Population Health Blog

Population Health Blog

Why It Matters

EPA advises MDEQ to improve public participation in permit process

By Dennis Archambault

If you attend public hearings on industrial permit requests, you’d think that minority communities are actively engaged in the process. However, Michigan Department of Environmental Quality (MDEQ) administrators staffing these hearings remind the audience that only comments of scientific merit will be considered as appropriate testimony. That rules out nearly all of those who attend such hearings, except for a few academic and scientific professionals.

The Environmental Protection Agency (EPA) issued an opinion in January that challenged the degree to which MDEQ engages its minority population (Detroit News, Jan. 23, 2007). The EPA’s letter to MDEQ referenced a 1992 complaint by African Americans residents in the vicinity of a new Genesee power plant who felt they would be exposed to toxic chemicals. Specifically, the EPA told MDEQ to “ensure its public involvement process is available to all persons regardless of race, color, national origin…”

That sounds a lot like distinguishing between universal access to health insurance and universal access to health care. Undoubtedly, MDEQ can defend its performance, and does: “MDEQ public participation processes, over the past 20 years, have been expanded to address the concerns raised in the (EPA) letter.” EPA may be following formal communication channels to inform minority citizens, but it’s probably not using creative engagement strategies necessary to elicit proactive comments, and providing credible assurances as to their concerns.

It’s a typical challenge for institutional communicators attempting to reach minority audiences. In the case of environmental health, informing the community of a public hearing isn’t enough. There needs to be engagement to deal with fears and substantive concerns that may not have scientific merit but can be responded to appropriately. In its response, MDEQ says that “there has been no harm to public health from this facility.”

The positive outcome of this opinion has caused the MDEQ to review its minority engagement. “Although the historic complaint is closed, the EPA includes some recommendations to bolster our public participation processes,” according to a MDEQ spokesperson.

Dennis Archambault is vice president of Public Affairs for Authority Health

Reflecting on health equity and the ‘Great’ Society

By Dennis Archambault

At this precarious moment in health policy, when the call to make America “great” comes with the goal of dismantling the Patient Protection and Affordable Care Act (ACA), it’s good to reflect on the often cited quote by Dr. Martin Luther King, Jr.: “Of all the forms of inequality, injustice in health care is the most shocking and inhuman.” Dr. King spoke those words in the context of a speech he gave to the Medical Committee for Human Rights in Chicago, 1966. At the time, the Great Society was rising, and there was great hope the civil rights would extend into the realm of access to quality health care for all, and ultimately, health for vulnerable populations.
“Great” in that society was meant to be inclusive. An affluent society could afford to properly care for its elderly, disabled, and low income populations through health and human services. Even those of a more conservative bent adopted a “compassionate” perspective that the needs of the poor should be addressed in some baseline way. That led to thinking about a two-tiered approach to care.

Today, Gov. Rick Snyder and others who realize the social and economic value of expanded Medicaid – for those who fall within 133 percent of the federal poverty level – are calling on president-elect Donald Trump and his administration to preserve this important component of the ACA, which has ensured that more than 600,000 Michigan residents have access to the same quality of health care as everyone else – a major step toward resolving the inequality and injustice that Dr. King spoke about in 1966. As the president and Congress review the ACA, Gov. Snyder says, “I hope they carefully look at the success we’ve had in Michigan, because we didn’t just do Medicaid expansion. We put requirements for health and wellness on the front ends, and personal responsibility.” While that latter requirement is controversial, most community health people would agree that incentives are helpful in getting people to adopt good health behaviors.

Health analysts are noting that expanded Medicaid is likely to go with several other provisions. It’s uncertain what would replace the ACA. There’s talk of block grants to states. There may be a yet-to-be disclosed plan that Congress will reveal. Proponents of universal coverage have felt that the ACA wasn’t the right solution. Opponents of a national health policy of any kind have opposed it. It’s hard not to conclude that it’s a return to the attitudes that prompted Dr. King to conclude that inequality and injustice in health care is the most shocking and inhuman of all forms of inequality. Dr. Brian Smedley, co-founder and executive director of the National Collaborative for Health Equity noted shortly after the 2016 presidential election, put it into perspective “The expressions of bigotry, racism, misogyny, and xenophobia in the aftermath of last week’s election must be stopped. But the ideology behind these attacks – even if never expressed – also poses a tremendous barrier to building a Culture of Health, which priorities equity and values all populations equally.”

It is a precarious moment for health policy. And as health policy has reflected society in so many ways, it’s a precarious moment for society. As the debate to preserve access to health care – and access to health – we would be wise to reflect on Dr. King’s quote. But also consider another often-quoted reference from the civil rights leader: “A genuine leader is not a searcher for consensus, but a molder of consensus.”

The debate that has waxed and waned in American society since Dr. King’s era has been revived, as has the meaning of what makes American society “great.”

Dennis Archambault is vice president, Public Affairs, for Authority Health.