Health commissioners' involvement in public policy

This national study assessed health commissioners' involvement in public policy and advocacy. Benefits, barriers and perceived outcomes were also explored. A previously validated four-page survey (Holtrop et al., 2000) was mailed to 700 health commissioners randomly selected from the National Association of City and County Health Officials (NACCHO) database. A three-wave-mailing was performed which yielded a 50% response rate. Of these respondents, the majority were female (70%) and Caucasian (88%). Overall, 15% of health commissioners were very involved in influencing public health policy and 25% said they were somewhat involved. Health commissioners reported engaging in the following activities most frequently: voting (84%), contacting public officials regarding policy (77%), and providing policy information to legislators (76%). Perceived barriers were time (64%), other priorities (46%) and lack of funding (41%). Perceived benefits included improving the health of the public (94%), making a difference in others' lives (87%), and improving the situation (77%). Perceived knowledge regarding changing public policy was marginal with 43% of health commissioners rating their knowledge at 3 or below on a Likert scale ranging from 1 (poor) to 5 (excellent). Although the American Public Health Association, and other health organizations emphasize the importance of involvement in policy formation and advocacy, public policy activities among health commissioners can best be described as moderate. Increasing health commissioners' level of involvement, knowledge of public policy formation, and removing perceived barriers to advocacy is vital to the future of public health.