What are my career goals?
I want to make my community a better and healthier place to live. I hope to do this by becoming a leader in the creation of healthy policy, ultimately resulting in the promotion of healthy choices and changes in society.
But what is health? And how do you promote it?
Health, as defined by the Declaration of Alma Ata, is not merely the absence of disease, but a state of complete physical, social and mental well-being. Health is more than just biology. Health is how we interact. Health is where we live. Health is what we do. Health is who we are. Health is how we balance ourselves between our social and physical environment. In short, it is pretty much everything.
Public health requires the ability to see beyond the absence of disease and the understanding that health requires interdisciplinary collaboration as it is inextricably linked to both the social, ecological and political environment. Health policy can be challenging, as it combines many different societal elements. That is why I find it so exciting. When health policy is implemented well, it has the ability to create positive wide-scale change. Good policy can really give you a lot of bang for your buck.
How has my internship at NORAPC helped me advance towards my goals?
Interning at NORAPC has provided me with an opportunity to learn more about the implementation process of policy. Implementation is the process of assembling the elements proposed in policy into viable programs. NORAPC is centered on implementing the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act.
As I have learned in my policy-related coursework, there are two classifications of implementation: top-down and bottom-up. Top-down implementation occurs when the policy includes clear and complete language of how the policy should be implemented. The directions are given from above and the administrators below are tasked to follow the set guidelines. Bottom-up implementation is just the opposite in that policy guidelines are not set in stone. This gives the policy implementers the ability to decide how to implement the policy in the way they see fit.
Each method comes with its challenges and successes. For example top-down decisions are difficult to apply to a whole country, because the U.S. is so diverse. In addition, who’s to say policy makers know best? Bottom-up is difficult to evaluate because implementation is so variable and accountability is difficult. So, what’s a policy-maker to do?
Working with NORAPC has taught me that bottom-up and top-down are by no means mutually exclusive. well-implemented policies likely incorporate aspects of both. One example from Ryan White is the 75/25 rule. Ryan White mandates that at lease 75% of funds must be spent on core medical services for HIV (Outpatient Care, Drug Reimbursement, Early Intervention Service etc.). Ryan White also mandates that up to 25% of funds can be spent toward supportive medical services (Housing Assistance, Medical Transportation, Psychosocial Support Services etc.).
I think this is a smart compromise. The legislation has set specific guidelines for the funding but yet left enough leeway to allow each areas planning council to decide how to best allocate funding (which if you read my last blog post you know I think this leeway is SO important). This compromise seems like a well-thought out means of policy implementation. In order to promote positive change though policy, good implementation is essential.
On a more tangible level, working at NORAPC has taught me a lot of new excel skills. Excel has been essential for data analysis, and for creating charts and diagrams for data presentation. “Basic working knowledge of excel” is definitely an important line I look forward to adding to my resume. NORAPC has also introduced me to many new people as well as many new facets of health care. If I do decide to stay in New Orleans, I am sure these connections will prove useful in the future.
All of this hands-on experience has been very exciting and ultimately will help enable me to work towards promoting health for all.