Sanctuary Cities Save Lives

Much has been made of the ongoing game of chicken about sanctuary cities in the United States. From threats to cut off federal funding by the Trump Administration, to affirmations of continued sanctuary city status by Mayors, to the consideration of sanctuary states, and even a redefinition by my very own Mayor, establishing Philadelphia as the country’s first “Fourth Amendment city.” Even given the dizzying confluence of worst-things-ever and best-things-ever, and all of the conflict associated with it when a proposed policy is simultaneously described as both of these things, the battle over sanctuary cities has continued to be a simmering issue throughout.

As politically-charged stories are wont to do these days, the rhetoric has been ratcheted through the roof. At the most basic level, a sanctuary city is one that, in any of a number of legal or procedural ways, refuses to cooperate with a standing request (not requirement) by the federal Immigrant and Customs Enforcement agency to detain undocumented people they come in contact with. Some cities never ask about immigration status, while others will cooperate with federal authorities when dealing with violent detainees, and other cities are just about every gradation in between. The Lowdown has a pretty good overview here.

At it’s most simple level — purely black and white — the idea of sanctuary cities being harmful can make some sense. If someone is breaking the law they should be punished and deportation is the punishment for being being in this country without the proper documentation. We live in a world, however, full of vibrant colors and each of those colors has an infinite number of shades. Anyone who feels this issue is simple, or black and white, has no understand of the myriad interconnected ways that it affects cities who have adopted the sanctuary, or “Fourth Amendment,” moniker.

Completely ignoring the unfunded mandate part of this argument (which is probably the most legally compelling argument for the continued existence of sanctuary cities), and the fact that immigration makes the United States less dangerous, and the fact that sanctuary cities are safer than non-sanctuary cities, there is another compelling argument for the continued refusal to cooperate with ICE:

Sanctuary cities save lives.

While I’m sure there are myriad other ways that the above statement might be true, I’ll be writing from a purely public health perspective.

Cities the world over depend on public health to flourish and grow and survive. With so many people packed on top of each other, breathing the same air, drinking the same water, eating at the same places, sharing germs, good public health saves lives. Good public health, however, doesn’t happen in a vacuum. Public health practitioners depend wholly on cooperation with their charges, with the public.

Imagine two scenarios. One in a sanctuary city (say, Philadelphia), and one in a city that detains any undocumented immigrants they find with the intention of deportation (say, Miseryland).

In Philadelphia, a young woman, June, falls ill. She is feverish and coughing. She has a rash. Because of the world we live in these days, we’ll even say she doesn’t have health insurance and lives in a one bedroom apartment with the four other people in her family. She’s a server at a local restaurant. She’s also an illegal immigrant. She goes to one of the eight government-run primary care Health Centers in the city. The doctors there quickly diagnose her with measles and implement isolation protocols, keeping her away from her four-month-old niece who was living two doors away in the apartment building. Little Sally, who’s too young to be effectively vaccinated against measles, never gets it. Neither does the immuno-compromised fellow who comes into the cafe where she works. The Health Department stops by the apartment building and does contact tracing of the other thirty people living in the building, ensuring that the disease doesn’t spread any further. (And because of the city’s liberal sick time law, June is even able to make rent this month.)

In Miseryland, a young woman, May, falls ill. Her situation is similar to our friend in Philadelphia, except she doesn’t go to the local Health Center because she’s also in the country illegally. She’s feverish with a cough, and her rash is spreading. Because her family does not have all of their vaccinations, the measles spreads throughout her apartment. Little Sally, from down the hall, catches it, is admitted to the hospital and dies. That wonderful older man at the cafe? He dies. May’s little brother spreads the disease like wildfire through his school, with every child who is under-immunized or not at all immunized getting sick, some even being admitted to the hospital. They, in turn, spread it to their families, and very quickly, you have an epidemic the likes of which we haven’t seen in the United States for decades.

Why didn’t May just go to the doctor? Because if she did, she would be detained. Investigated. Her whole family, at best, wondering where she’d gone, shipped back to a country she hasn’t seen in a decade. At worst, her entire family uprooted and sent across the ocean. Her landlord, with an empty apartment, or several. Her cafe, down a server, or several.

It’s called a chilling effect. When something stops someone from taking an action because they are scared of the consequences. May didn’t go to the doctor because she was scared of the consequences. The consequences in May’s mind were very real, being deported. The cascade effects of her illness were more abstract in her mind, but are no less real.

The thing to be terrified of is that the actions that will keep folks from seeking care when they — no, when WE — really need it, are already happening. Two instances came through the wire this week alone. Luckily they weren’t of the infectious type, but they don’t need to be. They just need to make folks think that they might get in trouble from approaching the authorities.

And public health aside, both of these cases will cause people to die.

Six men were taken into custody after leaving a hypothermia shelter. People will refuse to go into hypothermia shelters in the future, and will freeze to death.

A woman was taken into custody while in an El Paso courthouse while seeking a protection order from her abusive boyfriend. The man who turned her in? The abusive boyfriend. Open season on terrified women. You like to beat women? Start dating an undocumented immigrant. You can beat her black and blue and she can’t go to the cops for fear of being deported. This will happen. Women will die.

Sanctuary cities save lives. They stop epidemics before they start. They make sure that abusers get the justice they deserve. They allow the least among us to sleep at night.

Is the system perfect? Of course not. Can violent criminals game the system to continue to commit crimes? Of course, but that happens anyways. But at least when undocumented immigrants can feel safe, they can make sure the rest of us actually are safe.

Sanctuary cities save lives. Even threatening political punishments for cities that care for their residents creates a chilling effect that kills people.


National Park Service Safety Hamstrung by Trump Administration

UPDATE 1/21/17: apparently the ban on National Park Service tweets has been lifted. If so, this is a good move. Though, the fact that we had even discuss this…

ORIGINAL: I grew up in digital crisis and emergency risk communication. I am some sort of expert in what to say when things go sideways, at least online. And when I say go sideways, I don’t mean like when nobody likes your Facebook post. I mean like when there is an active shooter, or a terrorist event, or a natural disaster or disease outbreak.

I’ve written plans that tell government agencies what to say when websites crash and hordes of media are bashing down the door. When people are hurt and scared and desperately trying to figure out what the heck is going on. I’ve trained dozens of communicators on what to post when they don’t know what to say and they don’t even know if their own people are safe. How to project calm, and openness, and safety on Facebook. How to save lives with a tweet.

If all you are used to seeing on your feed is this morning’s breakfast and kids and memes, this might seem outlandish, but it can work. It does work. Think about it: where do you get your news? When something happens, where do you turn? When do you check your Facebook in the morning? Is it first, or second? Where do you go to see if your friends and family are safe after a big storm?

Emergency management agencies, police departments, public health departments, fire services all across the country, and indeed around the world have adopted the standard of posting to social media early and often as one of their primary response duties. This is standard today. This is best practice. This is the bare minimum agencies should do.

And a major, massive government agency cannot do that anymore.

In one of the first actions of the newly-installed Trump Administration, in response to two admittedly inappropriate tweets, has apparently banned all National Park Service Twitter accounts from posting. The blowback from the White House from this was swift and thorough:

We have received direction from the Department through [the Washington Support Office] that directs all [Department of Interior] bureaus to immediately cease use of government Twitter accounts until further notice.

Please ensure all scheduled posts are deleted and automated cross-platform social media connections to your twitter accounts are severed. The expectation is that there will be absolutely no posts to Twitter.

On its face, this seems like overkill and probably not that bad. Maybe a bit childish. So some huge parks out west can’t tell you about ski conditions today. But the NPS, for all of the beautiful vistas they publish online, aren’t just backwoods country. They are places like Independence National Historical Park in Philadelphia, site of the signing of the Declaration of Independence and the Liberty Bell; places like the Statue of Liberty in New York City, one of the premiere tourist attractions in the nation; places like the National Mall in Washington, D.C. Places that are so-called soft targets. Places which sit at the top of every terrorist wish list. Places where danger is constant, vigilance is eternal, and being able to give up-to-the-second evacuation or shelter-in-place information could quite literally save lives.

And now they can’t use the tool that is guaranteed in the first two or three things that their crisis communications plans says they should do. The best practice that is being proven over and over again in disasters to be the right thing to do to protect people. Hamstrung because of two errant tweets and a wild overreaction.

The email to NPS employees even acknowledged that this would affect safety and security:

PWR parks that use Twitter as part of their crisis communications plans need to alter their contingency plans to accommodate this requirement.

The email, posted by Gizmodo, makes no mention of the expected duration of this ban, any recommendations on how to issue safety and security warnings if needed, nor any planning process to ensure errant tweets don’t happen again. Just stop using it.

The, “hope you don’t need it,” is implied, I’m guessing.

I hesitate to call this bad policy, because it doesn’t even approach the level of policy. It is unsafe, dangerous, and goes against best practice that has been established and vetted around the world.

What Is It, You Would Say, You Do Here?

The title of this post is obviously the classic line from the 1999 flick, Office Space, and has come to define so much of how we understand what happens in industries that we don’t understand. We gaze over the tops of rows upon rows of light gray cubicles in back offices in office parks in suburbs from sea to shining sea, and wonder how many of these people are actually working. How many contribute to the bottom line and, conversely, how many get paid to take orders from the customers and pass them to the organization’s doers?

In private industry, we dispassionate observers can forgive some of the organization’s “people persons” taking up space because the company is still making money (or else, we’re told, they would quickly be out of business). We don’t know exactly what it is they do, but somebody in charge has a need for them, and in the black box of business, that’s acceptable.

But, what about in government? Remember, in government, they work for us, we pay their salaries, dammit! So when we peer over the slightly (or not-so-slightly) out-of-date light gray cubicles full of government workers, is our reaction as forgiving? Are we as dispassionate as observers? What the hell are they all doing?

Okay, sure, I’m not talking about the cops or the firefighters. Or the DEA, or the nurses, or the letter carriers, or the drivers, we get their jobs. They are government widget-makers. They do an easily definable thing that has an input (salary and benefits) and an output (criminals in jail, mail delivered, fires extinguished).


But, the rest of you, you government workers. What is your job about? How much solitaire have you played today? If you’re all done screwing up, why haven’t you started providing the rest of us with an easily quantifiable, tangible thing that we can point to and say, “Your job is productive, you may stay.”

As a government worker with a very ill-defined job in the very poorly-understood field of public health, I’ve been promised that when the pitchfork-wielding anti-government head hunters come calling, my office is near the top of their itinerary. I’m no nurse or doctor, my car doesn’t have flashing lights or sirens, there aren’t really any concrete answers to the problems that I work on. Squishy is how I define my job. Relativistic.

But. It’s important work. And so is all of the work that my colleagues do. The accountants and human resources folks. The epidemiologists and sanitarians. The record keepers and front-line office staff. And it’s not just in public health, the same bias of assuming that government office workers are somehow less acceptable than private industry office workers permeates us all.

After all, they work for us, and what they do isn’t easily understood. Isn’t tangible. Every time a news story comes out about government, it’s about hours wasted online, loads of laundry done, work NOT done.

Where are all the stories about what’s gone right? The stories about the kids who don’t have asthma because we’ve cleaned up the air? The stories about the disease outbreaks that never get started because everyone is vaccinated? The stories about the restaurants that are closed before a single person spends two days moaning, a vomitous mess, on their bathroom floor?

Where are the stories that detail the epidemiologist seeing disease trends shift to a new zip code, which prompts the department to shift their condom giveaway program and six months later sees the incidence of those STDs drop back to normal?

They don’t exist. This isn’t to say that positive government stories don’t exist, they do. But they are overwhelmingly about some fancy new initiative. And if you can interview a twenty-something-year-old who’s applying private industry techniques to government work, it’s that much easier. But nothing about the day-to-day slog. Nothing to combat the negative stereotypes that so many of us hold.

So, this means that if government workers want their story told, they need to realize that no one but themselves will do it. The only chance to fight against negative stereotypes and work toward rebuilding their image lies in doing it themselves. Because thy’re government and they can’t count on some fancy PR firm to come in and spruce things up. (Unlike private companies can.)

This is an image rehab that won’t be conducted with a slick mass media marketing blitz, but instead will be successful only if one person sees the value in the work being done, and helps convince a friend. It will be done slowly, and at no cost, and not consistently, and often not well. But it will be done. It will be done, or those lactation consultants won’t be around much longer to ease new mothers fears, and those inspectors won’t be there to make sure the public pool is clean enough to swim in (if there even is a pool still).

So, what about you? Are you that person that sees value in the work that faceless, nameless government automatons do? Have you said anything to your friends about how they’ve kept you safe? Or are you just waiting for it to get really bad before you start helping?

Social Media Stats are Useless

I do social media all day.

Which means that all of the myriad social networking support groups and blogs and websites and feeds that I follow each come out with their annual statistics on the size and scope of social media and what trends are coming and who’s swinging the most wood after raising Series C funds. And there’s usually a drop-shadow-less infographic that tells me some tip about how to make my pins more pin-tastic and that 65.4% of all B2B partnerships thrive due solely to LinkedIn conversations.

And I read them all. Because it’s my job.

And I’ve yet to glean ANYTHING useful out of them.

1,440,000,000 people on Facebook. 77,600,000 Instagram users in the US. 4,000,000,000+ views on YouTube every day.

Lovely. Wonderful. But what does that do for my organization? Nothing.

The problem comes down to the maturation of social media. When the field was young and needed to prove itself, it sold eyeballs. How many people can see your posts!? Follower counts were like gold. Every time the “Facebook nation” rose up the ranking list of most populous countries, we forwarded those stats to our executives and pleaded to stop being kept from the promised land.

But now, when I post to Facebook, when I want to talk to the 3,876 people who have taken a half a second to click that happy thumbs up icon on our Page, when I have something that could potentially save their lives, their health, their humor, and/or their sanity, I’m lucky if 387 people ever see that post.

Sad Clown Mark Holthusen Photography. Photography by Mark Holthusen

Maybe I’m not as funny as I think I am. Maybe not.

Today, though, I’m not concerned with how many people could see my posts. Telling me there are 15,000,000 pairs of eyeballs out there waiting for my posts doesn’t do anything for me. Because I know 15,000,000 pairs of eyeballs aren’t waiting for me.

What’s waiting for me are the twenty people in my city that are thinking about quitting smoking today. Or the 4,000 people that would be interested in free yoga on the Parkway. Or the 150 that need to be reminded not to leave their kids in the car because it’s 95 degrees out.

We need new metrics on engagement and interaction. We need new advice for today’s social media. So I call on you, Social Media Expert/Maven/Ace/Superhero Person/Group/Blog (honestly, I tried so many combinations there, but they’re all already taken by real people)! Instead of selling us on how to get 10 zillion views using your One Simple Trick! on social media, help us learn how to find the right people and get the right people to ENGAGE with our social media.

Until you guys start doing that, I’m swearing you off. I’ll make my own damn social media best practices that work for my audience.

Do It Slow

Nina Simone is more than one of my favorite musicians; she was an absolute treasure, one of America’s finest exports. One of her most famous songs was famously performed at Carnegie Hall and it happened to be one of her more political songs: Mississippi Goddam.

Written in response to the Medgar Evers murder, Ms. Simone railed against the black establishment and their admonitions that equality takes time, to “do it slow.”

But that’s just the trouble
“do it slow”
“do it slow”
Mass participation
“do it slow”
“do it slow”
Do things gradually
“do it slow”
But bring more tragedy
“do it slow”
Why don’t you see it
Why don’t you feel it
I don’t know
I don’t know

Her frustrations are real, and I believe, completely justifiable. Medgar Evers was one of the rising stars of the equality movement, and a real American hero to boot. To accept his murder was to accept that black folks were little more than cannon fodder in the larger battle.

Now what the heck does this have to do with public health? Only everything. Because of a media article on one of the studies in the April edition of the International Journal of Obesity, the one on environmental affects on obesity. (I’m not writing the name of the study because it’s completely unreadable to real human beings.) The folks at The Salt, an NPR program on food and eating, covered that part of the study that focused on how food was stored in the house by talking to the lead author and soliciting comment from other public health researchers.

The upshot was that there is a real correlation between how food is stored in the home, and how fat the people who live there are. If you’re obese, it’s more likely that you’ve got food, like snacks, sitting out. It’s likely that that food is placed in the obese person’s favorite spot, like by the couch, or in the bedroom. The authors theorize that unhealthy snacks placed by a mindless place (like in front of a TV), makes them more likely to be consumed mindlessly, leading to or contributing to the person’s obesity. Skinnier folks tend to have food stowed away, and have less of it on hand.

Seems pretty simple, no? And not really a bad piece of advice, to boot:

If you’re looking to lose weight, don’t leave unhealthy food sitting out, where it’s easier to snack on.

But! Very August Public Health Thinkers tell us, “do it slow!”

James Hill, a physiological psychologist at the University of Colorado, says, “All [Emery’s study] does is point out a few things that seem to be different among people who are overweight and people who aren’t.” The NPR article attributes the idea that leaving a bag of chips by your favorite armchair doesn’t necessarily mean that habit will lead to obesity, just as being obese might not lead you to have chips by your side, to Dr. Hill.

Hill says that we shouldn’t be doling out advice based on these correlations, saying it “would be a mistake.”

Because heaven knows we wouldn’t want people to put the damn chips away!

Dr. Hill (whom I hold no enmity against; I’m sure he’s done tons of good work), and his Very August Public Health Thinker pals, ascribe to the idea that we shouldn’t be advocating for people to make changes to their lives until we know for sure that making a very specific change will provoke some specific, measurable change. Evidence-based, we call it.

Go slow! Until we have evidence!

Did Ms. Simone, when railing against the leaders in the fight for equality, counsel for us to wait until we have evidence that things would work out? Or did she simply point at the dead bodies and yell, “Shame! Despicable!”

Well I can do that, too. I can point at JAMA, AJPH, RWJF and the Trust for America’s Health, the US Surgeon General. I can point at the bodies. The millions of dead Americans and yell, “Shame! Despicable!” How dare we wait to tell people to put the chips away; wait while we search for funding for a study to prove that a bag of chips on your nightstand isn’t a particularly good idea.

This isn’t to say there isn’t a place for evidence-based recommendations. The cottage industry of academic research (and it is an industry) is safe. But this? Why isn’t this a full-throated recommendation? Why do we equivocate and delay and hem and haw and call for more study? Why do we wait while the cannon fodder of this war on obesity continue to be mowed down?

There is a place for common sense in public health. There is a place for good enough. There is a place to err on the side of the public. There is a place for public health on the mountaintop, shouting. To be unequivocal. To be an advocate. To be political. To be argumentative.

To not go slow. To stop the flow of bodies.

Public Health is Boring

There’s a great post by Dr. Kumar over at Healthcare and Public Health directed at public health mavens. I’m not sure what a public health maven is specifically, but I’m willing to bet that anyone who reads a blog post proclaiming, “public health is boring,” probably fits that description. So you’re in the club, too.

View story at

Dr. Kumar says that public health’s message is important, but it gets lost. No, scratch that. It doesn’t get lost, it gets ignored. He asks:

So why don’t we, the general public, really hear your message?

I posit that the answer is simple: public health is boring. And I say that as someone who has worked in public health for more than eight years. As someone who holds a senior-level position in a health department in a major city in the US, and who is charged with communicating public health to the great masses. I have quite literally seen the enemy, and he is us.

I know that we’re boring because I’m complicit in it. I run our website. (BORING.) I manage our social media accounts. (SNORE.) I regularly review public education materials. (YAWN.) And doing those things makes me look like I’m in the top five percent of most UNboring public health workers. At least to other public health workers.

The thing is, though, that of everyone that I work with, I literally am THE MOST BORING PERSON THERE. I do nothing. I create nothing. I save no lives. I play around on Tumblr and hit the RT button with alarming alacrity.

Others here teach women how to breastfeed, saving their already poor families thousands of dollars and hours of time. Others track down insidious bugs that prey on the weakest among us, killing indiscriminately. Others are healthcare providers of last resort. Kill disease-spreading mosquitoes. Monitor the very air we breathe. Give vaccines. Help people quit smoking. Help people get health insurance. Shut down unsafe restaurants. And then train the people that work at those restaurants how to do it safely in the future. You want heroes? I can’t even count how many we’ve got.

So how, when you take all of those stories, all of those heroes, can public health still be seen as boring?

It’s easy, I’d argue. It’s because we’re an insular, disconnected field that talks to ourselves. Masturbatory, one might say (and yes, the public health double entendre is intended). Dr. Kumar lays it out so well:

The message of public health is not reserved for academic settings. It’s not just for conferences or journals. And it’s not for public health experts.

And yet.

Have you looked at public health outreach and education materials? Websites? Social media accounts?

Who are they written for? Even if you avoid the dichotomous groupings, general public versus gentrified academics and place these materials on a continuum, almost without fail more will fall on the academic, BORING side.

The reasons we’re boring are myriad and long-standing. First up is our field’s fetishization of John Snow. Additionally, we’re gun-shy thanks to a big miss in disease forecasting way back in 1976. AIDS played a role, and now age is slowing us down even further.

First things first. John Snow, father of epidemiology. Famous for removing the pump handle from the Broad Street pump to help hasten the end of a cholera outbreak in Soho, London in 1854; his map of confirmed cholera cases in relation to the public water pump is widely considered one of the first examples of using data to convey information about disease spread. He’s our rockstar. He’s our reason for being. Wind beneath our wings and all that.

I find no fault with Dr. Snow. He was a smart man (and a smart dresser) who did something innovative and world-changing. My problem, though, is that public health, as a field, has seen his success and tries to emulate it. Exactly. We collect data. And present it (sometimes even in map format). And then we wait for our decision-makers to emulate the St. James parish authorities and heed our advice, removing the pump handle. Dr. Snow’s data was powerful enough to stimulate action. As we feel our data should be. Instead of taking time and making effort to make our data digestible and understandable, we still want to put on our John Snow jammies and cape and save the world, just like he did, marketing be damned.

Then 222 years later, on the other side of an ocean, we freaked out about some pigs. Well, maybe freaked out isn’t exactly right. But that’s the way the public remembers it (those few who actually do remember it). For those of us who don’t remember it, in February 1976, four soldiers at Fort Dix, New Jersey were hospitalized with a novel type of influenza A (H1N1). One of the soldiers died. And public health authorities, knowing that it had been more than a decade since the last influenza pandemic, sounded the alarms. Between October and December of that year, more than 40 million Americans were vaccinated against this swine flu. Including President Gerald Ford:

But there were problems with the vaccine. The most notable were cases of Guillain–Barré syndrome as a side effect. The vaccine program was halted in December because of the GBS. All told, about 500 cases of GBS were blamed on the vaccine, with 25 deaths. The flu? One death, out of 20 sick.

One of the biggest lessons learned from that episode was for us not to get too excited about things. Slow down. Disease forecasting is an inexact science, at best, and when you mess up and people die, you naturally get gun-shy. This isn’t particularly a bad thing, but it’s another reason why we don’t get all excited and excitable about our work.

A few years later, as a new disease known as the 4H disease (homosexuals, heroin users, hemophiliacs, and Haitians) became GRID (gay-related immune deficiency), and finally became known as AIDS. The stigma associated with the disease, and the fact that this was primarily a public health concern lead us to further internalize our desire to stay out of the news and away from trumpeting our work. Far from there being no benefit to our crowing about our work, doing so could now very much harm people.

Today it’s not so much high-profile failures that keeps public health from standing proudly and tell the world what we do, it is our demographics. We, as a field, are old(er). In 2008, it was anticipated that 250,000 new public health workers would be needed by 2020 to replace retiring employees. What is implicit in those figures is that retiring employees are usually old. And, research has shown us that as we age, we become more risk averse. We avoid new things, we shy away from innovations, we cringe when some young punk comes in and says we should be more open about what we do.

The combination of all of these things, most good, most natural and expected, is a toxic soup that shields public health from the public. Allows our messages to be ignored. So maybe it’s not that we’re boring. Maybe it’s that no one knows that we exist outside of our boring charts and graphs and walls of text written at a twelfth grade reading level in journals that charge to read those words and on websites that are nigh inscrutable (and don’t render on smartphones). We still have public health messages, and we still publish innovative thinking and ideas, we just don’t do it in public. Thinking back to Dr. Kumar, his quote comes into play again:

The message of public health is not reserved for academic settings. It’s not just for conferences or journals. And it’s not for public health experts.

Except that that’s where we talk. And that’s who we talk to. And that’s where we tell our stories.

And that’s a real shame, because today, more than ever in the history of the world, we have the ability to tell our stories in an unfiltered way thanks to things like social media. We don’t have to depend on the mass media to pick up our message and hope they get the word out. We don’t have to hope that the right someone is in the right place when our tri-folds are placed on a folding table. We don’t have to be boring anymore.

But, the fear. The risk aversion. The once bitten, twice shy. The particularly not-bad idea of, “let’s not over-hype everything.” Those things still exist. Those things still make public health boring.

But they need to stop. It’s okay to be nervous, we all know that the internet is forever. But until public health, as a field, gets over those fears, we will continue to be shouted down by those who understand that the permanency and virality of the internet and social media is useful to their cause.

We must compare how our field communicates with the Jenny McCarthy’s and the Dr. Mehmet Oz’s and the other modern-day snake oil salesmen who are exciting and easy to find and easy to understand and whose ideas are easy to share with our friends and family. When we do that, then we will see how we have been found wanting. And then, I believe, will we finally understand the answer to Dr. Kumar’s original question:

So why don’t we, the general public, really hear your message?

Public health, as a field, needs to undergo a radical realignment and re-envisioning of how we communicate. The status quo is not just, “not good enough,” anymore, it is now harmful.

So where do we go from here?

Students, administrators, public health mavens: enjoy your biostats classes, and your program eval classes. Understand and embrace the social determinants of health. And then take all of that knowledge and then don’t talk to another public health person for an entire year. Don’t mention an odds ratio or the transtheoretical model during that whole year.

Instead, take that year and learn how to use Instagram. Learn to code. Understand what lead generation and conversion rates are, and how to track them. Like Coca-Cola’s Facebook Page and steal all of their good ideas. Become a guerilla marketer. Blog, tweet, Vine. Learn how to tell a story. Learn how to sell.

Then, come back to public health. Take all that you’ve learned and teach public health how to not be boring. Pull us out of our doldrums and circle jerks and poster presentations. Give us our pride back. Make us cool.

…and heard.

Rethinking Government Communications

Communicating today is tough for anyone trying to do it. It used to be easy. Craft a message in a pre-approved format (inverted pyramid, anyone?), then give it to pre-approved people, then Miller Time. Today? Not so much.

Lots of us still do it that way, though. And in lots of cases, it’s not because we don’t want to do more. Or be more targeted. Or take advantage of all of the new avenues of communication. It’s just that we already have full time jobs, and inadequate staff, and not enough money. (Welcome to government, my friend.)

Adding Facebook to our portfolio was a tough enough sell. Now you’re telling me that Medium is another thing to add, and I need a Meerkat, too? And I’m going to sell the idea of a live-streaming rodent to my bosses exactly how? It sucks, no doubt.

The real problem, though, isn’t that we aren’t doing these things. We’re providing the level of output that we’ve always done, and have done successfully. No, the real problem is that others are doing these things, going the extra mile.

You think I’m joking about Obama? Hardly. He really is the problem. At least for overworked government communicators. The White House today is setting the stage for how government can communicate, and pretty soon, the rest of us will be expected to do the same.

With that in mind, you can see the looming conflict between government capacity and public expectation. We will be seen as failing our constituents for simply doing what we’ve always done, even though we haven’t been given the capacity to meet those increased expectations.

The solution is easy to see; it is harder to do. It is basically us adopting this new worldview and adapting our work to the expectations of the public. How I imagine it will happen will look like a diffusion of innovation curve.

Our innovators are the folks on the CDC social media team, at the White House, and at NASA. Early adopters are just now starting to learn how best to create media. The rest of us, though, while we’re usually perfectly happy to be part of the early or late majority, are in danger of falling out of step with the public. If we haven’t already.

What’s needed, then, is a radical reimagining of how small, traditionally underfunded government agencies present themselves to the world. That S-curve up there won’t help. The how, again, is perplexing. How do you change everything in a field that is almost completely hesitant to change?

How about this: if you can’t change the end result, instead consider changing the process. If we can’t expand dedicated communications staff to meet the expanded communications burden, why not expand the definition of our communications staff? Why not decentralize a lot of the day-to-day social media work to those best placed to tell those stories? Yes, let regular employees get online and tweet and livestream and give the public a view into what goes on in their agencies’ work.

Scary? Absolutely! But, given the choice between being completely out of touch with our audiences, and having non-communications people talk about what they do everyday… Well, which is really worse in the long run? The details and rules and training definitely need to be worked out, but given how quickly we can lose the ear — and trust — of the public, isn’t it worth the risk?