​​​​​​Summer 2017

​The need for a laboratory voice in budgetary discussions has become more urgent recently, and “human-to-human relationships” are as critical as technical knowledge. So how does a public health laboratory raise its profile within the community? By telling a good story…over and over again.

Invisible No More: Sharing the Value of Public Health Laboratories

Photo: A television reporter interviews former SHL Director Christopher Atchison (far right) while a videographer films the conversation.

​by Nancy Maddox, MPH, writer

When Christopher Atchison, MPA, became director of Iowa’s University Hygienic Laboratory a decade ago, one of the first things he did was change its name to the State Hygienic Laboratory (SHL) at the University of Iowa: “We’re a state agency. I want the legislature to think about us as a state agency.”

That simple act of advocacy paid off. When the Iowa legislature drafted, and passed, the Iowa Medical Cannabidiol Act earlier this year, it listed only one laboratory by name as an option for mandatory “spot check testing” of cannabidiol products produced in state: the SHL. For a facility that “lives or dies on volume,” that is a success.

Said Atchison (who retired June 30), “Restoring that historic name gives us more recognition as a state laboratory [as distinct from any of the other labs located on any of Iowa’s three state university campuses].”
 
He said, “What that [bill] tells me is that we have achieved the purpose of being seen as a resource in the area of science. That’s more significant than people might realize.”

Indeed, at a time when government budgets are under threat, visibility can be a lifeline. Said Chris Whelen, PhD, head of Hawaii’s Department of Health State Laboratories, “As laboratory scientists, you’re not in the spotlight; you’re the supporting cast. And lab folks kind of like it like that. But anonymity is a bit of a liability, especially when you’re trying to advocate for resources. If folks don’t know you exist, they don’t know why they’re spending money on you. And they certainly don’t want to give you more.”

The need for a laboratory voice in budgetary discussions has become more urgent in the past year. According to a recent Washington Post report, “More states are facing financial trouble than at any time since the economy began to emerge from the Great Recession...and will grow more dire as the Trump administration and GOP leaders on Capitol Hill try to cut spending and rely on states to pick up a greater share of expensive services such as education and health care.”

Undoubtedly, the biggest common threat to laboratories’ bottom lines is the preliminary federal budget for fiscal year 2018, which calls for slashing $54 billion from nondefense discretionary spending.

Proposed public health-related cuts include:

  • CDC: $1.2 billion reduction, with substantial cuts to programs addressing HIV/AIDS, TB, emergency preparedness, global health, birth defects, and emerging zoonotic and infectious diseases.
  • Environmental Protection Agency: Elimination of the Water Security Program and a $19 million cut to Preparedness, Response and Recovery.
  • Food and Drug Administration: $71 million reduction, including $49 million in external funds for implementation of the Food Safety Modernization Act.
  • Health Resources and Services Administration: $35 million reduction, including $32 million for newborn screening.
  • State Department: $2 billion cut to global health programs, but a redirection of $75 million in Ebola funding for global health activities.

On top of these possible losses, the proposed repeal of the Affordable Care Act would scrap the Prevention and Public Health Fund, which contributes significantly to CDC’s budget and provides $40 million for Epidemiology and Laboratory Capacity grants.

APHL’s Senior Director of Public Policy Peter Kyriacopoulos said the massive downsizing represented by the president’s budget—which would reduce CDC funding by 28.3% in all—is, in fact, so draconian that “nobody on Capitol Hill appears to be taking this very seriously.”

Yet, he is quick to point out that the lack of seriousness is small comfort: “My biggest concern is that the huge budget cuts could be used to advance a smaller cut in funding and do so in a way that tries to convince people that it could have been worse.” He said, “The reality is that public health has never been well funded, and we would have as much difficulty absorbing a 5% cut as a 17% cut.”

Regardless of immediate outcomes, however, the current political climate does not auger well for public health. “This is not the end of these attempts to cut spending,” said Kyriacopoulos. “We are going to need to pursue this as a marathon, and not a sprint.” In other words, it is time for stakeholders to speak up for public health laboratories.

“Human-to-human relationships” as important as technical knowledge

Efforts to raise laboratory visibility fall into two categories. So-called 360 degree communications involves, according to one marketing researcher, “bringing a brand to life, using all possible contact points and...collaborative partnerships.” For the public health laboratory (PHL), that means building a base of understanding and support for the laboratory’s high-stakes mission and scientific work. By definition, this is a perpetual process that encompasses everything from laboratory open houses to lunch outings with the lab’s designated public information officer.

Proactive 360 degree communications is complemented by a second type of outreach: targeted advocacy to attain specific goals, such as supplemental funding for equipment purchases. This is where a pre-existing groundswell of goodwill toward the laboratory pays off.

Owing to its university affiliation, in-house communications staff and commitment to education and training, Iowa’s SHL has one of the best PHL outreach programs in the country. Its 360 degree communications include a robust internet presence, representation on the governor’s STEM advisory council and a monthly, electronic newsletter, Lab Link, that reaches over 800 readers, including regional and national partners.

Last year, the SHL was covered in the local media at least 40 times, including a KCCI Channel 8 story about swimming water quality and a Des Moines Register report on herbicide-laced honey.

Pat Blake, MA, who leads the SHL communications department, said the laboratory’s most visible product is its annual report, which includes testing statistics. In addition, those statistics are “plugged into” an Iowa map, showing how many tests have been performed for customers in each of the state’s 99 counties.

“As a state agency, we serve every county in Iowa, and we can demonstrate that,” said Blake. The same information is repackaged into one-page “impact handouts,” focusing on individual testing programs or individual counties.

Thanks to the laboratory’s website analytics, staff know that the most highly viewed items posted on the website are test menus and items pertaining to newborn screening, radiochemistry and water quality—a big issue in a state with a large agricultural presence, an imposing rivershed and heavy reliance on well water.

Yet even with her department’s impressive array of products (including coloring books!), Blake said, “One of the most helpful things we’ve done is to make the laboratory available for interns,” such as high school teachers who come for summer externships and, a few years ago, a doctoral candidate from the University of Iowa journalism program (who developed a widely viewed newborn screening video).

Blake’s work is complemented by the SHL’s Education, Training and Outreach program, led by Beth Hochstedler. The program focuses mostly on STEM education for teachers and students from kindergarten through post-doc, but also hosts educational events for lawmakers, focusing on issues like Zika virus. For the past ten years or so, the program has chosen a SHL “ambassador” to promote the laboratory. The inaugural ambassador was the then-reigning “Miss Iowa,” who had an interest in steering young girls into science.

“One of the things we’ve been successful in,” said Hochstedler, “is finding unlikely partners who have helped us to be effective in the state.” For example, she said, “When we’re engaging students, we’re engaging their parents too.”

One measure of the program’s success is the fact that schoolteachers tweet about it. Another high-powered communications shop can be found at the Wisconsin State Laboratory of Hygiene (WSLH), located at the University of Wisconsin–Madison (UW–Madison). Jan Klawitter, MA, the lab’s communications lead, said her job is “to build a broader base of people who are aware of what the lab can do for them.”

She said, “I think when people think of laboratories, they think of equipment and testing; it’s technical and abstract. But in the end, our ability to do our job and to serve our customers comes down to relationships—those human-to-human relationships, which prove to be as important as any technical knowledge.”

In addition to UW–Madison —where senior scientific staff have faculty appointments that help bring in research grants—notable WSLH partners include the Wisconsin Public Health Association, state hospital association and large networks of clinical and local health department laboratories.

“When we have been under threat,” said Klawitter, “local health agencies have advocated for us. They understand that the state lab is there for the whole public health system.”

Among other things, Klawitter credits laboratory stakeholders with providing the final push needed to eliminate a 2015 state budget provision that, if enacted, would have moved the laboratory off campus and trimmed its funding.

The WSLH may be the only state PHL with a technical advisory group with representatives from clinical labs from throughout the jurisdiction. Erin Bowles, MT(ASCP), who coordinates that group (and oversees an impressive range of technical assistance activities), said Wisconsin’s clinical labs have been “very agreeable” when there is a need to supply specimens for disease surveillance or “to contact legislators and write letters.” The relationship, she said, “is beneficial for both sides.”

As with other stakeholders, the WSLH’s outreach to policymakers—including occasional facility tours for legislators—underscores the laboratory’s public health mission and its technical expertise.

“One area where we have had some involvement with policymakers is around synthetic cannabinoids and opioids,” said Klawitter. “When they’re drafting legislation, we’re sometimes able to get involved with the actual language of the legislation, so it’s scientifically more accurate. There’s not necessarily more money coming in, but it shows that we are a resource for them.”

Making PHL needs “among the highest priorities”

Yet while virtually all governmental laboratories engage in outreach, not all have equal freedom to advocate for specific needs. In fact, some state laboratories are prohibited from contacting the state legislature directly.

Yet sometimes it is possible to advance laboratory interests in creative ways. For example, when the Hawaii PHL was facing $700,000 budget deficits because of a spike in the cost of electricity, Whelen decided to “think like a legislator and how they do outreach.” He and his senior staff—on their own time—designed two postcards: one describing “who we are and what we do” and the other describing challenges.

“I didn’t want it to sound like complaining,” said Whelen. “I wanted them to know that we had identified some of our vulnerabilities and some approaches to meet those challenges, but to make it clear, we couldn’t do it by ourselves. We needed help.”

The postcards were printed using money raised through a bake sale and distributed at the state capitol by laboratory volunteers in their off duty hours.

Despite minor blowback from his bosses, Whelen succeeded in spotlighting the laboratory. And, yes, he got a $700,000 increase to his operating budget.

When, some time later, the PHL needed money for a gas chromatography mass spectrometer for pesticide analysis, Hawaii’s CDC block grant coordinator offered up $200,000. The lesson, said Whelen, is that “you’ve got to convince your leadership in the department of health that [laboratory needs] rank among the highest priorities for the department.”

Sometimes strategy and luck work together. Such was the case when Atchison was searching for money to build out the SHL’s Center for the Advancement of Laboratory Science (CALS), which was, at the time, 5,000 square feet of unfinished space in the basement of the SHL’s brand new, $38 million Coralville facility.

“We had achieved a landmark accomplishment,” said Atchison, “and I’m standing in it wondering, How do we find another $2.5 million?”

The answer presented itself when Atchison had the good fortune to sit next to the executive director of the Roy J. Carver Charitable Trust at a meeting. After some conversation, it became clear that CALS’ educational mission synched with the vision of the Trust, which subsequently gave the laboratory $300,000 to build out a wet lab training room and then $260,000 to outfit an auditorium, with the hope that the SHL would raise matching funds from other sources.

Touting the Trust’s support, Atchison billed the enterprise as an economic development project for the University of Iowa Research Park (where the SHL is located) and for the City of Coralville, which made a small, but symbolically important contribution to CALS via tax increment financing. This initial support was sufficient to capture the attention of local legislators, who secured $1 million in state funding for the project. The University of Iowa then agreed to make up the shortfall, and CALS was completed in 2014.

The problem that sometimes arises for PHLs, however, is that some public health services, such as routine disease surveillance, have no clear-cut constituency. The Minnesota PHL, for example, relies on federal funding for about 45% of its budget overall, but a whopping 85% of its infectious disease testing.

Whelen said, “The bottom line is: we do what we’re resourced to do. And if the current administration decides that certain things are not going to be resourced, we stop doing them. It’s as simple as that.”

APHL’s Kyriacopoulos uses a timely analogy. He points out that London firefighters were stymied during that city’s catastrophic Grenfell Tower inferno because the fire department budget had been gutted.

He said, “You can fund the work of the PHL or you can ignore it and accept the risks that ignoring it brings.”

In addition to successes, that’s a story worth telling too.