Jeff Niederdeppe: Involving Policymakers in Discussions of Childhood Obesity

Jeff Niederdeppe is an Associate Professor in the Department of Communication at Cornell University. His knowledge exchange project, which focused on discussing child obesity with politicians in the New York area, began at UW-Madison and moved with him to Cornell.

How did you develop your knowledge exchange project?

This particular project grew out of a larger project that Dave Kindig [a site director] was working with the Robert Wood Johnson Foundation on, the County Health Rankings. He was a very strong advocate for my work on engaging policymakers’ perceptions of different ways of talking and thinking about population health issues, so he asked me to put together a sub-proposal that would be part of that larger grant proposal. The grant proposal was to turn it from a Wisconsin-level project to a national project. We argued that we needed to make sure state legislators or policymakers are part of this project. We said that we wanted to do some interviews in the first year and go out and meet these policymakers in their offices and learn how they think about these issues.

It felt like it was a good fit in this County Health Rankings project, which was all about using rankings and metrics to put these points on the agenda and identifying areas where action could happen. If you’re going to say, “We need to do something to improve these rankings. Our county doesn’t do well on this, this, and this,” you also need to know how to talk about those things in ways that are in tune with what decision makers have to deal with in their jobs.

Let’s document what we learn, let’s do it in a scientific sort of way, and then let’s publish these results so other people can use these conversations as a starting point.

People often say, “Let’s pay a communications firm to do this work.” That certainly can be helpful, as many communications forms have relevant expertise, but this kind of process doesn’t lead to anything that is generalizable or transferable, since those data become proprietary. So that information doesn’t get shared with the general community. It was important not only to do this kind of work but also to be systematic about it and say, “Let’s document what we learn, let’s do it in a scientific sort of way, and then let’s publish these results so other people can use these conversations as a starting point.”

How did you feel going into this project?

In the last several years, I’ve gotten interested in health policy and public opinion and the role of media and messages in shaping how we think about policies and what kind of policies are implemented at various levels. By definition, that involves a translational research component; by definition, it includes engaging with the public and engaging with decision makers. So I definitely see it as part of this kind of work.

Any worries?

I felt pretty nervous when I started. You know, I’d go right into their offices, sitting in there, and I think they all kind of wondered, “What’s his angle?” I wanted to be careful not to convey a partisan stance on these issues because I was dealing with people across both sides of the political aisle. I think some of my work could be interpreted as being political, in the sense that I’m talking about policies that are relevant to health and income inequities. In some circles, that places you in in a spot on the political spectrum. So I thought about those things.

Did all the policymakers agree to participate? Was it hard to get time with people?

It was harder the higher up they were. City-level and county-level folks were easier to get in touch with than the mayors of larger cities. People who had bigger jurisdictions were harder to get ahold of, but I think being from Cornell, which is a land-grant university in New York, helped. One of the reasons that a lot of state senators and state legislators spoke with me was because they had connections to Cornell. They saw that I was from Cornell, and they wanted to be a part of it and help out. Some of the people spoke to me because they wanted to learn about the issue and they saw me as being a person with expertise.

Persistence paid off. We would send [policymakers] emails and then follow up with phone calls, and we’d talk with assistants. We were patient over a period of 3 or 4 months, and we wound up talking to a lot of people.

I was quite pleased with the response. I couldn’t tell you exactly what our response rate was. It wasn’t 100%, it wasn’t 50%, but it wasn’t 5% either. Persistence paid off. We would send them emails and then follow up with phone calls, and we’d talk with assistants. We were patient over a period of 3 or 4 months, and we wound up talking to a lot of people.

How did the exchange work?

I should say for context that the project was about health and health policy, but we decided to make it fairly concrete, so we focused on childhood obesity. We talked about their perceptions: Where does this issue rank among all of the other things they have to think about? How important do they think it is relative to other things? We asked how much they thought they knew about the issue and how much they thought about it. We got into what they thought could be done at their level of jurisdiction, and we gauged their responses to a few kinds of statistical graphs showing how things have changed over time when it comes to childhood obesity. Those were kind of conversations starters. What do you think is going on here? What do you think has led to this increase? Here’s a comparison of people in rural vs urban areas, why do you think it’s higher in rural communities? We used these images as a window into how they were thinking about disparities, structural causes, social factors, etc.

They were allowed to ask questions, and I tended to follow this semistructured script. At the end we left it open for “What else do you want to know? What other questions do you have?” That led to some broader conversations about the issue. Some people did some follow up. They sent me things. They cut things out of the newspaper and said, “Here’s what we’ve been working on. Here are a couple policies related to childhood obesity that I’ve been a champion for.”

How did you measure the results of your knowledge exchange?

In real practical terms, we wrote up the results of our interviews and published a paper in an open access journal, so there was knowledge exchange in the sense that we reported what we learned from our interactions. Sometimes when you’re doing open-ended-interview type work, there’s a tendency to impose judgment or comparison to some kind of standard, and we tried not to do that. We tried to just report, “Here’s how these elected officials are thinking about this issue.” We didn’t wind up focusing on political differences so much, because we didn’t see a whole lot of them in how Democrats and Republicans talked to us about these issues. We tried to be transparent and certainly respectful of the people we worked with.

Did you get the results that you hoped for?

We learned about how the health policy–makers in New York were thinking about this issue, at least the ones we were able to speak with, and that has certainly informed my thinking and my work on the topic. On the flipside, I think the people we spoke with learned about childhood obesity through our conversations.

Do I think it led to concrete or specific, documentable changes? I wouldn’t say that necessarily. I couldn’t say these conversations led to policy X. I would say that multiple people commented that they learned quite a few things and had not thought about this or that before, so that’s a good thing. Nobody wants children to be sick and unhealthy—I think that’s a universal value that people across roles and jurisdictions appreciate. If I were to say what kind of outcomes happened, I would say people thinking differently about the issues, at least for a period of time. I think it was useful, and I think I could now follow up with these people to start to build relationships if that was part of where I wanted to go with the work moving forward.

Did your involvement in this project have an effect on your career?

It’s useful to see where people are starting from. That helped me think about what needs to be done and what might be something that’s feasible vs what’s 20 years down the line.

It definitely made me think about the relevance of some of the work that I’m doing. The kind of things that were of interest to policymakers and the kind of questions they asked were pretty telling. You sit around with a bunch of population health folks and you sort of all have a baseline way of thinking about things that is not the way the rest of the world necessarily thinks about these things, in terms of priorities, in terms of understanding that there are inequalities period, in terms of social factors that contribute to them—that there are things that can be done that impact health and health equity that are beyond health care and individual-level action. Having these kinds of conversations helped me see where people stand. These are all well-educated people who are serving the public and who want to do the right thing and who don’t think about these issues as often as I do. It’s useful to see where people are starting from. That helped me think about what needs to be done and what might be something that’s feasible vs what’s 20 years down the line.

Do you envision knowledge exchange projects being part of your future career?

Once I work toward being a full professor, I sort of feel like my goals—internal, promotion-wise—will be accomplished, and then I think I’ll be able to look outward even more. I see this interest as something I have started and that I want to develop and expand over time. I’m not at that position in my career where I want to tip the balance to where I’m doing more knowledge exchange than building foundational knowledge, because I think I still have to refine and develop my expertise and experience.

Has your thinking about knowledge exchanges changed over time?

When we first started talking about this at UW-Madison, it was about knowledge transfers, and I think it was a good change to use the term exchange vs transfer. I always thought this idea of knowledge transfer was simplistic and didn’t really resonate. It’s not like, “Here’s the knowledge, take it.”

Especially for the type of work that I do, which is public health communication, of course [knowledge exchange] should be part of what I do. I came to see it as essential and central through my participation in the HSS program.

Definitely being at Wisconsin, seeing the models, how they’ve gone about doing things that are policy relevant and outward facing, writing reports and disseminating them, working with the media to get them in circulation, working with legislators to say, “Alright, what are we going to do about the fact that Waukesha County is ranked 32nd on some outcome…” I hadn’t really thought about that as part of my role before I came to Wisconsin and participated in the program. But once you see that, you think, “Of course!” Especially for the type of work that I do, which is public health communication, of course that should be part of what I do. So I came to see it as essential and central through my participation in the HSS program.

Do you have any knowledge exchange activities underway right now?

I did my sabbatical in Australia, and I was working with Cancer Council Victoria, an NGO. They have a prevention arm out doing on-the-ground health promotion work, but they also have an advocacy arm working on advocating for public health policy, going out and doing media work, meeting with leaders—they have some liaisons and folks to meet with, representatives and that sort of thing. I am part of a project that we just developed before I left where we’re looking at different ways to talk about health policy issues related to alcohol and sugary beverages. We’ve been working with some of the advocates in developing our research study to ask, “What are the questions that would be helpful to answer to help you do a better job of advocacy for health-promoting policies?” So we’ve been working with some of those advocates and some of the prevention folks at this stage of developing the research project.

We will get the data and write it up for peer-reviewed stuff, obviously, but it will also feed back into their advocacy efforts. Not quite policy change in that they’re not decision makers per se, but they’re people who are trying to shape those decisions. I’ve enjoyed that project a lot. I’ve learned a lot from it, and I think it’s a nice model. You don’t see a lot of organizations here in the United States that bridge the research/advocacy gap successfully. You have public health advocacy and practice on one end—I guess health departments sometimes do both research and advocacy or promotion work—but in universities you don’t typically see that.

What type of scholars do you think would benefit from knowledge exchange?

There’s exposure and then there’s doing it. Thinking about knowledge exchange as a valuable thing to be done is good, and I think instructional models of people who are doing it would be a useful thing for people to be exposed to. But I don’t think everyone should be out there trumpeting their latest scientific finding as policy relevant.

I study this stuff. A lot of the time what happens is anything that’s new and controversial shows up on the news, and people hear about it. “Oh no, this new additive in food is causing cancer.” What you really need are people who are very good at translating, people who have deep and broad knowledge of lots of different things to be able to synthesize lots of accumulated evidence over time. I don’t think everyone is good at that. I don’t think that many people are good at that. So this idea that we should train everyone, especially if you do work that is very specific to a particular thing and you’re sort of on the cutting edge of things… Science takes time, it needs to be replicated, it needs to run it’s course before it’s actionable. Translational exchange work is often based on relationships and interpersonal things, too, and I think you have to have been around awhile to have a broad view and a long view. So I scoff a little bit when I see people saying we need everyone out their sharing their research. I don’t think you do. You don’t need every person out there talking about every study. You need people that are good at pulling it together, saying, “Here’s really the essence of what matters and what we should do about it.”