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No state has fallen further than Kansas in America’s Health Rankings. We used to be 8th in 1991.
Why did we slip so far down in the rankings? The answer might surprise you; it’s based on a leadership challenge.
At the Kansas Health Foundation, our bold vision is to make Kansas the healthiest state in the nation and to do so, this movement must be powered by Kansans in positions of authority and influence to shift Health outcomes.
Starting with the launch of the 2025 publication, Leading Health, written by President and CEO of the Kansas Health Foundation, Ed O’Malley, this podcast aims to break down key concepts of this leadership challenge and actionable ways that we can work together to make a real impact on Health in Kansas.
In each episode, Ed O’Malley, and Senior Advisor at Kansas Health Foundation, Susan Kang, will highlight a chapter in the book and discuss with Kansans who are actively engaged in expanding our definition of Health.
Leading Health is an invitation to move the needle on Health in Kansas, and we invite you to join us in leading the way.
Ep17
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Chapter 17
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[00:00:00]
Ed O'Malley: Welcome back to the Leading Health podcast, where we go through this book, Leading Health: How You and 30,000 Kansans Help Communities Thrive. Susan, we're here today to talk [00:01:00] about chapter 17, Policy Over Politics. It's good to be with you again.
Susan Kang: It's great to be here, Ed. I'm really excited to talk about this chapter.
Uh, so we're now on mindset number six.
Ed O'Malley: We are well into part three of the book. Of course, listeners who've been following along will know that we are marching through the book chapter by chapter. The first part of the book was all about setting the stage- for why America's health rankings matters, why it matters that no state fell further than Kansas in those rankings- over a 35-year period. The second part of the book was really kind of the surprise. It's not a health challenge, it's a leadership challenge. And we tried to break down why it was a leadership challenge. Now we are in the heart of part three of the book, where we're describing these mindsets that we need more of the 30,000 to hold.
Uh, today, later on today, we'll be joined by Drew [00:02:00] Wilburne from the Kansas Health Foundation staff to be a part of this conversation with us. It'll be great to have Drew join us here in just a little bit. But Susan, let's get started. How should we dig into this chapter?
Susan Kang: Yeah.
Why Policy Over Politics
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Susan Kang: Yeah, so this is, you know, this chapter, you know, the, it's entitled Policy Over Politics.
And, uh, and in this chapter, we talk about the discerning line between policy advocacy and political advocacy. Talk a little bit more about that as a way to set it up for us.
Ed O'Malley: Yeah. Well, and Susan, I think I wanna start by, um, first saying that this was the chapter that as I started talking about, uh, this chapter with, with people- and I mentioned the title of this chapter when we were still drafting the book, I had a handful of people kind of look at me and say something along the lines of, "Oh, that is so naive." Huh. You know? "It's so naive- Uh-huh ... that we're gonna be able to put policy over politics." And, and I get where they're coming from, and I get the hard-nosed nature of the [00:03:00] political arena, but I, I do think...
So I think we're, we're, we're after a kind of a fine line here, right? And we're trying to help people think about the fact that on our, on our major challenges facing our communities, facing our state, I would suggest facing our country, that you really need progress. If you, if you're gonna have progress, you really need people to work together who come from different points of view.
Like, very few issues are solved for the long haul by one faction, you know, kind of hammering the other faction over the head. Now, that happens, and they might win in the short term, you know, but they won't win in the long term. And so, so we're trying to, with this chapter, we're trying to get people to think about if we wanna close the health gap, and this health slide, by the way, in Kansas happened when we had Republican governors, it happened when we [00:04:00] had Democratic governors- Right, right
it happened when, when Republicans controlled, uh, the federal, you know, the federal government, it happened when Democrats controlled the federal government. So it, it, it happened on all of our watch, and we're trying to get people to understand if we're gonna make progress on the health gap, we're gonna need more people who can kinda rise above the, the kind of two meta factions that we seem to have created in our society, a progressive faction and a conservative faction- Right.
and, and see how we need to get them working together.
Policy vs Political Advocacy
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Ed O'Malley: Now, I mean, to, to your question about policy advocacy and political advocacy- one of the things we play with in this book is know, policy advocacy is, is advocating for certain policies to get passed. You know, political advocacy is, in my opinion, is advocating for certain people to hold certain seats, um, in, in elected office.
And what we're finding a lot is those two things are [00:05:00] getting blurred often.
You know? Like, the people who are advocating for certain policy changes often, um, are, are advocating for s- for- Certain candidates ... for ca- certain candidates. Right. And it's just so blurred- Right ... that it becomes almost one and the same.
Susan Kang: Yeah.
Ed O'Malley: And there's nothing wrong with political activity, and there's nothing, um, wrong with people working hard to elect the people that they care most about. And we need people who can understand the difference between those two things and engage in policy advocacy- Right ... in a way that doesn't look like they're actually just after political advocacy.
Does that, does that make sense?
Susan Kang: Yeah. Yeah, I mean, you know, we're not naive to the importance of politics, right? Right. But, you know, but it's... the, the whole idea behind this chapter is to really, for the members of the 30,000, to keep in mind the importance of holding policy maybe over politics. Yeah. And, and I think that's what, that's what we're saying for the reasons that you just outlined.
Um- Yeah, and-
Ed O'Malley: We're not telling people they shouldn't ha- have deeply hel- held [00:06:00] political beliefs.
Susan Kang: Right. Right.
Ed O'Malley: We're... I think what we're trying to land in this chapter is that on some types of challenges, w- and I would say health is one of those, no one perspective is gonna rule the day.
Right. So we're gonna have to have people who work together, find the best of conservative ideas, the best of progressive ideas, the best of centrist ideas, knit those all together, and few and far between are the people who can have their own deeply held political beliefs and- Still work together ... at the same time realize- Yeah
we're gonna have to work together- Yeah ... as we're crafting policy, and we need more people like that.
Susan Kang: Yeah. Yeah, in this chapter you talk about the inherent upstream nature of policy work, and one of our mindset number one actually is, um working upstream. And, um, so I want... Will you just link the two concepts for us at this, at this point?
Ed O'Malley: Yeah, you bet, Susan. The longer people are involved [00:07:00] with trying to improve health, the more they begin to realize that health, improving health requires, uh, you know, getting further upstream- to use, to use that language from the first mindset. And getting further upstream, and what, what we mean by that is, you know, helping somebody who... an individual who is, quote unquote, unhealthy. Like, helping that person, you know, motivating them to go for a three-mile, you know, walk every day. Well, that's cool, and let's do that, but if the conditions around that person, like if the, the neighborhood they live in isn't safe to walk in, or if to survive that person is working three jobs as a single mom- and, and they have three kids too, um, you know, the, the, the... Like, we could try to motivate her to do a three-mile walk every day, but there are so many other issues- that, [00:08:00] um, are getting in the way of health for her. You know, things like, um, you know, i- is healthcare even affordable? Is health coverage affordable for her?
How can she work in a way and take care of her children that provides her then time to take care of herself? So a lot of... The more people work in this area, the more they begin to realize that actually making game-changing progress on health for a society, for a state, for a community, requires, uh, moving bigger levers.
And, and that's where we get to policy work. That's where it requires policy change that is in support of improving health. Now, we say several times throughout the book, a- at least once in this chapter, that there are conservative ideas and there are progressive ideas to improve health, policy ideas.
Right. We're gonna need a mixture of both. So [00:09:00] s- w- w- what we need people to understand, we've gotta get further upstream. We've gotta look at how, how, how do current policies get in the way of people being healthy, maybe inadvertently, right? Maybe not intentionally, but how do they get in the way of people being healthy, and how could we change those to make health, you know, the easier choice for more and more people?
Susan Kang: Yeah. Yeah, no, I, I appreciate that, um, connection.
Advocates Activists Bridgers
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Susan Kang: Um, another, another concept I want us to land a little bit here is, this notion of for transform- transformative change, policy change to happen, we need three roles: advocates, activists, and bridgers. And can you talk just very briefly before, 'cause I wanna bring Drew on, so can we talk just very briefly about the three different roles?
Ed O'Malley: Yeah, you bet. And this is, um, this was our attempt of trying to help people just create a little more precision with how they think about themselves when they're doing political advocacy or [00:10:00] policy advocacy, how do they think about others- um, and how do they think about what's, what's needed. And w- we name in the book is that, you know, there are, there are advocates.
So in, in the world of policy change, there are advocates, and we think of advocates as people who are willing to speak their mind, people who might be willing to, um, stand before their city council and, and during the public comment period and share their experience on a particular issue- or, or things like that.
We need advocates, and we need to admire and support people who choose to be advocates in their community and our state on behalf of the issues that they care about.
Susan Kang: Absolutely.
Ed O'Malley: What we also know is that there are also what the language we use is activists. And, and to me, these are people who mobilize advocates to work together.
So actually, they create more advocates, and they mobilize them to work together- to speak with a larger voice. This happens, um, [00:11:00] on, on all sides and all perspectives of politics. So we have advocates, and then we also have activists who are actively mobilizing those advocates and creating more of them.
That's great. We need that, too. We need people to help create order out of all of the different ideas and to help people see a path forward, and that's often what activists are doing. But what we point out in this book is especially right now, where our world has sorted itself into these two meta factions-
Susan Kang: Right
Ed O'Malley: we also need people who can be bridgers, who can find a way to find the connecting interests among enough of those advocates and enough of those activists. And if we don't have enough bridgers, we won't end up with policy change that's sustainable. And, and that... If we just, if we look at, like, what's happening nationally- the last 10, 15, 20 years, you just see, [00:12:00] like, policies getting swapped out, right? depending on who's in office.
Right. Yeah.
Susan Kang: So, so,
so,
Ed O'Malley: so one, one faction takes control. They implement their preferred ideas.
Susan Kang: Right.
Ed O'Malley: And four years later, another faction takes control, or eight years later, and implements their preferred ideas, and it's just like swapping out back and forth.
Susan Kang: Right.
Ed O'Malley: And so you're, you're not giving many things a chance to, to stand the test of time.
Susan Kang: Yeah, yeah.
More bridgers can help with that- Yeah ... which is why we lift that up in the chapter.
Ed O'Malley: Let's get Drew up here on the, on the set.
Susan Kang: I- Drew, thank you so much for joining us on this, um, episode around policy over politics.
Um, I'm really excited to have this conversation with you, just given your depth of experience y- in the political advocacy world, in the policy world, with that background, I'm curious to know what are some things that resonated with you about this chapter?
Drew Wilburne: Sure. I, I really appreciate the question about what resonated with me.
Harder Than Kumbaya
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Drew Wilburne: I think I'm, I'm gonna start with s- some of, some of the tension that it brought up [00:13:00] for me, to be frank. Um, I think an easy way to read this, and I think, Ed, I, I heard you mention this in the intro, is that this is about, like, being kumbaya, um, that this is about being naive to the realities of the world, um, that there's, uh, you know, a way to just navigate conflict really easily, um, and that's how we're gonna get this whole thing done, and that's what policy over politics, in my opinion, is not about.
It is not about, papering over disagreement.
It is not about avoiding the tough things. In fact, it's actually about leaning into them.
and I think there's an important distinction that happens there. Are we leaning into talking about people, or are we leaning into talking about issues?
Okay? And I think politics we end up talking about people.
Okay? We start, so we just start saying, "This isn't the lineup. This isn't the crew that's gonna get this done." And when we start talking about policy, that's when we start talking about answers, solutions- to the problems that we face.
And so I think [00:14:00] that distinction's really, really important, and I think throughout my life and throughout my, experience I have activate- or I've acted in, all forms- Of those things more unconsciously than consciously. And what this chapter helped me do is get out of default modes and into more intentional choices around how I'm acting, when I'm acting that way, and why I'm acting that way.
Ed O'Malley: Drew, I, love your point that this isn't easier. We're not saying this is easier. It's actually, what you're saying, it's actually harder.
Drew Wilburne: Way harder.
Ed O'Malley: You know? It's, so it's, the easy road is to fall into the default approach of, like, what faction am I a part of? How do I make sure I, um, articulate that kind of quote, unquote, "party line"?
Might literally be a party line- or might just figuratively be a party line. What we're saying here is, is much harder, it's actually riskier- Yes ... for the individuals who try to do this- Yes ... because they risk, uh, frustration with [00:15:00] their own people. So I love your point that, yeah, this isn't kumbaya, this isn't we're holding hands.
This is harder than, than the prevailing approach, which is actually the easier approach.
Drew’s Background and Lessons
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Ed O'Malley: But Drew, tell us just a little bit about, like, where, where does this, where do these ideas form for you? Like, tell us a little bit about your background. Sure. Susan and I of course know, but people will wanna know a little more about you 'cause you've, you've done a lot now here in Kansas, but you're, you, you, you come to us from far, far away.
So te- tell us about how your ideas about policy and politics have been formed based on what you've b- been doing in your career.
Drew Wilburne: I'd be happy to. And just to kinda continue on that last point that you made, I wanna say very clearly that it is easy to mobilize the people you agree with.
It is hard to mobilize the people that are the opposition, that you don't agree with, and that's why this is harder.
Um, and I think that it's really important because, um, I have times where I have to look at myself in the mirror going into a meeting and say to myself, "You are about to do one of these things, not the other," and that [00:16:00] has to change my behavior. And the way that I got to that was through time and through trial and error.
So, the large portion of my career the past eight, nine years, um, prior to coming to, uh, the Kansas Health Foundation, I worked in Pennsylvania state government. And I started for the Pennsylvania Department of Aging, where we oversaw Older Americans Act services, home and community-based services. Small state agency, and I transitioned from that to the largest state agency, Department of Human Services, where we oversaw Medicaid, where we oversaw SNAP, TANF benefits, substance use disorder, uh, child protective services.
16,000 people, $41 billion annual budget. The reason I bring that up is I was the little guy in the room and I was the big guy in the room, and that shapes a whole lot of how I bring, uh, myself to this work now. What I figured out was that yelling loud enough didn't do anything. Uh, what I figured out was that sneaky strat- strategic decisions [00:17:00] behind closed doors alone did not solve anything.
And what I figured out was we did a whole lot of perfunctory, performative listening to people that translated to nothing. And so I started finding myself figuring out how we knit together these different modes of operation, these different, uh, types of formal, informal authority to actually drive something forward.
And the greatest example in my life that I have seen around this was led by Judy Heumann, who is a, a, a hero of mine, and she's really the, the mother of the Disability Acts movement. Um, or the disability rights movement, excuse me. And what she figured out was that through informal relationships, by going to a summer camp called Crip Camp-
okay?
Susan Kang: Yes.
Drew Wilburne: And building relationships with people like them, like her, that they could create movements that were otherwise impossible. [00:18:00] Some of them had formal and informal relationships, um, with policymakers, with others. Sometimes they had to handcuff themselves to federal buildings to get that done. But at the end of the day, they did whatever they needed to.
They acted as activists, they acted as advocates, they acted as bridgers, and in with their own, within their own life and their own ecosystems, they acted as leaders, folks with formal authority. That model, which has stayed in place to this day- Okay? Have we fully realized the vision or the spirit of it?
Absolutely not. But that is policy that is locked in and that we aspire to bring about, uh, to its fullest at all times. That, to me, in seeing that alongside of the work that I did is what got me to this place. Now, it would not have crystallized to the degree that it did absent this book. Hm. So I think there's a reality in which 15 years ago, Drew having this in front of me is a very different Drew.
[00:19:00] And I think I may have gotten there a little bit quicker. And so while I'm grateful that this is here now, I still feel maybe a little bit of disappointment in myself that I didn't get here sooner. Hm. Hm.
Susan Kang: Thank you. Yeah, no, that, that was great. And, um, and I think there's... I think I- going back to the Crip Camp, I think there's a documentary-
Drew Wilburne: There is
on that. And I've watched it-
Susan Kang: So, yeah,
Drew Wilburne: yeah ... mul- so many times
Susan Kang: I have, yeah, I have watched that. That was, that's a really-
It's really great.
Yeah. It's really heart-rending in some ways too, but, you know, it's amazing progress. It's amazing. Yeah. Okay.
Coalition Example Pennsylvania Reform
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Susan Kang: Um, so I have another question for you. Sure. So can you share, um, an example of a coalition or a partnership that you're a part of, right?
That brought people together who otherwise, you know, I mean, wouldn't have, you know, normally been together, so w- that is to say, with different perspectives.
Drew Wilburne: No doubt.
Susan Kang: And talk a little bit about that, and then I have a couple of follow-up questions around that- Great ... as well.
I have two examples. So one that's relative to Kansas and one that's relative to Pennsylvania.
Drew Wilburne: Um, the first one that I'll talk about is in Pennsylvania, when we [00:20:00] found out... I, I worked, again, for the Department of Human Services.
Ep17_wide: Right.
Drew Wilburne: Um, we were the oversight, um, authority, the regulatory body for, um, children's facilities, youth in need, uh, facilities.
Um, so we're talking some very high-need individuals, behavioral health problems, substance use problems, uh, problems within their family. And, um, there were facilities throughout the state that we were responsible for making sure that those kids were okay. That's the job.
And we failed. And, um, in one instance, the only reason that we figured that out was because a journalist did their job-
and uncovered issues- Yeah ... that no state entity could have ever figured out. Why? Because they built relationships with those kids That sent us on a whole, um, trajectory of figuring out what do we do to make sure that this doesn't happen again? And when we talk about thinking systemically, we think about, okay, this is just, [00:21:00] this is, this extends far beyond the children and youth system.
Okay? It, it extends to their housing. It extends to their transportation, all those things. And what we realized was we need to overhaul a health and human services system-
Susan Kang: Yeah ...
Drew Wilburne: not just a child-serving system. And so, uh, the governor at that point in time appointed me to serve as executive director of what he called the Council on Reform.
The design by nature was to bring together factions.
We're talking about service providers. We're talking about kids who have been abused in the system. We're talking about, uh, state government, state agencies, local agencies. We're talking about police, the whole ecosystem. And our job in three months was to get into a room and to say, "What do we all need to do to make sure that this never happens again?"
So whether you came from public safety, whether you came from health and [00:22:00] human services, whether you were a senior living in a senior facility- okay? We said we're gonna look at every single one of these nodes along the system and say, "What can we tweak here? What can we reform there to make sure this doesn't happen again?"
It was an aggressive timeline, um, and it was one of the most intense experiences of my life. I, prior to that moment, had not had to bridge people-
to that extent.
Um, and I figured out real quick what that meant. Um, and I messed it up, uh, plenty of times. At the end of that, we developed what was the basis for the governor's budget proposal the following year.
So we literally said, "Okay, we have a health and human services ecosystem. Every single one of us plays a part. We all must indict ourselves for the role that we played in, in not protecting these kids. How do we roll up our sleeves and get to work to make sure it doesn't happen again?" Is the system perfect now?
No. Did meaningful changes occur? Yes. Rating cr- I could, I could go down the list of changes that occurred, [00:23:00] but that was a huge, major foundational example for me for, like, what working in that, uh, uh, mode looks like.
Ed O'Malley: Dr- Drew, I wanna hop in real quick because I, I think that's a great example. And remind us which governor that was.
Drew Wilburne: That was Governor Tom Wolf.
Ed O'Malley: G- Governor Tom Wolf. So, so it's a great example of Governor Tom Wolf in Pennsylvania using his authority. A governor has a lot of authority. Yeah. A g- a governor is a member of the 30,000.
Drew Wilburne: There you go.
Ed O'Malley: Right? a good example of somebody in the 30,000, which th- those who've been listening know what we mean by the 30,000.
Those are the 30,000 Kansans, that's an approximate number, but, you know, pretty good back-of-the-napkin math. Right? I remember the bar I was at when I used- ... the back of the napkin to add up the number of Kansans we think are in roles of civic authority. But that's a good example of, uh, of, of a, of, uh, somebody in authority using their authority To create collaboration.
Yeah. So that's one of the mindsets- Yeah ... create collaboration. So the way he set [00:24:00] up that task force, strike force- committee, whatever it was called, right? it sounds like it was designed- Specifically ... to force the different factions and interest groups to work together.
Drew Wilburne: Bingo.
Ed O'Malley: It had an aggressive timeline, which is another s- s- uh, kinda tactic of people in authority.
They can set the timeline. Right? And that timeline, sometimes they might set it wrong. Uh, they might give too much time. They might give not enough time. But by the fact, if they get it right, if they set a time boundary, it forces work.
Drew Wilburne: Bingo.
Ed O'Malley: Right? And then it sounds like also he, he did all this with an expectation on bridging.
Drew Wilburne: No doubt.
Ed O'Malley: And I, so I just think it's a great example, not only of policy over politics and helping us better understand your perspective. It's a great example of what somebody in the 30,000 can do with their authority.
Drew Wilburne: No doubt.
Systemic Strike Force
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Susan Kang: Yeah, and the other, the other thing that, um, came up for me was this, that whole, um, strike force worked systemically.
I mean, it, it really looked at the entire system. It wasn't just [00:25:00] about transportation.
Drew Wilburne: That's exactly right.
Susan Kang: It wasn't just about childcare, just about ch- you know, substance abuse. It was all, you know, the entire system put together, and I, that, you know, that's another great thing it sounds like-
Drew Wilburne: Yeah ...
Susan Kang: that the governor did, right?
Um-
Drew Wilburne: Yeah, it was really great. Yeah. And, and what he did is he put people with high degrees of formal authority on it. So every cabinet secretary that oversaw those agencies- they were there, and they weren't decision-makers. They were a resource to the people-
on that council to help them make decisions.
Wow.
And those folks are what told the governor it needed to happen. So my point is he structured it, I think, very intentionally, um, to, to make sure that the, the, the outputs, um, were, were in line with, I think, a lot of the, the mindsets in this book.
Designing the Process
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Ed O'Malley: I, I j- I just wanna play with this for another minute or two, 'cause I think we're onto something here.
You just said he structured it very intentionally, and m- I, I think a hypothesis that might be emerging in this conversation is that if you, if you are a mayor or [00:26:00] you're s- a member of the 30,000- You hold authority. And if you're wanting to help create an environment where there's a policy over politics mindset, how you structure the, the work is your ticket.
Drew Wilburne: There you go.
Ed O'Malley: I mean, that's how you help your people focus on what we're talking about in this chapter. You, you- if you're a mayor, you use your authority not to complain about the problem-
Drew Wilburne: Sure ...
Ed O'Malley: not to get together with just people who think like you already and talk about the problem. Not, not to propose your solution to the problem.
You use your authority to create the conditions for the right mix of people to have a healthy type of pressure, the timeline-
Drew Wilburne: That's right
Ed O'Malley: ... the aggressive timeline. You surround those people with the right resources-
Drew Wilburne: Yes
Ed O'Malley: ... right, like the governor did for you-
Drew Wilburne: Yes
Ed O'Malley: ... uh, that made the cabinet secretaries be there not as decision-makers but as a resource.
That's kind of a cool- ... kind of, kind of turning the [00:27:00] world upside down a little bit. It, so it's just a great example that what we're talking about is you can create a more, more of a policy over politics mindset by how you create the process. What a, what a gift those members of the 30,000 who know that, and how amazing it would be if more of them could work in that way.
Drew Wilburne: Yeah, I appreciate you saying it so much be- you're already, like, making me realize so many other elements of that- that I don't even know that we made consciously. Um, but when you start from that perspective, you start to find yourself, like, there's this cascading effect of, like, making decisions in that- Yeah
in that spirit, which is really important.
Inviting Opposing Voices
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Drew Wilburne: And, and, and on that note, the one that I want to say is, uh, he did not have to do this, but he made sure that the Speaker of the House, who was an opposing party, had a seat at that table.
Ep17_wide: Yeah.
Drew Wilburne: He made sure that-
Susan Kang: That's great
Drew Wilburne: ... the Senate leadership had a seat at that table, or at least a designee.
So, like, from a political perspective, from where you sit in the ecosystem, whether you're a part of his administration, whether you were a journalist, you had a seat at the table to bring your voice. Does that [00:28:00] mean you got everything you wanted? It certainly did not. Um, but that's the beauty of the whole thing.
So I really appreciate you mentioning that because it, it is both intentional and also unintentional that that kind of unfolds. Unfolds.
Susan Kang: So it sounds like, it sounded like, you know, um, you acted as bridger- .. in this context. Um, so in the end, what, what helped to make progress around that issue, you think?
Drew Wilburne: Yeah.
Setting the Stage Long Term
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Drew Wilburne: Half of it's the c- the conversation, and half of it's the process and the structure.
Susan Kang: Okay.
Drew Wilburne: Um, and there are things that are happening to this day- okay, that, um, had to happen on their own timeline. Um, I believe the governor of Pennsylvania just recently passed the largest, um, property tax, uh, rebate increase for seniors in third, 20, 30, 40 years.
That was something that was in that report set of recommendations. It couldn't happen on that timeline. It happened now. So it set the stage. And I think a lot about that in, in our work when we talk about each challenge and, uh, um, the reps that we're getting in. It's how do we set the stage so that things that we don't even know are possible [00:29:00] can happen later?
Susan Kang: I love that. So Drew, thanks so much for sharing that example from Pennsylvania. Um, uh, that was really amazing. I love that conversation. The, um, you had also mentioned, um, that you had a Kansas example, and I would love for you to talk about that, and I think it's around the groundwater issue that we've been working on.
But before you answer that, I would appreciate Ed, uh, giving us a little background on that.
Ed O'Malley: Great. You bet.
Kansas Groundwater Crisis
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Ed O'Malley: You bet, uh, Susan. So yeah, here in, in Sedgwick County, uh, in Wichita, w- the community has been wrestling with, with a tricky situation where f- you know, 40 years ago, maybe more than that now- Yeah ... I can't remember, uh, there was a, a contamination spill, a chemical spill related to, um, one of the, the railroad companies here in town.
That, th- that spill got into the groundwater- in the northeast part of Wichita, and, um, unfortunately, that only kinda [00:30:00] came to light just a few years ago, and the community for the first time fully understood that this spill happened and that they had been living over contaminated groundwater for almost four decades.
A really sad situation, scary situation, uh, for a lot of those residents because of the, the, the, the challenges with th- those chemicals and the, the fact that many of those chemicals, with too much exposure, lead to cancer. So, um, it has been a, a massive challenge over the last few years for that community to understand what happened- to, to seek justice, accountability, and help with, like, testing and- treatment. So yeah, as Drew knows, the Kansas Health Foundation, along with a number of partners, have been right in the middle of that issue. Uh, there's still a long way to go, but, um, but it is, um, an interesting example, an interesting case study on, on trying to get things to happen in civic life.
Drew Wilburne: Yeah, and, [00:31:00] and one of the reasons that I'm really, uh, grateful to be able to talk about this one is I'm not a native Kansan.
And, uh, I am a Kansan. Uh, and my family moved here. My parents moved in with us. We are Kansans. Um, but as that issue came to light, you can imagine how the type of credibility that you have really affects the way that you have to operate.
I just wanna be clear.
W- water, the thing that gives you life, okay?
Ed O'Malley: Lit- literally.
Drew Wilburne: Literally life. Okay, water is life, is what was contaminated, and a community of people did not have any or a full understanding of that for four decades. Unacceptable. It is literally what we talk about when we talk about inequities and health disparities.
And those are compounded by a number of other things.
Collaboration Across Sectors
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Drew Wilburne: You can imagine how intense and how hot and how difficult these conversations were.
They are nonlinear. They do not go from A to B. [00:32:00] They do not go from A to B to C. They go from A to X to G to T to B maybe sometimes. And there were many times where we thought that this thing was just gonna fall apart.
But through time and through proximity, and by bringing the right people together, we figured out how to do it. We're talking about state government. We're talking about endowed foundations. We're talking about community organizations, nonprofits. We're talking about local and city government. We're talking about banks.
We're talking about community foundations, other statewide foundations. Every single one of those entities played a role, and absent one of them, absent one of them, this doesn't happen. And so the point is more about us getting to a place where we could conduct testing for community members who have been hurt and harmed by a total injustice [00:33:00] through collaboration among many, and that is only one small step toward, uh, what this community needs and deserves.
But other... Or absent that process and that structure, it does not happen
Ed O'Malley: You know, that it's another great example of process matters.
Leaders Using Authority Well
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Ed O'Malley: So, uh, what, what's emerging for me in this episode, which frankly is not in the chapter. So r- I mean, right, right before this chapter was the chapter on valuing process and structure.
Kenny Wilk joined us for, for that one. Right. And Drew, I know that's something that you talk a lot about, you know, these days, is process and structure. Yeah. And, and I think what I'm doing, what this conversation is doing for me is it's connecting these two chapters in ways that I hadn't thought as clearly about.
The groundwater issue you're talking about, there were, again, there were, there were key members of the 30,000 who seemed to intuitively know how to use their [00:34:00] authority to create conditions that allowed for, for collaboration, and that allowed for us to focus on, um, on policy. You know, how do we solve this issue?
Drew Wilburne: Bingo.
Ed O'Malley: Rather than political games.
Drew Wilburne: Bingo.
Ed O'Malley: And I, I think about, you know, Senator Oletha Faust-Goudeau ... who, a state senator, happens to be my senator. Senator, if you're listening, uh, thank you for the work you've done on this, uh, groundwater contamination issue. But Senator Oletha Faust-Goudeau mobilizes the governor and the legislature to allocate $2.5 million-
Drew Wilburne: Bingo
Ed O'Malley: uh, to support, uh, testing of residents But, but also understood, she understood that, that the local people are probably best to figure out how exactly to administer that
Drew Wilburne: Key, a key moment and a key observation.
Ed O'Malley: Key, key, key moment. Yeah. Key moment. Right, right. So that, that, that's key, right? So, so like we don't get to where we ended up but for Senator Oletha Faust-Goudeau.[00:35:00]
But then you end up with y- like Ryan Beatty, you know, chair of the, the county commission that year. Yep. And, and you end up with Brandon Johnson, city council member, uh, from the, the area of the contamination. Right? And you end up with county manager Tom Stoltz, and city manager Bob Layton. And those four individuals in particular for the county and the city I think also understood how to use their authority, right?
So they convened the right people to come up with kind of a, a process plan-
Drew Wilburne: Yep
Ed O'Malley: ... which relied on community members-
Drew Wilburne: Bingo
Ed O'Malley: ... making decisions about how to best use those dollars. So the lots of examples. We were, with your story about Governor Tom Wolfe and your story about the groundwater contamination effort, lots of examples of members of the 30,000 using their authority appropriately to help people end up focusing on policy, like good policy, and not overplaying [00:36:00] that hand.
Drew Wilburne: Bingo.
Ed O'Malley: You know? That's a, that's a key, that's a key dynamic.
Drew Wilburne: Yeah, and I really appreciate you bringing that up because I actually think that doing policy over politics is not an act in and of itself. It's the other mindsets in this book that enable it to happen.
Susan Kang: Yeah. Uh, uh, that's, I, you know, with both of your examples, it really brings to the light all the different mindsets beyond policy and politics-
Drew Wilburne: Yeah, yeah
Susan Kang: right? Um, that we need to keep in mind to, to, for us to ch- to close the health gap. Yeah. So I think that's really amazing.
Kansas Ten Years Out
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Susan Kang: I have one last question for you, and that is, okay, so imagine Kansas 10 years from now, and if the members of the 30,000 kept policy over politics mindset, okay? What, what would, what would it look like?
What would be different? Not, not in necessarily in government, but what would be different for health in Kansas? K- health with a capital H.
Drew Wilburne: Yeah. I, I'll go to some, uh, specifics on this-
Susan Kang: Yeah ...
Drew Wilburne: um, rather than even speak conceptually, and I'm [00:37:00] gonna, uh, hit a lightning rod here, and we can talk some other issues if, if helpful.
Medicaid Expansion Reframed
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Drew Wilburne: But, uh, one thing I care a lot about is healthcare access.
And when I first got to Kansas, um, the Medicaid expansion debate was alive and well for a decade or more. Um, and what I quickly realized was we talked about a singular solution to a problem that literally everyone's agr- agrees with.
Susan Kang: Yeah.
Drew Wilburne: I have yet to meet a single person who says, "I do not want people to have access to healthcare."
Hasn't happened. And even if someone does think that, I think they're afraid to say it out loud. Um, and so my point is there's a window there. Medicaid expansion is a solution to that problem. I will put a ribbon on anyone's chest who can find any other pathway to get that many people healthcare insurance coverage Outside of Medicaid expansion.
That's what I'm here for. I am here for us to, the no stone, [00:38:00] unturned method. We look under every single rock to figure out, is there a pathway to get more people healthcare coverage in Kansas? That's all I care about. There was a day where I would not have said what I just said or believed what I was saying.
This book literally helps me lock those things into place and operate in a totally different mode. So I think that's an example. One way that things could change in Kansas is we could have a lower uninsured rate-
by figuring out how policy, the solutions that we bring to the table, overrides politics.
I don't care who in the legislature doesn't like this, uh, approach. I don't care which approach they do like. What I care about is us figuring out how to get from point A to point B, no matter how nonlinear that is.
Ed O'Malley: Yeah. Drew, what- ... what I'm thinking about right now is, you know, the Medicaid expansion debate in Kansas, which you're right, it has gone on [00:39:00] forever.
It feels, not forever, but it feels like forever.
Drew Wilburne: Yeah, sure.
Producer: A long, long time. And, um, and, uh, to, to be clear, Kansas Health Foundation is on record- Yeah ... of supporting Medicaid expansion. We think it's a, a really good idea. We think it's a good way, probably the best way, the fastest way to cover a, a, a large number of Kansans-
who will struggle to have access to, to insurance otherwise. And as you pointed out, and as we say in the book, it is a strategy. Uh, it is not the goal. The goal is reduce the number of Kansans who don't have health insurance.
Drew Wilburne: Bingo.
Susan Kang: Right? Right.
Ed O'Malley: Right.
Bridgers Over Factions
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Ed O'Malley: Um, but what I, what I started to think about as you were talking is the Medicaid expansion kind of effort over the last 15 years, it might be kind of an example of, uh, this was not intentional by anybody, I believe, but it might be an example of politics being more important than policy.
Drew Wilburne: I agree.
Ed O'Malley: You know, it, it pretty quickly became [00:40:00] a debate among political factions.
Drew Wilburne: Yes. Yeah, that's true.
Ed O'Malley: Right? It became a proxy-
Ed O'Malley: uh, debate, right? There was very little, uh, if we think back to the chapter, there were a lot of advocates and there were a lot of activists.
Drew Wilburne: That's
so true.
Ed O'Malley: There haven't been a lot of bridgers
trying to find common ground among those acti- And there, by the way, there have been advocates and activists on both sides of the issue.
Drew Wilburne: 100%.
Ed O'Malley: Haven't been a lot of bridgers, right? There've been a, a, a one moment, uh, when we came cl- the state came close to passing it. Maybe there were some more bridgers in that moment, right?
But-
Drew Wilburne: Good, that's a great point how, how it's not static.
Ed O'Malley: Yeah, yeah.
Drew Wilburne: At any point in time, there's shifting factions-
Ed O'Malley: Yeah, yeah
Drew Wilburne: ... and I think that's an important point. Yeah.
Ed O'Malley: But it, it, and like, for so many people, I think it, especially now, 15 years later, you know, I think there are, there are Republicans who feel like, well, they're, they're just supposed to be opposed to Medicaid expansion, and there are Democrats who feel like, well, they're just supposed to be in favor of it, and which is all fine.
That's all fine, whatever. [00:41:00] And it might be an example of w- politics is now trumping the policy. It, it is no longer really a policy debate. It is a proxy political debate. And what this chapter is trying to say is we need people who can recognize when that is happening, and find ways of intervening, and we have some ideas in the book, find ways of intervening- to try to create a different reality.
Drew Wilburne: Yes. Yeah. And I think there's so many examples of that in our culture right now, and we don't have to go down these rabbit holes, but I think about data centers. I think about voting. Uh, and, and so I think actually all of the major cultural, like the, the issues fixated centrally in our culture tend to have that profile- Yeah
and it's the ones outside on the periphery where I think the most opportunity can o- often lie.
Ed O'Malley: Yeah,
so true. So true.
Susan Kang: Yeah. I, I think part of it is that it's really, really hard to- So hard ... disentangle the people from the issue.
Drew Wilburne: I get caught up in it myself-
Susan Kang: You know? Yeah
Drew Wilburne: ... regularly.
Susan Kang: And I think that's, I think that's what makes it hard.
Drew Wilburne: I agree.
Susan Kang: Um, and I think that's all the more reason why it's important to have bridgers.
Drew Wilburne: Totally.
Susan Kang: Um, all right. [00:42:00] so thank you so much for an amazing conversation, Drew. This was really enlightening, um, and it brought to the fore the things that we really wanted to highlight in this, in this chapter.
So thank you for helping us do that.
Drew Wilburne: And thank you both, um, very sincerely for the ways in which you helped me, um, bring about these ideas. Um, I literally think absent the two of you and others here at KHF, I wouldn't be able to embody these things, so- ... thank you both for creating containers- Thank you, Drew
for us to behave this way.
Key Takeaways
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Susan Kang: Um, so we've come to the point where we talk about, you know, what our biggest takeaway is. Um, and so I'm gonna start. The thing that really resonated with me, um, in, around this chapter is how you started your, um, your story, which is the difference between politics about being the person and policy being around the issue.
And I think that that is a... You know, so for the, for our listeners out there, um, I encourage you to really take a look. I mean, really, [00:43:00] i- whatever issue you're working on right now, I'd be curious to know whether you are working, you know, on y- the politics aspect or the policy aspect, um, of the issue that you need to be concentrating on.
Drew Wilburne: Great
I think my key takeaway is stick to the plan. Um, and, and what I mean by that is, um, the longer that I've been in this mode of operation, the more I've seen its potential. Um, it can be unsatisfying at times because I like things to change immediately. Um, and what I've realized over time is that that's not the business that I'm in.
Um, and so, um, this conversation and, quite frankly, the experience of operating this way and bringing these things to life, um, has just created a resolve in me to, to see the work through and to continue it because I don't know what other way forward we have.
So yeah, I really think that this is just another example of a conversation that helps crystallize and set that in place for me and wanna do more of it.[00:44:00]
Ed O'Malley: Fantastic. Drew, thank you for joining us. Uh, Susan, as always, we had a, a great conversation. I think my, my, my biggest takeaway is I think I'm gonna be obsessed over this for a while. I, I mean, I think it's the idea that those in authority can create a policy over politics mindset with how they craft the process-
of engagement for, for their people and for people that they have influence over. Th- that feels like something that might need its own book someday. Um, I, I know so many mayors, county- commissioners, elected officials, chamber of commerce CEOs, uh, you know, highly involved community, uh, you know, private sector CEOs.
And, and for them to think about use your authority to create the process, you know, that's, that, that's big, and we're gonna keep playing with that. So that, that's, that's my big t- takeaway today. [00:45:00] Um, we will be joined next time by Ben Hutton will be back with us, and we'll be diving into the conversation, the chapter about embracing bold vision.
Until then, we encourage people to, uh, visit the show notes for additional information about this episode. Dive into this book, Leading Health: How You and 30,000 Kansans Help Communities Thrive. And Susan, we just keep marching our way through this book. Handful of chapters to go.
Susan Kang: It's been awesome.
Ed O'Malley: All right.
Take care, everybody. Bye-bye.
[00:46:00]