Open Government is Public Health

I’ve sat on a fair amount of boards and committees over the past decade. I’m often the youngest, most technologically savvy, and probably the only one who actually enjoys Robert’s Rules of Order. Out of this, I have come to strongly believe that government transparency is essential to address most public health issues. I could argue that the Freedom of Information Act and related state laws (e.g., the Minnesota Government Data Practices Act – PDF summary) are the most powerful public health laws in existence. That’d probably be a pretty boring post for most people to read. Rather, I want to give two examples of (varying levels of) transparency in action from appointed positions I’ve held.

The Minnesota HIV Services Planning Council

The Minnesota HIV Services Planning Council is an appointed body that allocates all of the funding for Part A Ryan White Services and recommends funding for Part B Ryan White Services in Minnesota. In less jargony terms, they decide which services are most important for people living with HIV in Minnesota, and then fund those services using federal dollars. The Council is made up of around 30 people, including those living with HIV/AIDS (“consumers”) and those who provide services to people living with HIV/AIDS (“providers”). As an epidemiologist, I was appointed as a provider to their Needs Assessment and Evaluation committee.

So, it came time to do our needs assessment, prioritization, and allocation processes. This is the primary function of the Planning Council; we had spent over a year doing research and studies, preparing summaries, and sitting in long committee meetings. In this process, the Part A Grantee provides their recommendation, and the Council discusses, amends, and ultimately approves a proposal. This cycle, the Council approved the recommendation with little discussion, no amendments, and more than 2 hours left in the scheduled meeting. Members were excited to leave and get back to work/home/whatever, and patted themselves on the back for a job well done.

Then, there was a survey of Council Members about how they thought the process went. More than half disapproved. The Council staff members were quick to dismiss the results because “three of the responses came from the same IP address,” suggesting that foul play had negatively skewed the results. In reality, there are three Council Members (including myself) who work for the same hospital, and probably took the surveys from within the same network. When I asked what the IP address was, I was told it was not appropriate to ask that, and they would not be released out of concern for members’ privacy.

In response, I made a Minnesota Government Data Practices Act (MGDPA) request to the Hennepin County Attorney’s Office. The head of the Ryan White Program for Hennepin County called my supervisor to complain that I was consuming resources in filing my request, and suggested that I be disciplined [note: this is illegal]. The County Administrator called me to personally apologize. Months later, the data I requested was released, and I was proven to be right: the three surveys were all legitimate and, in fact, the majority of Council Members did not approve of how they allocated funds for HIV services.

As a result of my MGDPA request and data practices concerns, a County Attorney came to a subsequent Council meeting to discuss MGDPA and Open Meeting Laws. I followed up via email with the attorney, specifically outlining my concerns regarding the Council. He sent a follow-up memo. This was discussed at a Planning Council meeting (emphasis added):

Memo from County Attorney’s Office – Tim distributed a document from Dan Rogan titled HIV Planning Council. This document provides written answers to questions asked when Dan attended a Council meeting to talk about Open Meeting Laws. Questions/Comments:

Antonio Mo. asked about #4. Tim said we have always treated Council information privately. Because of the law we are required to provide the home address of Council members if requested. Current staff have never received this kind of request. The question was brought up around the Council roster which includes addresses, email addresses, and phone numbers.

Keith asked that Council member information being shared with other members be discussed with new applicants. Tim said this is discussed during the interview and in the application.

Loyal said a Google search of his name will bring him up on the Council website. He is disheartened that his affiliation with the Council is so public.

Mike B. asked that this document be posted somewhere so it can be referenced.

Adam asked if this can be addressed at Operations. Tim said yes.

Loyal is a good guy: very thoughtful, well-spoken, and respectable. He is not the only one on the Council with this concern (although, he may have been the only one with the guts to express it). It certainly is valid.

However, this concern epitomizes my issue and belief. Every time I vote on a matter, regardless of how seemingly insignificant, I want to be absolutely sure that I have a reason behind my decision. If what I say and do is publicly available, then I should assume that at some point somebody may ask why I said or did something. I’ve failed if my response is simply, “I voted for it because everyone else did.” In the same vein, my name and contact information being publicly available provides a means for this to occur — if nobody knows who I am or how to reach me, then they have little recourse in expressing their disagreement. So, for me, MGDPA and Open Meeting Laws provide an impetus to ask questions and, when appropriate, dissent in public meetings.

The Public Health Advisory Committee (PHAC)

The Public Health Advisory Committee for the City of Minneapolis hears concerns from citizens about public health issues, advises the Minneapolis Department of Health and Family Support (MDHFS), and distributes (with City Council approval) $400k in Public Service Community Development Block Grant (CDBG) funds. I serve as a Co-Chair of this Committee.

When it came time to distribute the CDBG dollars, we established a process, funding principles, and priority areas (PDF). We had a large community review process, and long discussions about the various needs of the community and what services would meet those needs. Ultimately, we came up with a proposal that the Committee (and City Council) felt satisfied with.

Of course, it’s never that simple. There were funding cuts, and our $400k dropped to $140k. The decision was thrown back to the Committee to decide how to absorb this cut. We returned to our principles, ranking, and discussions. Being reminded of what we originally thought was important, and remembering the desire to address socioeconomic determinants of health and health disparities, we (relatively easily) came to a conclusion as a committee about where to put our remaining dollars. It sucks that we didn’t have enough money to go around, but it feels good that we debated and considered almost every possible solution and ended up making a decision that seems fair and socially just given our constraints. I feel confident defending the decision to fund those specific organizations, and believe they will be able to make the most impact on the health of Minneapolis residents.

Open Government = Public Health

Most public health organizations strive to address socioeconomic determinants of health, eliminate health disparities, and (in general) help people be healthier. The Planning Council and PHAC both, to their own extent and in their own way, do that. However, in their last funding cycles, PHAC had a much more significant discussion regarding the needs of the community. The Planning Council essentially rubber-stamped a flat-funding proposal with barely any discussion.

The only way public health is going to identify and address the needs of a community are by talking to members of that community. That’s exactly why the Planning Council and PHAC exist. However, the Planning Council, in their creation of a privacy-centric public body, has created an atmosphere where few community members are willing and able to start or engage in meaningful dialogue. The result is a process that few are happy with, and a product that could only be improved. Neither of these results creates an environment where innovative policy solutions to health disparities and improvements to socioeconomic determinants of health can be created.

When a positive attitude towards open government and transparency is adopted, members let go of their personal privacy. If there is no personal privacy, then concern shifts from protecting information (e.g., “I don’t want anyone to find anything about me online”) to protecting reputation (e.g., “I want to make sure my statements and votes are accurate and consistent with my ideology”). If concern is primarily regarding reputation, then members feel compelled to seek out information and knowledge to make informed decisions about presented topics (i.e., an informed decision will, hopefully, prevent public criticism).

In order for public health to be successful, we need our elected and appointed leaders to engage in meaningful discussions about problems in our communities. For that to occur, we need a constituency informed and ready to hold public officials accountable. Information only comes when the public has access to data, and that can only occur when the government is compelled (willfully or legally) to provide it.

That is, public health can only succeed within an open and transparent government.