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Sarah England spent a fellowship working with Senator Hillary Rodham
Clinton on public health policy. |
When I was granted my PhD, I
thought that running a research laboratory at a top-tier university would
fulfill my professional aspirations. However, after heading my own research
program for eight years, I became interested in pursuing opportunities that
would complement my career. In the fall of 2004, I received an announcement
for the Robert Wood Johnson (RWJ) Health Policy Fellowship (http://www.healthpolicyfellows.org/home.php),
which offers mid-career health professionals the opportunity to work in a
congressional or executive branch office in Washington, DC. The overall goal
of the program is to enrich fellows’ understanding of public policy
practices and how government health research relates to the mission of the
fellows’ institutions and local communities. After researching more about
the program, I decided that this experience would increase my understanding
of the legislative process and the relationship and interactions between the
National Institutes of Health (NIH) and Congress that affect my day-to-day
existence as a researcher in the basic sciences.
I was selected to be a member of the class of 2005–2006 along with five
physicians and one epidemiologist. Before accepting and pursuing a
fellowship of this nature, it was essential that all the stars aligned
correctly—I would be on developmental leave for 12 to 16 months. This
required support from my institution, most importantly from my department
chair and college dean, both of whom were open-minded about this atypical
sabbatical realizing that this would not only benefit me, but also my
institution.
Prior to embarking on this adventure, I was fortunate to have senior-level
research staff in my laboratory capable of continuing on in my absence. My
grants were all funded and not up for a renewal the minute I walked back on
campus. I was able to pack up and leave with relative ease; however, there
were many personal factors to consider. Some of the fellows relocated their
entire families, some brought just their spouses, and others traveled home
every weekend. Logistically this is different for each fellow.
In September 2005, I moved to Washington DC to explore my interest in the
intersection of health and educational policies as it relates to training
students and eliminating health disparities. After a three-month orientation
that included meeting with representatives from think tanks, trade
associations, the Institute of Medicine, and key health policy gurus, we
interviewed for positions on Capitol Hill. At this point the experience
seemed surreal, as I never imagined when I got my doctorate that I would
work on Capitol Hill focusing on health-related legislation. We were
interviewed by members of the House and Senate, Democrats and Republicans,
and personal offices and committees; a few fellows interviewed in the
executive branch. After many hours of discussions with health staff and the
other fellows, I accepted the offer to work with Senator Hillary Rodham
Clinton on her health legislative team.
Moving from academic researcher to working as a health legislative fellow
had some distinct challenges. The biggest was moving from being a specialist
to being a generalist. I was accustomed to knowing intricate details about
my academic research into the mechanism by which potassium channels regulate
uterine and vascular smooth muscle. However, when juggling a dozen issues,
one realizes that it is important to have a broad working knowledge on
multiple subjects rather than a detailed understanding of a single topic. My
portfolio was expansive and included health care workforce, NIH
reauthorization, maternal child health issues, rural health, medical
liability, women’s health, health disparities, and nursing issues, to name a
few. The learning curve was very steep, but not impossible. With the large
volume of information available on each topic, trying to stay current on all
issues took a lot of energy. Many times some specific aspect of each of “my”
issues would surface during the year and there hardly seemed to be ample
time to know all the details about it.
There is no “typical” day in the Senate. I met with constituents from New
York, drafted legislation, attended Senate and House hearings and briefings,
wrote scholarly articles, prepared speeches, statements, and briefing memos
for the Senator. I also traveled to New York to attend an event and staff
the Senator on one of the issues.
The largest portion of my time was spent drafting three pieces of
health-related legislation: 1) The SHINE Act (Screening for Health of
Infants and Newborns) was developed to help states increase their newborn
screening capabilities so that all babies have the opportunity for early
diagnosis and lifesaving treatment; 2) The GEDI Act (Gestational Diabetes
Act) focuses on lowering the incidence of gestational diabetes, which puts
women at risk for complications during childbirth and puts children at risk
for developing Type 2 diabetes as adolescents or adults; and 3) The Nursing
Education and Quality of Health Care Act (NEQHC), which was drafted with the
hopes of increasing the number of nurses who become faculty and developing
initiatives to integrate patient safety practices in nursing education; it
also provides funding for rural nurse training programs.
As I participated in the development of health-related legislation, I gained
greater perspective about how my research fits into the bigger picture. For
instance, my research at Iowa focuses on the basic science of premature
labor. During my time as an RWJ Fellow, a bill was being considered about
the high rate of premature births in our country. The bill was signed into
law in December 2006, allowing me to see the tie between basic science
research and legislation. I also learned the value of advocacy and how far
an issue can proceed based on the passion of those affected by the
legislation.
My fellowship also gave me a broader understanding of how the federal
government makes decisions about funding the NIH and other organizations
that provide grants to researchers. One of my assignments was to research
NIH reauthorization, and it opened my eyes to the difference between
authorizing and appropriating funds. I tracked the NIH reauthorization
through the House and became entrenched in the process of how NIH is
structured and funded and how the budgeting process works. Working in the
minority party last year in Senator Clinton’s office allowed me to learn
that policy and politics are very different things. Most of the health
legislation that I helped develop and worked on throughout the year was
bi-partisan, with the senators often wanting the same things, though their
ideas about implementation were different. Knowing at the onset that
differing views were held by the different players made the process easier
and enhanced my negotiation skills.
While government is a very different environment compared to academia, there
are many parallels. Much of my research on a policy topic paralleled my own
academic research methods, including delving into the problem, identifying
key issues, interpreting data, and suggesting solutions. I also worked with
a talented and collaborative group, not only in the Clinton office, but also
in many other congressional offices. The health issues I addressed crossed
interoffice boundaries, much like the collaborative efforts within the
various colleges at the University of Iowa.
In summary, the experience was truly a once-in-a-lifetime opportunity that
gave me added skills and insight into both health policy and my own academic
position, and I encourage scientists and physicians who are interested in
policy to explore these types of opportunities.
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