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Lemonade in the new normal.

As I enter into the second half of my NEHA presidency, I thought I'd write about the changing landscape of American life and accordingly the changing landscape of our profession. We've been through a very tough couple of years with this economy, but my parents lived through the Great Depression--in fact, they both graduated from high school close to the beginning of it in 1932 and married in 1935 in its very depth. What they went through changed them forever. What we've experienced in the aftermath of the financial meltdown of 2008 is not anywhere in the same league.

Living through the thirties, especially if you were unemployed, was pretty grim. Government assistance just wasn't there and people were desperate. The national unemployment rate peaked in 1933 at 25%! Even in parts of the country hit the hardest by this recession, unemployment is only half that. Of course, that matters little if you're the one who lost your job. Another thing: folks back then didn't call it the "Great Depression" while they were living through it. That was a moniker bestowed by people after the fact. Those who lived through it simply called those years "hard times." As I said, by 1933 millions of Americans were unemployed. Bread lines were a common sight in most urban areas. Farmers were hit especially hard, and unable to pay debts for farm machinery, many were foreclosed on. Hundreds of thousands roamed the country in search of food, work, and shelter as chronicled by the famous Dorothea Lange photographs of migrant farm workers or the dustbowl fiction of John Steinbeck.

Nevertheless, the collective members of our organization, especially those of us 40 and over, definitely took a hit in our 401(k)s or 401(a)s and building them back for our retirements won't be as easy as before. The Great Recession has changed us and the way we view our world now. The "hard times" we're experiencing, although not as bad as those of my parents, are probably far from over. Even as the nation slowly emerges from the recession, all the indicators say high unemployment, low housing values, rising taxes, and much lower limits on what government can afford may well be the new normal. In the public sector, to which the vast majority of our members belong, government employees have seen unprecedented measures in the form of layoffs, pay cuts, furlough days, increased retirement contributions, and unfilled vacancies for long periods of time, always with the admonition to "do more with less." Actually, let's not kid ourselves: in most cases you do less with less! In recent research completed by the Trust for America's Health and the Robert Wood Johnson Foundation about America's public health readiness, local public health departments reported losing 23,000 jobs, totaling 15% of the local public health workforce, since January 2008.

Americans emerged from the dark days of the thirties and I attribute the recovery in no small way to the national leadership of Franklin D. Roosevelt, who said at his first inaugural, "... [T]he only thing we have to fear is fear itself." We got through that mess, and, with the help of our allies, the world war that followed. We recovered to become, in my opinion, the greatest nation the planet has ever seen. We'll get through this one too, but that doesn't mean things haven't changed, that there isn't a "New Normal" we all need to align with. And that the New Normal will be with us for a while. I guess that's the hardest part for me to get. After having gone through several recessions in my career and the associated effect they've had on environmental health budgets, I'd say this one feels different. We bounced back from the others as the pendulum swung back. This time, that pendulum is ratcheting back slowly and it is a much more stagnant recovery.

My call here to the NEHA membership, and particularly to those of us who are in management positions, is to make lemonade from these lemons. As we steer our various environmental health programs through the economic recovery ahead and attempt to stay clear of the shoals, it will be about recalibrating. We will need to downsize, slash, and painfully work our way back to balanced budgets in our respective organizations. That means adjusting spending, expectations, and changing the way we think about government. But here's where the sweet lemonade comes in. These difficult times also cause the distillation of priorities and make unpopular corrections understandable. It's called priority-based budgeting and, in a nutshell, it has to do with looking at all elements of an operation, whether in government, corporations, small business, or academia, and prioritizing each of those internal elements. When everything is laid open in that process, it also presents an opportunity to see what's not being done and who best can do it.

That, I submit, is the opportunity for environmental health programs to expand beyond the traditional roles we have heretofore been encapsulated in. In organizations where priority-based budgeting has been introduced, new and more meaningful conversations have occurred, enabling decision makers to achieve a better alignment of scarce resources with their stated priorities. For example, the city of San Jose, California, is well known and recognized for its innovative approach as a "green, sustainable city," which is one of their city council's top priorities. Their "Green Vision," a 15-year plan to achieve environmental sustainability, is considered a premier environmental policy document, and it is recognized nationally for its innovation. A "green sustainable city" was just one of San Jose's priority goals, however, along with the achievement of a "safe community," cultivating a "prosperous economy," providing "reliable, well-maintained infrastructure," and creating an "attractive and vibrant community." As the city's health department evaluated the overall relevance of their programs to their city's top priorities, they clearly recognized that there was a direct link to the "green, sustainable city" priority. Thanks to the priority-based budgeting approach, they also could make the case for environmental health programs having a direct influence on the other city priorities as well, thus increasing the overall relevance of some of their programs. For example, the restaurant inspections program could demonstrate a high degree of influence not only on the "green, sustainable city" but also on the "safe community" result, as well as the "prosperous economy" result. Most health department programs could do the same. In short, the department successfully communicated the relatively high importance of their programs by showing that they materially contributed to the very results that their city council cared about.

Similarly in the city of Grand Island, Nebraska, the city council, like most city councils across the nation, staunchly maintained that "public safety" was a top priority for the city. Like San Jose, Grand Island's priority-based budgeting initiative opened the conversation about all of the council's priorities so that public safety alone didn't define why the city existed; results such as "environmental stewardship," "sustainable development," and "quality of life" also were identified as top priorities for that community. When the city council was faced with the possibility that reductions in police and fire would be necessary to balance the budget, they contemplated reallocating resources back to those departments from elsewhere in the organization. Through the perspective of priority-based budgeting, however, the city council could see that their definition for "public safety" was far broader than just traditional police and fire programs. While aspects of "crime prevention" and "emergency response" were certainly intrinsic to the way the city defined this particular priority, through their work in priority-based budgeting, the definition was expanded to address the way the city "protects the physical and environmental health of the community" and "promptly alerts and responds to emergencies in the community." As the city council approached reallocating resources to their top priority, public safety, this now meant that all programs that achieved the result, as defined, were eligible to vie for new funding, including those programs which influenced the "environmental health of the community." The trick is not only to be able to properly identify new roles and then to make the case why environmental health practitioners are the best qualified to conduct those functions, but also to identify how existing environmental health programs meet the stated priorities.

Since my column this month is about the national economy, I'm happy to report to our membership that the economic outlook for our organization itself is on rock solid ground. Due to the careful stewardship of Executive Director Nelson Fabian and your board of directors, both current and most recent past, an economic course has been chartered that has helped NEHA steer clear of the pitfalls that have plagued other similar nongovernmental organizations (NGOs). Additionally, due in large part to NEHA's Entrepreneurial Zone, its research and development, its credentialing services, careful Annual Educational Conference & Exhibition planning, and its strategic direction that as our executive director likes to say, "keeps us on the balls of our feet," we have been able to change direction as the times warrant, instead of marching down the path of some preordained strategic goal that is no longer relevant. That makes a lot of sense. At our upcoming annual conference in Columbus in June, preconference workshops will be offered on the concepts of priority-based budgeting. Stay tuned. I'll provide more on that in my April column.

The optimism for our economic recovery, I think, is based on the American spirit and the knowledge that the pendulum always swings back in the opposite direction. It will also be a recovery different from past ones in which the same old, same old was reinstated. I don't think that will work anymore and we all need to adjust to the new. We just need to be able to use the times we are living in to seek new opportunities for ourselves personally, and for the profession we know as environmental health.


Keith L. Krinn, RS, MA, DAAS, CPHA
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Author:Krinn, Keith L.
Publication:Journal of Environmental Health
Article Type:Essay
Geographic Code:1USA
Date:Feb 25, 2011
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