2010 APHA Public Health Fellow in Government  

Craig Mosbaek, MPH

Working for Congress in 2010 was a unique, fascinating experience. It was politics at the highest level, a year of historic legislation, and a learning opportunity will cherish forever. Here are my main take aways from the year I spent working for Congress.

The good news is that public health and prevention are gaining momentum. There is a growing appreciation in Congress for the value of public health in reducing long‐term healthcare costs, and polling is showing thesame understanding among the general public. You know the prevention message is taking root when people use it as a metaphor.  

Senate Majority Leader Harry Reid used the prevention metaphor to support the financial reform bill when he said, “Wall Street reform is preventive care; unemployment insurance is emergency care.” (http://www.nytimes.com/2010/07/14/business/14regulate.html) 

Although the major focus of the Affordable Care Act is to increase access to health insurance, it has a number of important public health provisions. The bill includes mandatory funding(eventually $2 billion annually) for the Prevention and Public Health Fund, which is being used to accelerate community‐based prevention activities around the country. The bill also requires chain restaurants to implement menu labeling.  

I took particular delight in this provision since I had worked on the passage of menu labeling in Multnomah County (population 700,000) and then the state of Oregon (population 3.8 million). These and other victories at the local level helped spur passage of this policy for the nation (population 300 million). As a Hill staffer said, good ideas don’t start in Congress, it’s just the place to take them to scale.

Politics is about people. Whether you work at the county, state, or nation levels, you need tohave people skills. Political power is garnered by building relationships with people and having the ability to influence others. I didn’t learn this in epidemiology! 

One thing I appreciate to a greater degree after my year on Capitol Hill is the importance of understanding people’s motivations and deciphering what they really think. And, in this intensely political environment, one cannot always obtain such an understanding by listening to the literal words people say. This understanding is critical to acting strategically and discerning how people are likely to respond in different situations.

There is a real dance between policy and politics. There is one set of analyses one does for policy development to try to determine the best policies for the country. And then, there is another analysis for political strategy and messaging, to determine the best tactics for getting a policy passed. The policy and political efforts interact, and the best strategists have a keen sense of the interplay between the two.

I learned these lessons while working in both a personal office and for a committee, and on both the House and Senate sides. The first half of my fellowship was spent in the office of Senator Akaka (D‐Hawaii) and the last part with the Health Subcommittee of House Ways and Means.   

The benefits of living in DC went beyond the fellowship work. The Capitol City has so much to offer, from rallies on the Mall to free museums, to history lessons past and present. And for West Coasters, we were able to more easily visit Philadelphia, New York City, Miami, the Maryland beaches, and Virginia countryside. We learned to live without a television or car. Our apartment was three blocks from the Bethesda subway stop and we took the Metro everywhere.

We are now living back in Portland, Oregon, happy to be close to friends and family though missing all the action of DC. Moving for a year took some planning and included some extra stresses. But, the experience was fantastic, and I encourage people to pursue this APHA fellowship or other similar opportunities.