Public Policy Update
APA's Public Policy Office (PPO) launched a coordinated grassroots advocacy campaign with the APA Committee on Ethnic Minority Affairs (CEMA) last fall that focuses on new racial and ethnic health-disparities legislation. What sets this campaign apart is its emphasis on developing relationships with members of Congress, both within and outside the Beltway, in their home states.
The campaign grew out of CEMA's 2003 spring meeting, when PPO staff proposed organizing a series of meetings to lobby for psychology-friendly racial and ethnic health-disparities legislation. CEMA members immediately agreed to recruit at least two colleagues in their home states to attend a meeting at their senators' local offices and to serve as the campaign contact in their state.
With guidance from PPO staff, the CEMA members met with, and expressed concern to, congressional staff over the lack of behavioral health integration throughout the Health Care Equality and Accountability Act (H.R. 3459, S.1833). Introduced last November by Sens. Tom Daschle (D-S.D.) and Edward Kennedy (D-Mass.) and the chairs of the House ethnic-minority caucuses, Reps. Elijah Cummings (D-Md.), David Wu (D-Ore.), Ciro Rodriguez (D-Texas), and Dale Kildee (D-Mich.), the 432-page bill neglects behavioral health and mentions psychology only once, in sharp contrast to legislation enacted in 2000.
Behavioral health loses ground
That 2000 legislation was called the Minority Health and Health Disparities Research and Education Act. The law was inclusive of behavioral health and psychology, largely due to the efforts of PPO staff and APA members. In fact, in recognition of those efforts, then-CEO Raymond Fowler, PhD, was invited to the White House Oval Office to witness President Clinton sign the bill into law.
PPO thus finds it disconcerting that the renewing legislation does not include behavioral health.
Rather, the new health-disparities bill covers a broad range of issues, including specific diseases and conditions (including HIV/AIDS, infant mortality, heart disease, diabetes and fetal alcohol syndrome), work force diversity, culturally and linguistically appropriate health care, family care, data collection and reporting, the strengthening of health institutions that serve minority populations, accountability, and loan guarantees.
The legislation also includes a provision requiring the Substance Abuse and Mental Health Services Administration to formulate and submit to Congress a strategic plan within six months for implementing the recommendations of former Surgeon General David Satcher's 2001 report, "Mental Health: Culture, Race and Ethnicity," and the 2003 final report of the President's New Freedom Commission on Mental Health. Unfortunately, the bill contains no specific provisions on how to implement or fund the recommendations.
The legislation also establishes five new scholarship and fellowship programs, but psychologists are only eligible for one of these opportunities, the David Satcher Public Health and Health Services Corps.
The campaign to regain past provisions
The primary goal of the CEMA and PPO grassroots campaign was to alert Senate offices to the need for integration of behavioral and mental health throughout the minority health-disparities legislation. PPO also aimed to establish a relationship between CEMA members and their senators and to emphasize to CEMA members the importance of grassroots mobilization at the local level.
By all accounts, the meetings were successful, and the goals were met. "My meeting with the senator went well," says CEMA member Tawa M. Witko, PsyD, of Kyle, S.D., of her meeting with Sen. Tim Johnson's office. "We went over the main points and then talked extensively about our state and services for Indian people."
CEMA member Elizabeth Vera, PhD, of Chicago, says she also had a positive experience when she met with staff of Sen. Richard Durbin (D-Ill.).
"We discussed the nature and magnitude of racial and ethnic disparities in health and mental health problems," she explains. "We also discussed recommendations of what could be done to increase research on these issues as well as decrease disparities. It helped me to gain more practice in advocacy and public policy work, which is crucial to the social justice agenda...."
In a related effort, PPO staff met in January with the Capitol Hill staff of Sens. Daschle and Kennedy to express APA's concerns. The congressional staff agreed to review language being developed by PPO staff for inclusion in the legislation.
This concerted effort is critical to the uphill battle PPO staff face yet again to ensure that behavioral health is included in this new legislation. However, the challenges are greater than in 2000. Shrinking budgets and the wars in Afghanistan and Iraq continue to occupy center stage for members of Congress.
In addition, health disparities are simply not a front-burner issue for the current administration as they were for the former one. Not to be deterred, PPO staff are encouraged by the potential of the campaign and regard it as a critical addition to our advocacy toolbox. PPO is already devising similar campaigns to affect the health-disparities legislation with other APA public interest governance groups.Lori Valencia Greene is a senior legislative and federal affairs officer in APA's Public Policy Office.
For more information on the health disparities legislation and related campaign, or on how you can get involved in advocacy, contact Lori Valencia Greene at firstname.lastname@example.org or visit the PPO Web site at www.apa.org/ppo/issues/ pethnic.html.