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Developing a Plan for Getting Community Health and Development Issues on the Local Agenda

  

Main Section

 Contributed by Phil Rabinowitz Edited by Val Renault

What do we mean by getting community health and development issues on the local agenda?

When is the best time to try to get issues on the local agenda?

Who should plan for getting issues on the local agenda?

How do you develop a plan for getting issues on the local agenda?



The Community Health Clinic had just done its annual review of cases. In past years, the review had shown a familiar array of childhood illnesses, diabetes, problem pregnancies, hypertension, and a range of minor complaints, with the odd case of meningitis or cancer. This year, however, the community seemed to be experiencing an epidemic of childhood injuries. A surprising number of small children had fallen down stairs or been hit by objects thrown by other children, or had fallen off of playground equipment.

A large number of these "accidents" were diagnosed and reported as possible signs of child abuse. When the review revealed the number of these incidents, staff members grew concerned about the magnitude of the problem. Their concern increased when they talked to staffers at the hospital emergency room, and found that their child abuse statistics for the past year had also jumped dramatically.

Times were hard in their community. A major plant had closed down, and many people were either out of work, or traveling long distances to work for lower wages than they had earned before. The stress of financially strapped parents might be taking its toll on the community's children. This was clearly an issue that had to be dealt with quickly. It was only a matter of time until a child was killed or permanently injured.

Most folks in the community had no idea that the problem existed, however. Those who dealt with it every day - clinic and hospital personnel, alert school staff, some mental health providers - wanted desperately to see child abuse discussed and addressed in the community. They had to find a way to get it on the local agenda as a critical issue that the community had to face.

Chapter 4 is about bringing issues to the public consciousness and putting them in a position to be attended to. This section describes how to plan for informing people in a community about an issue and persuading them of its importance. Other sections in this and the next chapter look at specific strategies you can use to get the job done.


What do we mean by getting health and community development issues on the local agenda?


The local agenda, as we use the term here, refers to whatever a community sees as necessary to address. Some of those things - road repair, or painting public buildings - may be unrelated to health and community services, while others - local financial support for child care, needle exchange programs, public-private cooperation to stop youth violence - have everything to do with them.

As you might guess from the introduction - or know from your own experience - getting issues into the minds of the public, officials, and policy makers is not a simple matter. Depending upon how much they already know (often nothing at all), there are several steps to go through, and each takes time.


1. Educate people about the existence of the issue. More often than not, citizens and officials in the community either don't know the issue exists at all, or are convinced that it couldn't possibly exist in their community. The first step in getting it addressed is raising public consciousness about it.

The director of an adult literacy program often spoke to community groups about the work of his organization. He would invariably begin his presentation by asking how many people in the audience knew an adult who couldn't read or write very well, or at all. Sometimes one or two people, but more often none, would raise their hands. His next comment would be, "I guarantee that a majority of you are mistaken."

After reciting the standard excuses that adults use to mask their reading, writing, or math difficulties, he'd ask again. How many people now thought they might know someone who had difficulties in those areas? This time, half the hands in the room would go up. Often, after a presentation, or sometimes weeks or months later, people would approach him to say that they had had no idea how widespread literacy problems were in their region, or how many people they actually knew who struggled with reading.

(Please see, in this chapter, Section 2: Communicating Information about Community Health and Development Issues, and Section 5: Making Community Presentations for detailed information on educating the community.)

Agenda-setting is essentially a competition for a limited resource: attention. As James W. Dearing and Everett M. Rogers point out in Agenda-Setting (1996), proponents of specific issues are constantly competing to gain the attention of the media, the public, and the policy makers.

Dearing and Rogers also point out that scarcity of attention is a factor in agenda-setting. In one national study, researchers gave individuals a chance to name as many "important issues" as they wished-and most named only four or five. So if the public agenda (the concerns of average citizens) contains a limited number of items, agenda-setting is a "zero sum" game: In order for one issue to appear the agenda, it must push another off.

Therefore, if people in your community and the local media are currently focused on dramatic incidents of teenage drug use, you'll have to work doubly hard to get adult literacy on the radar screen.


2. Make sure people understand the issue and its general importance. Awareness of an issue is only the beginning. People may understand that it exists, but not understand its implications. They may feel that it doesn't really matter, that it only affects a few people or places far away, or that there's really no proof of its effects.

So the next step is to explain the issue clearly. People need to know whom it affects and how it works, where they're likely to run into it, and what its significance is. If they have good information, they'll at least realize that the issue is serious.

In his presentations, the adult literacy program director spoke about the effects of literacy issues on the community as well as on those who struggled with them. The loss to the community, he explained, was as great as the loss to the affected adults themselves. People with literacy problems often were stuck in low-skilled, poorly-paid jobs, resulting in a lower community tax base. Local employers were less able to be competitive, because they couldn't find workers with the skills to quickly learn new procedures or new jobs. Fewer and less-informed voters meant fewer community decisions that were based on good information and consideration of the alternatives available. And, perhaps most telling of all, the children of those with low skill levels often had difficulty in school, perpetuating the pattern.

Once people understood these aspects of the issue, they were much more likely to take it seriously, and to ask whether it was a problem in their own community.

(Section 4 in this chapter: Talking About Risk and Protective Factors Related to Community Issues, has more to say on this topic.)


3. Generate real local concern about the issue. Once people are aware of and understand issues, the next step is to foster concern about them. This involves making sure that people understand how issues affect them directly or indirectly, and play out in their communities. It's when they realize their own link to the issue that they'll begin to see it as something that's not only serious, but that needs to be addressed locally.

Even once they perceived it as an important issue, most people still weren't ready to put adult literacy at the top of their lists of problems to attend to. They needed the sense that it actually affected them in some way.

The adult literacy program director handled this in two ways. First, he had fact sheets prepared, which he distributed not only at presentations, but at every opportunity - through personal contact, community bulletin boards, businesses, etc. These informed citizens of the extent of the problem both in the state and in the local area, an extent far beyond what most would have estimated. (See Chapter 6, Section. 15: Creating Fact Sheets on Local Issues.)

His other strategy was to arrange talks by current and former learners in the program. In a particularly effective presentation to the Chamber of Commerce, a local man told how he had graduated from high school - in the same class as many of those in the room - unable to read or write, and how he had hidden his problem from everyone, even his wife, for years. He at last, at her urging, sought help, and learned to read. When he described how stupid and worthless he had felt for so many years, and what it meant for him to be able to do something as simple as go to a restaurant and order what he wanted from the menu, much of the room was in tears.

This learner's talk brought the issue home to the Chamber members. It was no longer "out there," but rather a concern for their community, and a personal concern for many of them, who had known this man most of their lives. Now it was on their agenda. (See Section 3 in this chapter, Gaining Public Support for Addressing Community Health and Development Issues, for more discussion of this process.)


4. Get the issue on the local agenda. Actually placing the issue on the local agenda really means a number of things.

There are less formal ways of getting on the local agenda that are equally important, however, and are usually necessary to reach the point of proposing a bylaw, regulation or other formal policy.

  • Influencing public opinion. Public opinion is an essential factor in setting the local agenda. Issues become items on the local agenda when they reach a certain level of public consciousness, and the community starts to consider them worthy of attention. Stories about them will start to appear in the media, speakers and programs that refer to them will be sponsored by mainstream institutions and organizations (service clubs, churches, universities), and ordinary citizens will talk about them in their daily conversation. Once it's clear that the public is concerned about these issues, politicians and other officials will take notice. (Please see Chapter 6: Promoting Interest in Community Issues, as well as the advocacy chapters cited above, for more information on communication and influencing public opinion.)
  • Affecting unofficial official policy. When we discuss policy in the Tool Box, we usually mean laws or regulations that formally structure how particular issues are considered and handled. Much of the time, however, especially at the local level, the policy that structures public affairs is informal, and depends on the assumptions, pressures, biases, and influences that form the opinions of elected and appointed officials. Economic development may be a priority as much because the mayor's cousin is out of work as because it's what is most important for the community. Official support for homeless shelters or adult literacy may stem less from bylaws or regulations, and more from public pressure or officials' personal acquaintance with people who struggle with these problems. Affecting this informal policy is a large part of getting an issue on the local agenda.
  • Changing individual responsibility. A final aspect of getting an issue on the local agenda is getting it on the agendas of most individual community members. A recycling program won't work unless most householders are committed to it, either out of belief in the need for a cleaner environment, or because it saves them money. Successfully eliminating youth violence may depend on many adults in the community - parents in particular - changing their own attitudes toward violence. When a community reaches a critical mass of individuals taking responsibility for an issue, that issue is on the local agenda.

Thus, getting a health or community development issue on the local agenda means helping the community reach the point where it sees the issue as important enough to deal with, and making sure that a sense of responsibility for the issue is assumed by the public at large, elected and appointed officials, and each individual citizen.


When is the best time to try to get community health and development issues on the local agenda?


Any time is a good time to promote community health and development, but some conditions make the job easier.


1. When an important issue surfaces that needs to be dealt with immediately. The discovery that the town water supply is tainted by leakage from long-buried gasoline tanks (a situation that occurred in a town in central Massachusetts) can be a perfect time to get a discussion of water pollution and water supply on the local agenda. The advantages are that the issue must be dealt with now, and that it won't go away without some permanent way of addressing it. There's no better time to raise an issue.


2. When an already-troublesome issue reaches critical proportions. A small child becomes a casualty in a drive-by shooting; several homeless people freeze to death in doorways on a bitter winter night; a factory closes and the local unemployment rate skyrockets. In circumstances like this, it often becomes easier to get a particular issue into the public consciousness.

Everyone hopes not to have to reach this point before people pay attention, but changing people's perceptions is difficult. Sometimes it takes a crisis to make getting your issue on the local agenda possible.


3. When an external source calls attention to your issue. A new government commission report, a New York Times article about a particular problem or community, a presidential remark, a book by a respected author, a mention on Oprah - any of these can make your issue hot, and make it a good time for you to bring it to the attention of people in your community.

In 1984, Jonathan Kozol published Illiterate America, a book about the huge number of American adults who had difficulty with reading and writing. The book shocked the country, spent weeks on the New York Times bestseller list, and alerted the general public to the importance of the issue. Adult literacy program staffs used the book and the information it contained to help rally local support and to create a base of knowledge in their communities about the importance of literacy and the number of their neighbors who struggled with it.


4. When new information reveals or underlines a serious issue. A university study or government report may alert the community to the fact that it harbors a very high number of cases of an unusual cancer. This information may open the way for more widespread local testing for the disease, an investigation of its possible environmental causes, or increased research into its treatment.


5. When political conditions make it easy or appropriate. There are a number of possibilities here. In an election year, for instance, there are two reasons why it may be possible to call attention to issues and get them discussed.

  • Politicians up for election or re-election are eager to please constituents and show their concern about health and social questions. Therefore, they may be willing to take up your cause as a campaign issue.
  • In many localities, you can put your issue on the ballot.

In many places, a question about an issue can be brought directly to the voters in a referendum. This is a direct vote of the people, which may be binding - i.e. if it's passed, it will become law - or non-binding - it simply acts as an indication of the will of the people.

The mechanism for placing a referendum on a local or state ballot is usually an initiative petition. This is a petition that needs either the signatures of a set number of registered voters, or the signatures of a set percentage of registered voters. In a small town, this may mean gathering as few as a hundred signatures; in a large city, it may mean tens of thousands.

A referendum is usually phrased as a question on the ballot. It may ask voters whether they favor a course of action, whether they approve a particular proposed law, or whether they support a policy position. In Massachusetts, over the past several years, voters have been asked, among many other things, whether to force corporations to disclose their tax payments, whether to enact a law for publicly funding elections, and whether to cut taxes.

Even in non-election years, a well-publicized political event or situation may help put your issue in the spotlight.


Who should plan for getting community health and development issues on the local agenda?


Making a plan for getting your issues on the local agenda, if you do it right, can be part of your strategy. Planning is the first step not only toward action, but also toward recruiting help and support for what you'll do. Choosing a planning group carefully can contribute a great deal to the eventual success of your effort.

A planning group should involve everyone who might be affected by the issue, or who might have a hand in addressing it:


1. Stakeholders. This term includes those with a direct interest in the issue.

  • Those directly affected or involved in the issue. In the case of youth violence, for instance, that might include the young victims of and participants in violence (gang members and other teens who live in or frequent high-violence areas); their parents; residents of neighborhoods where violence is common; and school personnel threatened by violence on their jobs.
  • Those who have to deal with the issue. Using the same example as above, that would include the police, the court system (judges, probation officers), the schools, hospital emergency room staff and other health professionals, youth and family agency directors and staff, etc.


2. Those indirectly affected. This category includes such people as merchants whose business has suffered because people are afraid to shop in the evening or to come to their neighborhoods; citizens who feel trapped in their homes by the violence on the street; innocent youth who find themselves painted with the same brush as those engaged in violence because of their age, appearance, or racial or ethnic background; and property owners unable to sell or rent their houses because of the reputation of the neighborhood.


3. Policymakers. There are really three groups here: those who make formal policy, those who make informal policy, and funders.

  • Formal policy. The group that sets formal policy might include local politicians, planners, and community governing or oversight bodies (the Board of Health, for example ). All of these can pass or sponsor local ordinances or official regulations that govern the way particular groups are treated, solve or create problems, and are more or less creative and effective in addressing issues.

A bylaw banning skateboarding can create tensions between teens and adults, stigmatize some youth, and result in arrests; one setting aside certain areas for skateboarding might solve or prevent such problems.

  • Informal policy. The other group, which includes some local boards or other entities, agencies, schools, the police and courts, and even businesses, can set policy unofficially through internal rules and regulations.

  • Funders. Funding organizations can also make informal policy decisions by what they choose to fund. If funding for youth violence prevention is mostly aimed at enforcement, for instance, it will result in a different kind of effort than if it is aimed at training youth in conflict resolution and involving them in other activities.


4. Influential people and other interested citizens. If you include people whose opinions are respected in the community, you are more likely to get community support for your effort. Such people might include business leaders; leaders of the groups most affected by the issue; clergy and other leaders of the faith community; community activists and advocates; and people with no official position, but with widespread community respect and credibility.

In this group also are people who, for personal or community-minded reasons, are simply interested in working on the issue. They can not only be helpful in the planning process, but can also act as liaisons with their families, friends, and neighbors to support your effort in the community.

Because they're members of the community and deeply involved, these groups can help, as the effort goes on, to identify real issues, and convey important information about the community. Plans that they're part of will take into account the realities of the community and the situation, and therefore be more effective.

More important is that all of these groups feel some ownership of the plan and the effort that your initiative makes to alert the community to your issue, bring it to the fore, and deal with it. They can bring both information, and, ultimately, an action plan back to their segments of the community, and help to gain support for your initiative. Without their support, there's less chance of actually getting your issue into public consciousness and onto the local agenda.


How do you develop a plan for getting community health and development issues on the local agenda?


So...now's the time to get to it. What are the steps you need to take to develop a plan for getting your issue addressed?


1. Identify and recruit a planning group. Using the information in the "Who should plan...?" part of the section and what you know about your community, put together a representative group that can help to make the best plan possible and carry it out effectively in the community. (For more information on contacting and recruiting participants in the planning process, see Chapter 5, Section 5: Coalition Building I: Starting a Coalition, and Chapter 7: Encouraging Involvement in Community Work.)


2. Pick and define your issue carefully. The larger issue you're dealing with may be obvious - say, a sharp local increase in a particular type of cancer. Even if that's the case, it's crucial to define your issue clearly enough so that people can easily understand it, and narrowly enough so that it can be addressed.

The cancer increase may be complex. You have at least three choices to focus on here:

  • Early identification and treatment of those affected.
  • Searching for the cause of the increase.
  • Attacking what seem to be environmental causes for the increase.

While this last often seems the easiest thing to do, and may garner early public support, the problem is that there may be no clear evidence linking the supposed cause with the disease. A highly polluted water source or other obvious health hazard may still not be the actual cause of the increase, regardless of how damaging it may be to the community in other ways. Without evidence, the issue is likely to die on the vine, while other courses of action that might be more productive remain untried.

By choosing and defining your issue carefully, you greatly increase the chances that you'll actually be able to do something about it.


3. Plan for a communication campaign, not just for a one-time barrage of information or persuasion. Envision the whole campaign, not just the beginning.

Some basic steps:

  • Be aware of the level of commitment you can expect from the planning group. They 're probably not ready to chain themselves to City Hall in order to call attention to the issue, at least not yet. They're more likely to approve letters to the editor or stories in the media.
  • Find out how much the community already knows and cares about the issue. Are community members aware of it? Do they care about it? Are they willing to do something about it? Are they already doing something about it? The answers to these questions will help you start where most community members are, rather than telling them something they already know, or asking them to act on a problem they've never considered before.
  • Plan a campaign that focuses on where the community is now, but plan for the next steps as well. If you're starting by trying to make citizens aware that the issue exists, for example, you should already be planning how you'll convince them that it's important.
  • Find "hooks" to pull people into your issue. These may have to do with their own connection to the issue (local statistics, testimony from community members) or with particular aspects, risk and protective factors, etc. that speak to their values and concerns. Many parents may not be willing to stop smoking for their own sake, for instance, but may be willing to quit to protect their children from the effects of secondhand smoke.

Please see Tool #1 and Chapter 45, Section 5: Promoting Awareness and Interest Through Communication, for more on how to run a communication campaign.


4. Address public opinion. Once the weight of public opinion is behind your issue, you'll have a number of advantages. You'll have community support for what you want to do; the media will take notice and further reinforce that support; and policy makers and funders will be more likely to formally consider the issue and provide you with resources. A plan for getting issues on the local agenda, therefore, should include aiming at public opinion.

There are at least three ways to influence public opinion:


5. Address unofficial policy. Try to find out why those who set or influence policy believe and act as they do. Approach them with individual stories of the effects of the issue on local people (told by those people themselves where possible). If possible, have conversations with them to discover what their major concerns and preoccupations are. These may tell you how to frame the issue so that they'll put it on their agenda (or who can present it so they'll listen).

6. Address individual responsibility. Once people understand the issue and its importance, you have to persuade them that it belongs on their personal agenda. It's a fairly good bet that preaching to them won't work, but showing them that the issue affects people they know - or could affect them - might. There are some other strategies that will help as well:

  • Let them know there are things they can do. Volunteering, writing letters to the editor or to policy makers, talking to friends, and speaking out at public meetings are some ways that people can be effective and become personally invested in dealing with the issue.
  • Create policy sticks and carrots. Increases in cigarette taxes, a ban on smoking in restaurants and other public places, and reduced insurance rates for non-smokers are all ways to urge people to take individual responsibility for quitting.
  • Use the media. The clout of anti-smoking campaigns on TV is only one indication of how powerful and convincing the media can be.
  • Show people there's something in it for them. If they can save money by recycling, or if their children can get a better education because of a school bond issue, they're more likely to support those causes. (Please see Chapter 45, Section 6: Promoting Behavior Changes by Making It Easier and More Rewarding.)
  • Appeal to deeply held values. Reminding people that racism and discrimination are un-American or contrary to the beliefs of most religions may help them examine their own reactions. Appealing to family values may be a way to get people thinking about medical care and health insurance issues.


7. Address public policy. To change official policy - and thus to place your issue permanently on the local agenda - you need to mount an advocacy effort, and work with legislators and local officials. The major elements of such a campaign are:

  • Find a champion among legislators, public officials, or policy makers who is both willing and powerful enough to be an effective spearhead for your issue.
  • Advocate with those who control official policy - legislators, local officials, etc.
  • To the extent possible, run a media and publicity campaign to get public opinion behind you. This doesn't have to be a multimillion-dollar series of ads on TV, but can be accomplished with press releases and press conferences, public demonstrations, Public Service Announcements (PSA's), letters to the editor, and other free or nearly-free publicity opportunities.
  • Mobilize those affected by or involved in the issue to call, write to, and visit the appropriate policy makers with a coherent and consistent message.

When a budget shortfall in Massachusetts resulted in the cutting of the adult education line by 50%, the state organization mobilized learners and educators. At the height of the campaign, legislators were receiving over a thousand calls a day, and there were almost daily stories on the issue in the Boston Globe, which is read across the state. Funding was restored in fairly short order.

Please see Chapter 33: Conducting a Direct Action Campaign, and Chapter 34: Media Advocacy, for more on mounting an effort to address issues officially.


8. Follow up. Once there are laws or regulations that address the issue, it is, by definition, on the local agenda. Don't forget to follow up, however. If your goal is simply to bring the issue to public notice, use that notice to move to the next step in the process. If a law has been passed, maintain contact with policy makers and the public to keep the issue at the top of their consciousness. Getting and keeping issues on the local agenda is not a temporary job: it lasts forever.


To sum up


While the ultimate goal of getting an issue on the local agenda may be to change official policy through laws or regulations, reaching that point takes a plan for educating the community to the existence and importance of the issue. You have to address not only official policy, but also public opinion, "official" unofficial policy, and citizens' assuming individual responsibility for the issue.

Two ways to help assure success are to pay attention to the timing of the effort and to the inclusiveness of the planning process itself. Timing means choosing or taking advantage of a political situation or a crisis that must be dealt with, or a situation where new information or media attention has brought the issue to the fore. Inclusiveness in planning means involving all stakeholders and as many other elements of the community as possible, in order to encourage ownership of the plan - and the issue - among as many people as possible.

The actual planning process itself includes carefully choosing a planning group and defining the issue; planning for a long-term campaign, rather than a one-shot effort; and addressing public opinion, unofficial policy, individual responsibility, and, finally, official policy in order to bring about change. There should also be a plan for follow-up once change has been accomplished, so that gains can be maintained.

If you can come up with a plan that covers all these areas, and that has involved many segments of the community, you have a real chance of success.



We encourage the reproduction of this material, but ask that you credit

the Community Tool Box: http://ctb.ku.edu



Resources


Print resources

Dearing, James W. and Everett M. Rogers. (1996). Agenda-Setting. Thousand Oaks, CA: Sage Publications, Inc.

Meredith, Judith C. and Catherine M. Dunham. (1999). Real Clout. Boston: The Access Project.


Internet resources

http://www.kac.org/subpages/Advocacy/advocacytools.htm
Kansas Action for Children provides an Advocacy Toolkit to support people attempting to change or create policy that supports children. The "Get Involved" section includes material about working with the media.

http://depts.washington.edu/ampol/agendabib.shtml
Center for American Politics and Public Policy bibliography on agenda-setting includes case studies and media studies.