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Speaking Truth to Power: An interview with Mary Lou Hennrich

By: CHP | Posted on: November 30th, 2008 | 5 comments | Share:
Categories: Interviews • Education • Policies and Laws • Nutrition • Public Health

“First they ignore you, then they laugh at you, then they attack you, then you win.”
- Mahatma Gandhi

If you’ve ever wondered if your best days were behind you, you can draw inspiration from Mary Lou Hennrich. After retiring from thirty years of work at the Multnomah County Health Division, which included directing the County’s public health clinics, she started a second career as one of the most important health care executives in Oregon.  As CEO of the nonprofit CareOregon, she was responsible for managing a large portion of the Oregon Health Plan population. After her departure from CareOregon, she then began what might have been the most important work of her life: serving as Executive Director of Community health Partnership, where she led the effort to remove soda machines from all public schools in Oregon in 2005.

Her thoughts on upstream and preventive health were recently featured in a new community access television program called Voices for Health Care TV.

She spoke with Chris Palmedo about this experience and the other projects she directs at Community Health Partnership.

How did Community Health Partnership start?

Community Health Partnership started when several of us hit our 30-year retirement from the Multnomah County Health Department. Instead of a standard retirement party, we decided to stage an event that celebrated public health in Multnomah County. As part of that event, we decided to raise awareness for Billi Odegaard’s concept of building a coalition around support for public health.

We called it “Friends of Public Health.” It was to be non-governmental, but it would speak in support of governmental public health. It wasn’t beholden to government, but would be supportive and in synch with what governmental public health, because we believed in it. We wanted to speak truth to power.

Eventually, thanks in large part to the work and leadership of Tom Higgins, they raised around $2 million. And it became Community Health Partnership. Originally, they supported student scholarships and small grants.

When you joined as CEO in 2003, what changed at CHP?

I wanted to get the organization to push the envelope and truly improve the public’s health in a dramatic way through policy issues and advocacy. The board identified a range of opportunities, and suggested that I focus on childhood obesity.

I did some research, and realized they were right. The data were starting to come in, and the rates of childhood overweight and obesity were doubling in short periods of time. The public health community had not woken up to it. We saw that no one else had claimed that piece or turf in Oregon, so we took it on.

I saw CDC maps with increasing waves of overweight kids, but what really got me were the pediatricians saying that for years they’d never seen kids with adult onset diabetes, and now they were seeing plenty. In fact, so many kids were presenting with it that they had to change the name from “adult onset” to Type II Diabetes.

And then we heard that the kids being born in 2000 could be the first generation to not live as long as their parents.

And I began to think of my dad, with type II diabetes, who got it when he was 70, and was then in his 80’s. No matter how well you manage that diabetes, it’s causing havoc inside, to all your internal organs. Somewhere twenty years from the time you’re diagnosed., you’re starting to have some of the side effects., neuropathies, retinal issues, cardiovascular problems.
No matter how well you try to regulate it, it will get you.

Things begin to take their toll after twenty years?

Yes, and when I think of my dad, I think, twenty years from when he gets in his 80’s — well, something’s gonna take you out at some point.

But then you start thinking about all the people who are getting it when they’re 20 to 25 years old. Twenty years from then, they’re 40 and 45 years old. This is the age of what should be the intellectual and economic engine for society!

So it’s a time bomb.

It is. That’s why we need to engage business leaders in this.

To tell them “your workforce will be affected by this.”

That’s what I say to my friends who run hospitals and health insurance companies. If we don’t fix this, where are you going to get nurses who can walk up and down a hospital floor, to stand by a bedside? We haven’t seen the final effects of all the amputations that haven’t even happened yet.

So much money is going into the health care system to fix the broken people, when upstream, we’re continuing to create an environment that’s toxic, and is leading them down the stream!

At the time, people like Kelly Brownell, Marion Nestle, Harold Goldstein, and Senator Martha Escutia from California, were beginning to talk about the effects of neglect and entrepreneurialism from schools, where, particularly in California, schools started to partner with soda companies in selling soda to the kids.

Mind you, they were not meaning to do bad. Most everyone thought it was fairly harmless. They weren’t selling cocaine to the kids. After all, what’s a little soda pop?

And the kids would go to the convenience store across the street anyway.

Yes. And why not make some money for our schools?

For the sports teams…

And when I talked to the schools, and asked them what the benefits were, they all told me “we’re making so much money.”

Now a debate coach in high school told our team never to take opposing information at face value. Just because they tell you something, it doesn’t mean it’s true. To get to the truth, you absolutely have to see the source information.

So I’d ask the administrators, “Just how much money are you making?”

And they’d just say “we’re making lots of money, Mary Lou.”

And I’d ask “What’s lots of money?

And they’d say “lot’s of money, Mary Lou.”

So I hooked up with a great young lawyer, Nicola Pinson, who had just graduated from Berkeley Law School, and under Freedom of Information Act, we got our hands on these soda contracts, and began to analyze them.

In the end, we found out the schools were not making out like they thought they were. They were getting money up front, as much as $1.2 million. But the contract might have been an eight-year contract, and the school got 30 cents for each dollar and Coke or Pepsi got 70 cents. And there were minimal sales quantities that had to be met.

They wouldn’t get the full amount of money unless the kids bought enough soda?

If they didn’t make the minimum sales contracts, the contract could extend for years. And the contract stipulated that if they wanted to get out of the contract, they’d have to pay the upfront $1.2 million back.

Most parents didn’t understand that if they wanted to have a fundraiser, they couldn’t go to Costco to buy their own stuff. They had to buy Coke or Dasani water. But they couldn’t buy it on sale at Fred Meyer. They had to buy it at the higher retail fee set in the contract for all school events — plays, school auctions, anything.

We had to tell the schools, “I know you were trying to do a good thing, but if you’re selling children’s health down the river, at least you could have gotten a good price for it.”

It was kind of pathetic.

We began to use our report to educate parents and children’s advocates about what was going on here. We did a public communications program and we worked with advocacy groups. We even ended up in the New York Times.

What kinds enemies did you make?

Well the soda companies didn’t like us.

But besides them. Was there local resistance? From school boards?

Yes. I could understand the soda companies. This is their business.. But COSA, the school administrator organization, and the Oregon State School Boards Association both tried to discredit us, to make out that we were wackos that were anti-school and all that nonsense.

It’s like the quote from Gandhi: “First they ignore you. Then they laugh at you. Then they attack you…and then you win.”

What a great quote!

That’s exactly what happened to us — just as he described.

As first the schools were just disrespectful to us. “These poor schools need to have band uniforms and sports uniforms and who is this crazy group?”

But as we started building a coalition of concerned citizens, they attacked our work and our credibility.

But when we finally passed House Bill 2650 that set the standards, we won.

So what’s next? Can you finish this sentence, like in the movie trailers: “Imagine a World…”

I imagine a world where the healthy choice is the easy choice. Right now, the healthy choice is often the hard choice.

I can walk across the street to Starbucks and get a huge sweet drink and a muffin with hundreds and hundreds of calories.

At least you’ll know how many calories they have.

Maybe, but it’s just harder to find a piece of fruit in the middle of the afternoon. I want an environment that helps make it easier.

Regence is subsidizing the cost of the salad bar in their employee cafeteria. When I come in with my ten dollar bill, I can get a wonderful luscious salad for a lesser amount than I would pay somewhere else. They also charge relatively more for the hamburger.

Which was artificially cheap because the government subsidizes the corn which feeds the cows, and makes the high fructose corn syrup that sweetens the bun.

Yes. So I see a world where at a national level, we subsidize farmer who produces fresh fruits and vegetables, and we cut back on subsidies for corn and soybeans and the row crops. At the state level, we should look at every environment where we live work, eat, play, and pray.

Even in church, we might begin to reconsider if our congregation should eat coffee and donuts every Sunday. Maybe a congregation might begin to think about providing an alternative to donuts. At the workplace, instead of filling our offices and break rooms with candy and birthday cakes, we reconsider some of these behaviors.

These are not things we legislate, but business might begin to wake up and think about how we can encourage, and even incentivize actions that lead to healthy behaviors.

It can be difficult to avoid paternalism and the “nanny state.”

But look at what Blue Cross is doing with their lunch room. We all need to open our eyes to the opportunities. My mother recently had a short stay in the hospital, and she told me how bad and unhealthy the food was. In a health care facility!

We need to keep asking ourselves why the wrong stuff is still in front of us, and in front of our kids, and why it is so often difficult to make the healthy choice.

I[‘d like to see more businesses offering incentives to get exercise, have walking meetings. Cities should encourage bike lanes, and better land use planning. Do our neighborhoods have good sidewalks? If not, people aren’t going to be as likely to walk.

If you can build it so I can walk to the store and back I’ll do it.

If we can build exercise into our day we’ll be more likely to do it.

As little as one century ago, most people would work, travel and recreate in motion. Now, most of us have to go out of our way to incorporate movement into our lives.

We need to systematically, look at each piece of that, and ask, “What are creative ideas?” We need to get people and communities to talk about these things. We need to organize in communities to get people to think about solutions. It can happen in smaller communities or in neighborhood associations of larger cities. But we need to start seeding ideas.

Neighborhood associations are a great idea.  Portland neighborhood associations have been specifically cited nationally as positive examples of strong social capital.

So what’s on the horizon for Community Health Partnership?

One of the next things we’re working on is “point of sale” menu labeling. People should be given the information to compare.

Only places with multiple outlets – not the single proprietor places?

Right. But there may be some small businesses that voluntarily do this, or get assistance to do it.

Point of sale is important? It’s not enough to put it on the website?

Gimme a break! If people had time to go to the website, and look up all that stuff, they could have cooked dinner at home!

No – this is about giving information in a short amount of time at just the right time.

Point of sale is the bottom line. If it’s not at the point of sale, it’s not as effective as it could be.

What else will you be working on?

We are also looking at child care settings. Plenty of kids are overweight when they first hit school, so what happens before they get there?

Around 70 percent of kids go to day care before their school years, so we’re looking at what some states are doing around things like ensuring active play, outside play, nutrition standards, and reducing screen time for little kids

My staff is also trying to introduce human health impacts into health impact assessments for construction projects.

We’re also studying breastfeeding. The newest data is so convincing that breastfeeding is protective of the baby and the mother. There’s a 40 percent lower risk of diabetes for the mother if she breastfeeds for six months. The baby also has a protective factor against obesity that seems to last into early adulthood — thirty percent lower chance of being overweight and obese if you’re breastfed for six months.

I’m trying to convince the insurance companies to join a collaborative effort that I’m calling the OR Health Insurers Partnering for Prevention (OHIPP). I want every one to come to the table to look at strategies to improve all these behaviors – to understand that to have healthy kids you need to get more women breastfeeding, you need to have kids eating more fruits and vegetables, you need to reduce the amount of screen time, you need them to be physically active every day, and you need them to avoid junk food and beverages.

So I’m trying to get the insurers into a discussion with us to present information, and it seems to be a no brainer to take down any barriers they may have to women breastfeeding.

For example, none of the insurers I talked to could conclusively tell me if they pay for breast pumps for women to continue to breastfeed when they go back to work.

The fact is that they usually don’t. For about $250, you can provide a breast pump, and the health benefits are huge. What I’m telling insurance companies is “Take down your barriers! Whatever your process is — if you need to label it durable medical equipment, just let that happen.”

We have 85% of women breastfeeding when they leave the hospital, which is better than most states. But it drops down to 40% after the first four weeks at home. Lactation consultation needs to be available to everyone who struggles with this.

It’s so cheap. A couple short visits, and most people are on their way. For the more complicated cases it’s still relatively cheap, and if we don’t do it, we’re still losing another opportunity to address these health problems upstream.

What are some things Oregon can do now to improve the health of its kids?

Right now, we’re looking at the food stamp program and trying to look at ways for food stamp users to make healthy choices. Is there a way to make an incentive in the food stamp program where your food stamp dollar stretches farther if you make the healthy choices? Right now we’re looking at federal regulations to see if Oregon can pilot a program to set a standard for others to follow.

We’re meeting with Oregon DHS food stamp staff, but the first step is to try to thoroughly understand the process before you begin to make any changes.

Back to what my debate teacher said to me — we need to see the regulations first hand, so we don’t have some federal bureaucrat interpreting for me why the system can’t be changed

Looking carefully at the regulations can help get us through log jams of people assuming you can’t do something.

Another way of saying it is “speaking truth to power.”

That’s one of the reasons your organization started…

And that’s one of the reasons that it’s so important for this organization to stay in existence.

What’s the underlying message that we need to convey to the general public about the value of public health programs?

The message is that we are all connected.

Oregon comes from a pioneering spirit and individualistic approach. My uncle Henry is a conservative and very much of an individualist. When I talk to him, I understand that I have to speak his language. He cares about his grandchildren, and the fact that they aren’t as healthy as he was when he was younger. I help him understand that the infrastructure and community isn’t there the way it was when he was younger. We need to re-create some of that community, and I believe that the government needs to be involved in it.

You have so much experience in both public health and heath care. What’s your perspective on what needs to be done for the two to work together?

Most people think of prevention as individual preventive screenings: getting your mammograms, or your vision screening, or your immunizations. 

But that’s about as far as health care can go — making sure that at the individual level we are doing what we need to prevent illness and disease.

Most people know that they should eat fruits and vegetables every day. I think we waste a lot of time and money with “pamphlets are us.” Passing out information and trying to “educate” people. Unless you’ve lived under a rock, you probably know the basics.

Public health needs to be focused on shaping environments that support health and support people making the healthy choice.

Public health needs to do the policy analysis, taking research and applying it, convincing representatives, politicians, and leaders to really re-think those environment and what they could be doing positively or negatively to influence our health.

The health care industry is so busy debating about resources, how much money to spend on this or that, on which drugs work, and which parts of the industry are most effective.

I’m getting less and less interested in those discussions. People say that the reason we have such poor indicators – infant mortality, etc., is because we don’t have enough health care. We can have our doctor standing at our sides, but that’s not the crux. The crux of the problem is around disparities, poverty, and the fact that so many people aren’t fully empowered to make healthy decisions. That is the conversation where I’d prefer to spend my time.

Look — prevention in the health care system is important, and any barriers should be removed in terms of copays, or anything else to get those screenings done. But even if we had that part perfect, we still have major social problems that are causing us to be sick.

And if we did begin to address these upstream issues, it would be less taxing on our health care system.

Of course it would. That’s the point!

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