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North Dakota StateHealth Officer Nizar Wehbi, MD
Colorado StateSenator Cleave Simpson
This conversation with Colorado State Senator Cleave Simpson and North Dakota State Health Officer Nizar Wehbi, MD, is the first in a series focused on policymaker “origin stories” — and how their backgrounds have influenced and inspired their public service. In conversation with Milbank Memorial Fund program officer Kate McEvoy, these two members of 2021–22 Milbank Fellows cohort discuss the communities where they grew up — and how they engage with colleagues with different experiences and perspectives to advance population health for the residents of their states. Milbank believes that the practice of appreciating the personal history of others — their life experiences and influences — is vital for leaders to build the interpersonal trust and connection that enables social progress.
Kate: Cleave, how would you describe your origin story?
Cleave: I born and raised in Colorado, in very rural part of the state. I’m the fourth generation of my family to farm and ranch in my community. I don’t very often say I’m the fourth generation because people here will laugh me out of the room because they are the sixth, seventh, and eighth generation.
I got an engineering degree and left the farm for some time, and then came home. I also manage a public entity, the Rio Grande Water Conservation District. So, you can imagine, rural Colorado and agriculture dominate my community, and water is extremely important.
In 2020, I debated for quite some time whether I had a driving passion about the Colorado legislature. It boiled down to an interest bolstering rural Colorado and having a strong voice at the Colorado capital
Kate: Thank you so much for sharing that. Nizar, what life influences and experience led you into your position of service?
Nizar: I was born and raised in Lebanon in a town that is approximately 25 miles south of the capital city, Beirut. For most of the time I lived in Lebanon, there was an ongoing civil war that affected a lot of my family’s decisions and how we lived our lives. Education was very important to my parents. They were always making sure that my siblings and I had access to good educational opportunities, and that we pursued our education to the fullest that we wanted.
I developed an interest in science, discovery, and research, and I was attracted to the clinical and medical field. That was driven initially by my interest in helping others feel better. Thus, I went to medical school in Europe, and then I moved to the United States and started medical research. That’s when I started to develop an interest in public health. In medicine, we are always treating and interacting with one individual at a time. And I thought: Wouldn’t it be nice to start working and impacting populations and communities and neighborhoods?
That led me to focus on working in public health and health policy. That was also one of the driving factors for choosing public service as the North Dakota State Health Officer — because of the possibility of impacting the population of a whole state, not just one city or one community.
Kate: Do you feel like there’s been a continuing influence of Lebanon that has been significant for you?
Nizar: Reflecting back, I always wanted to be involved in politics. Politics is like the everyday bread of the community in Lebanon. You wake up talking politics. But growing up in Lebanon in a civil war, politics was a dangerous thing, especially to leaders who are very effective in the political arena.
Kate: That’s extremely powerful. My next question centers around how you’ve approached working with people who may have very different origin stories.
Cleave: You start with treating people with dignity and respect and understanding. I think from both sides of the aisle, we tend to think we all want the same thing. We all want to see the standard of living of our constituents and those across the state be raised. The challenges come with how we’re getting there. I’m still learning about how to be effective in not only to learning about other people’s perspectives, but also in getting my constituents’ concerns shared equally. To be an effective legislator in the minority position does require you to be more thoughtful and more engaged.
Last Memorial Day weekend, Senator Coleman of Denver, a senator from the other side of the aisle [and now President Pro Tempore of the Colorado Senate], brought his wife and his two kids to stay with me and my wife on my farm. We were friends anyway, but I showed him what we do — here’s how we get water out of the Rio Grande River, how we move it through a series of canals. Here’s how I irrigate crops. And he had appreciation. Taking opportunities to build those relationships is a little cliche, but it really is the reality.
Kate: I love how you described your approach as reciprocal. It’s about taking a posture of inquiry, but also making sure that you are advancing the voices of those folks that you represent, so it has that loop aspect. Nizar, how about you?
Nizar: One thing that comes naturally to me is showing interest in other people’s backgrounds, their achievements, activities, beliefs, and thoughts. This allows for building a relationship with other people who we may agree with on certain issues or disagree with on other issues. But I think when talking to any person and every person, there are always commonalities starting with being a human being. Building that stronger relationship is based on finding the common thread that brings two individuals together. And this will extend from two individuals to a whole community or a population.
Kate: That’s so powerfully said. My personal experience with you involves exactly that type of inquiry and your affirmation of people, which is such a lovely quality. Finding commonalities is really the essence of policy making, to get things done. How have you used this approach to advance policy?
Cleave: In the second session this year, I introduced a piece of legislation about the State of Colorado investing $60 million in water to help communities in the state. This bill went through the interim committee, council committee, the Senate Agriculture Committee, the Senate floor, the House Agriculture committee, the House appropriations committee, House floor, with not a single no vote in the entire process.
That’s just unheard of in this environment. I attribute the success to taking the first year to build relationships and strong support for how important the water bill was not just the community I represented, but to the other communities that I was building those relationships with. It was the largest single investment in water that this state has put forward in decades.
Kate: I love that. I resonate with relationship building being the groundwork for the consensus that you were able to achieve.
Cleave: I’m a conservative Republican, but this was kind of a unique opportunity with one-time federal dollars, but there were lots of competing interests for this limited federal pool of money. Not being in the majority, a lot of those discussions about where that money was going get allocated happened without me. But my Democratic colleagues that I’ve engaged with were advocating on my behalf and were successful in securing that funding.
Kate: Congratulations on that result. Nizar, may I turn to you on that same question?
Nizar: In my current role as state health officer, I want always to be neutral and speaking on behalf of public health and the health of the state and our citizens. So, I stick to science and the facts. Not only with the executive branch, but also with the legislative branch and our constituents; my first goal is to bring back the credibility of public health and science and take it away from politics. That has been, to an extent, successful.
Kate: When you look at your short list of priorities, is there something that you think is likely to have traction on a bipartisan basis?
Nizar: We want to make North Dakota the healthiest state in the nation. And this is a goal that I believe anyone would support. It’s a long process, and multiple initiatives will be involved. Maybe not all initiatives will garner all the support, but I am confident that there will be many initiatives that will garner everyone’s support because they are serving our citizens.
We also want to instill the value of social determinants of health. So, it is not just having the physician or the hospital, but rather how everyone can sustain healthy living. So, people need to have access to proper housing and to behavioral health services. We know that there are a lot of behavioral health issues and substance use disorders increasing in the state. We have to make sure that we have preventative measures, as well as interventions, to set us on the trajectory to better health.
Kate: We’re talking about working across differences of culture. Cleave, how have you worked with people in the executive branch on health care issues?
Cleave: For me, there’s this very distinct point in time in 2020. I’m in Denver all week and Friday nights, I come home. That night, I picked up the paper and [read about] a young woman who took her own life and the life of her two elementary school–aged kids. It was this moment that marked me forever. [I thought] there’s something so wrong in our community, and I sit in a spot where maybe I could have an impact. And it motivated me to dig in around suicide prevention and mental health disorders and the creation of a behavioral health administration in Colorado.
A senator had presented the bill, the Behavioral Health Recovery Act, in committee. I didn’t quite understand it, and I voted no. And then between the time the bill was in committee and on the Senate floor, I had this experience. This was the fifth or sixth suicide in like six months. I came back and went to the Senate floor and described this article and how it impacted me and changed [my vote on] the bill. I hadn’t even been in the legislature 90 days yet when all that occurred. But it just set the stage for me going forward in the policy space.
The administration has really been engaged with me in helping me along. Understand, we don’t always agree, but they were always willing to sit down and talk about the concerns I have and what they’re trying to accomplish. And again, we’re trying to find that spot where we can do things.
Kate: I appreciate the point that you’re making around people’s belief systems not necessarily being static. They’re influenced by different life events and exposure and learning.
Nizar, what would you say to folks who are policymakers that might help them engage more effectively with the executive branch?
Nizar: It’s important to recognize that we are all working for the same constituents. I always try to verbalize that when talking to legislators because sometimes they might think that the executive branch is disconnected from citizens. But that’s the beauty of the government structure in the United States. There are three branches of the government, and in the end of the day, these three branches are serving the same people, but in different capacities. They have different responsibilities, they have different authority aspects and action capabilities, but they are all working to serve the same constituents.
The other important point is to engage in the conversation. The more conversation we engage in, the more knowledgeable we are about each other’s perspectives, the likelier it is that we find a solution that is acceptable for both.
It is not a secret that the US is a great country with great people. We have great ideas, and we have substantial resources. We just have to come together and implement the solutions that we agree will be most impactful to people’s lives.
Kate: I couldn’t have proposed a more inspiring and hopeful winding-up point.
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