our research area fits with the agenda of a policy maker. Working on Capitol Hill helped me to realize that just because a topic is very important to me (e.g. health disparities policy), policy makers may not necessarily be interested in that topic at all! So, I have been thinking a lot about how to encourage a policy maker to be interested in a topic and how to communicate those topics. Prior to the fellowship, I don't think I'd really thought a lot about how do I situate what I do with the priorities of a policy maker. We (academics) always have that very trite statement at the end of research papers: “policymakers should do something about….” After the fellowship, I think I have a greater appreciation of what it takes for policy makers to “do something” in the context of everything else they are managing.

The fellowship also encouraged me to ask more policy relevant research questions. Specifically, I think a lot more now about how my research question(s) or how could my research findings impact people's lives today? Or how can my research question change the process in which people who have historically been left out of the process be included in that process? So for example, I am engaging in more policy scan related projects and starting to look at the kind of legislation that has been introduced or even passed that's relevant to the things that I do. For example, I have a small project now funded by an internal grant at USC looking at legislation at the Federal level and in a couple of states that focused on vulnerable populations related to the impact of COVID-19.

Another thing I realized during my time working on Capitol Hill was that it generally felt like the “Whitest” place I have ever worked, both in terms of who gained access and who was there. This impacts the topics for legislation that gets introduced and passed. The fellowship experience further strengthened my interest in health disparities policy and highlighted the need for me to do whatever I can to ensure that many more racial/ethnic minority voices are in that environment.

How can we actually get policy makers to value things that are on our agenda, whether that's equity related or other topics?

Well, I'll use the “Capitol Hill day” as an example. I think sometimes academics might assume that the “Hill day” visit is the end of the process. But, actually, the “Hill day” should be considered the beginning of the next stage of the process. That is, it is starting a conversation that has to continue. And so whether it's you or someone else within your organization that continues the process, attention has to be paid to continuing that conversation because there are so many other people/topics trying to get the attention of the policy maker and their staff. To go back to the “drinking from a fire hose” analogy that the staff is managing, consider your topic/issue as one of the many water droplets that the staff member is attempting to drink.

Anything else you want to share about your experience or recommendations you have for people thinking about this?

I recognize that if you don’t already live in the DC, Maryland, Virginia (DMV) area that moving to Washington, DC for the year can be disruptive, but to any mid-career SBM member who can fit a health policy fellowship experience into their lives, do it! I don’t think there is any other opportunity like the RWJF Health Policy Fellowship to show you how the legislative process works and that gives insight into how you can later use your research to influence that process.

The last thing I want to make sure I mention is that we always hear that Congress isn’t doing anything about “insert your topic of interest.” I wholeheartedly disagree! I met some of the smartest and hardest working people serving in the United States Congress working simultaneously on a myriad of issues to make our country better.