National Healthy Start Association
Sustainability Committee


On Thursday, September 28, 2005, the NHSA Sustainability Committee met and received an update on our appropriations and reauthorization status. The collective discussion moved to reviewing some of the current events in the political climate in Washington and throughout America and how they might transform our appropriations and reauthorization objectives and tactics. I was asked to prepare an analysis of these developments and propose a new policy and action plan.

National Political Climate Report:

As I reported during the conference call, the Republican majority in Washington is currently on the defensive and their domestic agenda stalled due to the current crisis of corruption, incompetence, and lack of confidence swirling around their actions and inactions. For the first time in three years the majority of the American people are losing confidence in the pursuit of the war in Iraq where increasing numbers of Americans believe that funds should be diverted from the Iraq war and allocated to addressing domestic needs like poverty where people are suffering in areas impacted by hurricanes Katrina and Rita. President Bush’s approval numbers range from 40 to 45% due primarily to his slow and pitiful response to the Katrina Hurricane and the dismissal performance of the incompetent FEMA director, Michael Brown.

The American public is very concerned about the Republican’s energy policy as the gas prices skyrocket. Congressman Tom Delay was indicted last week and Senator Bill Frist, Karl Rove, and Vice President Cheney’s chief of staff, Louis (Scooter) Libby are currently being investigated for criminal activity. To top this off, former Republican Education Secretary, Bill Bennett’s comments concerning aborting African-American babies and crime reduction highlights the Republican mindset about race in America.

All of the developments above have reduced the American public’s confidence in President Bush’s leadership and moderate Republicans are considering deserting his camp and self-described independents say they intend to vote Democratic in next year’s congressional elections by a two-to-one margin according to a recent Pew Research Center for the People poll. What we have here is a national crisis of confidence and a demoralized mood among the American people about the effectiveness of their government.

The National Healthy Start Association can take advantage of the current political climate by understanding its impact on the current Republican agenda and develop our own policy responses to further the goals and reach of the Healthy Start program as the lead program to confront poverty across America and further the recovery of millions of Americans (mothers, babies, fathers, etc.) in the states impacted by the natural disasters.

Impact of Political Climate on Current Republican Agenda:

*President Bush was forced to communicate a Republican agenda to address poverty and
racism in America even if most African Americans and Latinos don’t believe him. I
quote him during his speech last month: “The poverty exposed by Katrina, has roots in a
history of racial discrimination, which cut off generations from the opportunity of
America. We have a duty to confront this poverty with bold action.” The President
then introduced a general program to help the poor with housing, education, job
training, healthcare and economic development initiatives.

*As a result of the Gulf Coast crisis, Senator Frist postponed a vote on repealing the
estate tax, a move that would benefit the wealthiest 1 percent of households. House and
Senate Republican leaders have delayed their plans to propose $35 billion in spending
cuts over the next five years for entitlement programs like Medicaid, student loans, food
stamps and welfare payments. The President’s strategic policy proposal to overhaul
Social Security since his reelection has fallen by the wayside in this current climate.

*There is a brewing debate in Congress concerning governmental spending and the
growing deficit and how Katrina and Rita aid spending should be paid for. The debate
could shift to a serious discussion about raising taxes or reducing the commitment of
troops and funds from the Iraq war thus allocating funds for domestic spending to
address poverty, the recovery process in the Gulf Region and the current energy crisis.

*Republican and Democratic politicians voted to approve sixty-two billion dollars to help
the Gulf Region to recover. Congress expects the price tag for recovery will be about
$200 billion dollars. Most of the discussion has focused on the physical rebuilding of
the cities but no discussion on rebuilding the public health systems and furthering the
people’s ability to rebuild their lives.

NHSA Proposed Legislative & Policy Response to the Political Climate:

Based on the developments outlined above, the NHSA has an excellent opportunity to reposition our legislative activity to take advantage of the current political climate that is not permanent but fluid and influenced by political action by both parties. The follow are proposals to reshape our appropriations and reauthorization strategy and tactics to align them to ride the wave of the current political climate. It is my belief that the current climate is favorable to increasing the allocation of funds to Healthy Start. Also, I believe that Healthy Start can lead the policy debate on how to address poverty in America.

Reposition Healthy Start as HHS/HRSA’s Main Intervention to Lead the Social Recovery in the Gulf Region:

Two days after the hurricane hit in New Orleans, Health and Human Services Secretary Michael Leavitt declared a public health emergency in Louisiana, Mississippi, Alabama and Florida. He later extended the order to nine other states where survivors had evacuated to. This allowed the other states to qualify for federal funding assistance.

Most of the $62 billion sent to the region has focused on search and rescue efforts and rebuilding the physical infrastructure within the area. There has been little focus on rebuilding the public health and social infrastructure that primarily meets the needs of the poor and working class populations in the Gulf Region. Healthy Start is the only HHS/HRSA program that can play a permanent role in rebuilding the maternal and child health-public health infrastructure as thousands of inhabitants of the parishes and towns in the Gulf Region return to rebuild their lives.

From an appropriations perspective, the NHSA should work with our Republican and Democratic friends in Congress to reposition our appropriations efforts in a bill that will increase Healthy Start’s allocation to one hundred and seventy-five million dollars. The expanded funding should be allocated to the Healthy Start projects in the states designated in Secretary Leavitt’s directive to strengthen the Healthy Start program’s ability to provide expanded case management, immunization, recording of births in the region, perinatal & women’s health systems rebuilding work, mental health counseling, health insurance enrollment, men’s services, and resettlement work in the thirteen states designated by the Secretary. The extra funds for Healthy Start can be secured from the $138 billion dollars yet to be allocated to the region for rebuilding. By October 20th, 2005, Congress will develop and approve legislation to send to the region the next installment of funds needed to recover and rebuild. We simply must move quickly to be included in this appropriation.

Currently there are hundreds of public health first responders in the region who are addressing the possibility of infectious disease outbreaks that relate to overcrowded conditions where diarrhea, tuberculosis and influenza could break out. Most of these Disaster Medical Assistance Teams are made up of volunteers from across the country that will soon rotate out of the region. It is now time for HHS to consider the need for second responders who must be permanently repositioned in the region that will conduct the hard work of giving the region a “Healthy Start” and play a strategic role in reviving the maternal and child health infrastructure in each city and town impacted.

I am arguing that Healthy Start workers should play the role as second responders. Dr. Peter. C. van Dyck should be contacted immediately to discuss this new role for Healthy Start projects in the region. He must take this message to Secretary Michael Leavitt and then we must work with our legislators to craft the legislation to reposition the national Healthy Start program in this role with expanded funding and a broader mission.

Funds could also be used to stand-up and re-staff Healthy Start projects that have been negatively impacted by the storms in the region. Extra funds will need to be used centrally at HRSA/MCHB to coordinate the efforts in Maryland. I have attached a file that documents several new legislative initiatives that relate to the recovery taking place in the region. We either can attach our efforts to one of these bills or get one of our legislators to develop a bill related to this objective. Healthy Start projects in the region should also link up with the strategic recovery and rebuilding efforts related to job training, home ownership & housing redevelopment, reforming the public school systems and TANF reorganization.

Reposition Healthy Start as HHS/HRSA’s Main Intervention to Lead the President’s Initiative to Fight Poverty in America:

Many of the activists and leaders within the NHSA believe that the only way we can reduce infant mortality and low birth weight rates around the country is to begin to address the social determinants of health disparities. These conditions which include poverty, adverse living conditions, unemployment, institutional racism, environmental toxins, affordable healthy food availability and unsafe neighborhoods are the chief causes of poor birth outcomes in our communities.

The NHSA should take President Bush up on his policy speech to do something concrete about poverty and racism in America. I am not sure whether he gave his poverty speech to heal political wounds suffered from the poor Katrina response or he actually wants to do something about poverty. He should be held accountable to address the deplorable conditions witnessed in New Orleans and uncovered by the storm.

However, President Bush in his speech last month defined the problem as regional in nature rather than national in scope and offered only regional rather than national solutions. Once again, Healthy Start is a national program in scope and could be the national infrastructure to launch health, economic development and social initiatives to confront poverty across America.

From a reauthorization perspective, the NHSA should work with our Republican and Democratic friends in Congress to reposition our reauthorization efforts in a bill that will increase Healthy Start’s allocation annually to $250 million. The expanded funding should be allocated to the Healthy Start sites in every region of the country to be the President’s core infrastructure to confront poverty in America.

There is value and cost savings in using an existing social and public health infrastructure rather than building a new one. The President and Secretary Leavitt will need a delivery system to implement their poverty reduction policy.

Besides our day-to-day work to improve the health of poor and working class households, some of our Healthy Start sites are involved in developing male involvement services, implement job training programs, working with public school activists to improve the effectiveness of their educational programs and work very hard to improve the affordable housing stock in cities and rural communities across America through community mobilization efforts.

Healthy Start is the only HHS/HRSA program initiatives that seeks out and work directly with the poverty population in America and could coordinate the efforts of other federal programs to address poverty across America. Once again these ideas will have to be shared with Dr. van Dyck and Secretary Michael Leavitt so that they can be included in the Bush administration’s plan to confront poverty.


I look forward to the Sustainability and Executive Committees’ review and contributions to this proposed legislative, policy and action agenda outlined in this document. We must act quickly to take advantage of the current political climate to strengthen the Healthy Start program nationally and address the needs of the survivors of poverty across America. I can make myself available for questions over the next week. Colleagues, as Bill mentioned during our last sustainability call, the time for action is now if we are to take advantage of the current situation. This situation will not last forever! While the Republican Party has taken some real body blows and is on the ropes right now, we should not underestimate their resilience to bounce back.

Already on September 30, 2005, President Bush organized a strategy meeting of cabinet members and key Republican leaders in Congress to make plans to pivot and salvage their shredded agenda of tax cuts and revamping Social Security. They made plans to press ahead on important priorities despite the current political crisis within their ranks. They plan to dominate the political debate throughout the country by using President Bush’s second Supreme Court nominee to set off an ideological showdown with the Senate Democratic minority to rally their base and deflect the American peoples focus on Katrina, Iraq and the current Republican criminal investigations.

On the policy front, the Republicans are already planning to reposition longstanding conservative policy proposals and goals to end poverty in America to address the social and public health crisis in the Gulf Region. They plan to use student vouchers to pay for private schools, paying faith-based organizations to help with temporary housing and public assistance and scale back business regulations through the President’s Gulf Opportunity Zone proposal. Recently, Mr. Bush issued an order that exempts federal contractors working on disaster relief projects from a longstanding federal requirement that they pay workers “prevailing wages,” which are usually pegged to union pay rates.

While many of these proposals are based on the current weaknesses within the Republican Party, the Democratic Party has failed to propose specific policies to address the current crisis of high gas prices, the Iraq war, Katrina and Rita recovery and rebuilding plans, poverty and the crisis of confidence the American people feel about their government. What is needed is concrete leadership and action to address the current malaise.

The proposals presented above could be part of a bi-partisan package of legislation to address the Katrina and Rita crisis as well as begin to develop a well thought out response to poverty in America. President Bush needs to try something new and big to regain political momentum. The fate of the Gulf reconstruction and his goal to confront poverty nationally will determine the fate of the Bush legacy. They are now inextricably linked.
Bishop T.D. Jakes, founder of Potter’s House, a 30,000-member mega church in southwest Dallas recently revealed to President Bush the following, “The storm has made us think and look and reach beyond the breach and dare to discuss the unmentionable issues that confront us. It is not so important on what we say. Real leadership is defined by what we do.”