The Fund supports networks of state health policy decision makers to help identify, inspire, and inform policy leaders.
The Milbank Memorial Fund supports two state leadership programs for legislative and executive branch state government officials committed to improving population health.
The Fund identifies and shares policy ideas and analysis to advance state health leadership, strong primary care, healthy aging, and sustainable health care costs.
Keep up with news and updates from the Milbank Memorial Fund. And read the latest blogs from our thought leaders, including Fund President Christopher F. Koller.
The Fund publishes The Milbank Quarterly, as well as reports, issues briefs, and case studies on topics important to health policy leaders.
The Milbank Memorial Fund is is a nonpartisan foundation focused on improving the health of communities and entire populations.
March 29, 2018
View from Here
State Health Policy Leadership Population Health
Christopher F. Koller
Jun 30, 2022
Jun 14, 2022
Jun 1, 2022
Back to The View from Here
As the know-it-all big brother, I take the job of telling my sister what to do very seriously. So when she starts giving me lessons in my supposed wheelhouse—the making of public policy to improve population health—I am brought up short; especially when the lessons are about strength, courage, and the role of advocacy to change set-in-stone policies—in this case, regarding the regulation of guns.
She did not seek the role of an advocate for gun violence prevention. After she was shot and nearly killed two years ago defending her daughter from a carjacking outside an airport hotel, the work sought her.
A teacher in the Baltimore city schools, she had already seen what violence had done to her students and their families. The circular-firing-squad logic of increasing access to guns, as numerous would-be experts argued in the wake of the incident in mostly anonymous Facebook posts, did not persuade this victim. If she had had a gun that night, it would have made no difference, she said.
So when she had sufficiently recovered from the gunshot wound that nicked an artery, placed her in the ICU for six days, and caused nerve weakness that bothers her to this day, she decided to move forward rather than retreat. What could be done to limit the gun violence in our country that takes 96 lives every day, reduce the 21,000 suicides a year from shooting, help the 4.5 million women in the US who, it is estimated, have been threatened with a gun or shot by an intimate partner, and eliminate the mass shootings with automatic weapons that capture our attention?
She discovered “Moms Demand Action” and co-founded a local chapter. She started to help organize meetings. She told her story on panels and in social media. She went to marches and set up informational tables at festivals. She learned about the legislative agenda in her home state, took time off to testify at bill hearings, acquainted herself with the legislators on the committees of jurisdiction, heard arguments against the bills she supported, and discovered what it is like to have bills die in committee.
The recent school shootings have increased the energy of the work. The meetings are now bigger. She and her colleagues were ready and organized, with opportunities for new recruits to pitch in. Not sure about planning public marches, but want to do data entry? Come on board.
This has been a pretty good winter for efforts in her state—a law banning the “bump stocks” that turn semiautomatic rifles into fully-automatic ones passed. After multiple years, legislation removing firearms from those convicted of domestic violence made it out of the state Assembly and is pending in the Senate, as is a “red flag bill” giving law enforcement greater authority over the firearms of people determined to be in crisis.
She has honed her speaking points during this process. Good advocates know their facts, how to communicate them, and how to organize others. Really good ones understand their opponents’ arguments and the values that drive them. Several of our immediate family members own and use firearms. “We respect the second amendment and the right to responsibly own and use guns,” my sister says. “We are not here to take away your guns. But the proliferation of firearms has risen to a national crisis.”
Effective advocates also know how to compromise. The gun violence prevention legislation that passed this year draws dismay from those who find it insufficient to address the mass shootings that capture the headlines. Our father, a World War II veteran, thinks she advocates for too little. Gun violence prevention advocates readily acknowledge that that might be the case, but policies change incrementally.
The far greater impact of advocates like my sister and the articulate students now speaking up is to create space for previously impossible legislative and campaign discussions. The tactics of the National Rifle Association—financing political candidates and activating membership—have been primarily responsible for creating an environment in which debates in legislative committees do not match public sentiment; an environment in which two thirds of Americans support stricter gun control laws, according to recent CBS and CNN polls, yet legislation enacting such measures struggles to even get a hearing.
We see the effects of this in our work at the Milbank Memorial Fund. Discussions in our closed-door policy leadership meetings on gun violence reduction and prevention generate more passion and divisiveness than any other public health issue. Moderate Republicans have asked us not to have public discussions about the issue for fear that any publicity will cause the legislators among them to face well-financed, single-issue opponents in their primary elections.
The capacity to use evidence and reflection to determine the right thing to do—and the courage to act—are essential for good public leaders. We at the Fund work to identify, inform, and inspire this kind of leadership. But capacity and courage are not enough; leaders cannot do the work of policymaking alone. They need articulate, well-organized, and sophisticated public advocacy—and not just from one position. They need thoughtful leaders of those movements, like my sister, who can speak from hard-earned, often painful, personal experience and help others—those without connections, lobbyists, or money to give to campaigns—to find their own voice and exert their own influence.
The public policies that result from this advocacy and leadership may please no one fully, but they will better reflect the sentiment of the full electorate. This is the case for any issue, but particularly current state and federal laws regarding gun violence prevention that are unbalanced and ineffective. Thanks for the lessons, sis.
Get the Latest from the Milbank Memorial Fund
An endowed operating foundation that engages in nonpartisan analysis, collaboration, and communication, with an emphasis on state health policy.