July/August 2004

The politics of health

An interview with Ana Micka of Campaign for Better Health

By Ravi Dykema

      As alternative and complementary medicine are becoming more mainstream, the opportunity has never been better to enact positive change at local and national levels. To promote health, it's essential for alternative health consumers to be active and visible. But until now, the so-called alternative community has been bedeviled by a lack of organization and, hence, lack of a united voting voice in national, state and local decisions. Now, a new organization promises to give "alternative" consumers a stronger voice.

      The Campaign for Better Health was created as an umbrella for Citizens for Health, a decade-old national grassroots advocacy organization aimed at protecting and expanding health choices. Formerly headquartered in Boulder and now located in Washington , DC , CFC helps give consumers a united voice on issues ranging from supplements to organic food to alternative and holistic health care. CFH is dedicated to protecting access to safe, effective and affordable natural treatments and products and promoting safe food, clean air and water, and the freedom to make health choices.

      The Campaign for Better Health was started to further promote integrative healing and create a strong national voice for consumers of complementary and alternative medicine. Campaign for Better Health was launched in October 2003, when a group of prominent health organizations and leaders-including Deepak Chopra, Andrew Weil, the National Foundation for Alternative Medicine and The Center for Mind-Body Medicine-joined together to address health care issues in America, including rising healthcare costs, and promote natural options. Its mission: To "accelerate the shift from a treatment-based health system to a new, broader and more profound health and wellness culture that reduces costs, empowers individuals and enhances quality of life." Here, Nexus publisher Ravi Dykema talks to Ana Micka, President/CEO of Citizens for Health and Campaign for Better Health about the current state of healthcare and the future of alternative and complementary medicine in America .

 

RD: Tell me about Citizens for Health.

AM: Citizens for Health has always been a consumer-based organization; we've worked on issues like preserving access to supplements; that's a core consumer issue for us. Another big issue we took on was keeping our organic standards strong. The USDA created standards for organic food that would have allowed things like toxic sludge for fertilization, genetically engineered food and irradiated food. Citizens for Health ran a major campaign to keep organic standards strong.

      When I got involved with Citizens for Health, I had spent years on campaigns, and was personally actively involved in both the alternative medicine community and the organic food community; I kept thinking that I could help the politicians see this constituency, these consumers of supplements and organic food. Because the reality is that they don't; we're not a known voting block. They can't rely on us as a vote because we don't identify our core issues as an agenda, so we're invisible. We're also not organized in a way that fits into the existing structure.

 

RD: Do you have to have an organized constituency to have your agenda considered in the discussion?

AM: I think so. If you look at the last couple of years, I think the alternative health consumers are the largest unorganized constituency. If you look at health, the major discussions have been a huge prescription drug giveaway. Our community has a lot to say about that conversation, but we don't have a seat at the table.

 

RD: What other discussions have we been left out of?

AM: All the discussions around Medicare, the health care cost crisis, insurance. We really have a role to play and a lot to say, but we have not organized our answers or organized ourselves. 

 

RD: How did you first become interested in changing this situation?

AM: I personally got frustrated with the inability of the people who are supposed to represent us to see this constituency and our issues and solutions. I decided that instead of working within the system, which I felt was just too rigid, I would step outside the political world and give it a little shove by organizing and making visible this constituency.

 

RD: Do you think it's working?

AM: Well, the community has become visible at moments, and when it does, you can see the tremendous power. For example, DSHEA, the Dietary Supplement Health and Education Act. We were able to generate two million letters to Congress to support this law, which helps keep the FDA and Congress from overregulating and limiting access to safe substances we've used for centuries. That represented more involvement than politicians saw during the Vietnam war. The proposed organic food regulations was another example: We generated 350,000 letters to the USDA pushing for stronger organic standards, the most they've ever received. When it needs to, our community can really pull together and have a great deal of power.

 

RD: Did these events make it clear to others that this powerful constituency could do a lot if it were organized?

AM: It's a combination of seeing those moments and looking at the millions of individuals in the marketplace. We're really making a huge impact, whether it's for organic food or green housing. It's the same impulse people are having for alternative wellness and better options. People are looking for solutions which they're not finding in the conventional model, often in opposition to what their families or doctors think is right. It's a very powerful constituency that's making a huge mark, and there's a reason that many hospitals now have integrative wellness centers within them. It's because of this demand from the consumers. 

 

RD: How do you know there are millions?

AM: The majority of Americans buys supplements. A majority of Americans has used some form of complementary alternative medicine in the past year. It's a $40 billion industry.

 

RD: And how do you know they would vote based on certain values or agendas, as opposed to simply buying vitamins and organic foods while remaining politically inactive?

AM: That's the problem-they're not presented with these issues, so they might not think about them in the voting booth. This is our challenge-to create a constituency, create a presence, create an agenda, hold our elected officials to that agenda. At the same time, these are people who have taken some pretty serious political actions in the past decades-like the letter-writing campaigns I just described. When people take that kind of action, they'll often then vote on those kinds of issues as well. They just need to see themselves reflected in the national and the state policies.

 

RD: Has anybody done an analysis or a poll regarding this constituency?

AM: Polls don't tell you much politically. They're really very deceiving. I go from the response I get from both the leadership and the consumers I work with who want to know how they can make a difference, how they can make alternatives available to more Americans.

 

RD: Do you know the work of Paul Ray [author of The Cultural Creatives, Harmony Books, 2003; Ray was interviewed in Nexus, March/April 2001]?

AM: Yes-I'm actually with him in a group called GEMS (Green Economic Movement Strategies), which is looking for ways to aggregate green housing and green investments. I think there are ways to help folks who buy organic food understand how they can also do green housing or green investing.

      What Paul has said is very important: The way people believe they can translate their personal values in the public arena, whether it's the foods in the schools or better policies at their local hospital, is to see themselves reflected. One of Paul's theories is that if people could just be visible and recognize each other as fellows in values, they will be much more potent. People need to see that, "Oh, what I believe isn't just crazy little me over here by myself; I'm really part of a large group of people."

 

RD: He describes the cultural creative demographic as being 25 million people. Is that the constituency your organization is going to be representing?

AM: As long as it's broadly represented. When people look at Paul's information, they oftentimes think, "Oh, that must be the elected Democrats." That's not true. We are transpartisan, all the way from the grassroots community level up to the national folks who help us and our supporters in Congress. A lot of our grassroots supporters aren't progressive Democrats, but they believe in alternative medicine and organic food and a more sustainable way of doing things. So, when you look at the category, cultural creative, don't assume it's just the "lefty" progressives. For example, our supporters range from Dan Burton from Indiana , who is one of the more conservative Republicans, to Peter Defausio, from Oregon , who is one of the more progressive Democrats. In fact, they're co-chairs of the Complementary Alternative Medicine Caucus.

 

RD: Do they report to the public through a website?

AM: No-caucuses these days don't have any resources, so we're helping them hold briefings. This caucus has been around for three or four years. They've gotten active on legislation, especially Senate Bill 722, sponsored by Senator Durbin (D-Illinois), which would put a lot of supplements into a pre-market approval, high-cost drug model, and remove a lot of supplements from the marketplace. The caucus has introduced a bill called the Full Implementation of DSHEA Bill (the Dietary Supplement Health and Education Act.), which would help give the FDA a little push to say, "Please, fully implement all of the bill that you were asked about 10 years ago."

      They've also been working on a lot of the communities' concern about Andro, a supplement in the sports community: Many folks feel that it's not really a dietary supplement and should be regulated as a controlled substance. They're also looking at other ways to help chiropractic and some acupuncture be better covered by insurance and Medicare and Medicaid.

 

RD: You are suggesting that when people in this constituency become more aware of each other, they'll do more. What do you want to have happen?

AM: That's a big question, and I don't proclaim to know all the answers. One of the reasons I feel confident that there needs to be a group like this is because the agenda is not fully defined. We're all doing some things in our lives that are helping us individually, and part of that is taking responsibility for our own health and healing, as opposed to aggregating it to doctors on high.

      But what would it look like 10 years down the line if we had our way? What kinds of payment systems would be in place? What would Medicare look like? Those are the really big questions. In the meantime, I'm looking to create this constituency around some of the core values and projects. For example, the Los Angeles School District has a wonderful policy about locally harvested, sustainable food, and limits on what can be sold in vending machines. I'd like to look at that program and get that implemented in other places around the country. 

 

RD: It sounds like you're blending two values: One is healthy food, the other is an environmental concern for sustainability, locally harvested food, things like that.

AM: They go together. The food that's currently served in the food system follows the commodity subsidies. We subsidize refined foods and corn syrups, but we don't subsidize fruits, vegetables or nuts. I'm not saying we should subsidize everything, but we should take a look at our policies. If we value nourishing food, if we know that it's important to eat fruits and vegetables and nuts and whole grains, we should model that, in both the national policies and in local communities-like the Los Angeles school system.

 

RD: Are there other arenas where your current projects are focusing on creative change?

AM: Yes. Here's an example. We would like to do a fair amount of work with the National Foundation for Women Legislators, who are Democrats and Republicans around the country at state levels. Women control most of the health committees around the country and are personally interested in alternative medicine, but are unaware of what they could do or tentative about taking something to the state legislatures. We're working with them on various pilot programs. For example, even the NIH (National Institutes for Health) says acupuncture reduces the amount of time someone with asthma spends in the emergency room, so let's see if we can get these solutions implemented in local hospitals. I think that as the grassroots base forms and gets involved both locally and nationally, the agenda will unfold.

 

RD: Are these programs the efforts of both the Campaign for Better Health and Citizens for Health?

AM: These are the more campaign programs. Citizens is really a lobbying group. Most groups have an education arm and a political arm-for example, the Sierra Club. Citizens for Health has been around for about a decade to specifically do lobbying on alternative medicine, supplements, and food and water issues. Campaign for Better Health is the umbrella organization involving a lot of different players in the alternative movement around initiatives that we can all do together. 

      A lot of the work I described is education and public awareness work in the communities, like building healthier lunch programs or doing pilot programs in different cities. Citizens for Health is also doing a nationwide voter registration campaign through health food stores to say, "Stand-up. Your vote counts. Start seeing yourself as a voter, start thinking about the issues around health and wellness." We're putting together literature, and making that information available through the food stores. It's an easy way to distribute information to folks who are probably concerned about food and health.

 

RD: What are you hoping will happen in the political arena? What would the platform be that would attract this voting block to a candidate or to a party?

AM: The full platform is unfolding. For me, the first task in all of this is to form the constituency, to start being present on a few specific issues, whether it's as small as the Farm to Cafeteria Bill that helps connect school children with local farms, or as large as issues about access to supplements and natural medicines.

      We're also starting to look at ways to enter the healthcare cost debate, and we're starting to look at the research. The majority of Americans are involved in some way with alternative medicine and supplements, but far less than one percent of federal resources are going towards researching or implementing any of these approaches. So we're shifting some of that balance. 

      If you were looking at ways to shift national priorities, it's not so much about electing a certain presidential candidate, one who's part of or sympathetic to our cause. That may happen sometime down the line. It may be 30 years, it may be eight years. I don't know. But impacting national priorities, inserting ourselves into the debate about healthcare coverage, around consumer safety issues, yes, we can have a major impact.

 

RD: I've wondered if people in the political arena have to get votes wherever they can get them, from whoever might vote for them.

AM: No, they know exactly where their votes come from, and who's going to deliver them. That's how they get votes. The Presidential race is a little different, because it's so big, but you know which constituency groups have endorsed you, so if you're a Democratic candidate, you want to make sure you have the pro-choice groups working for you, and they know who their voters are-they have a national database on them. The environmental voters are the same way. The labor unions are the same way. Candidates don't look for votes wherever; they look to specific bases to deliver the votes to them. 

      We've said earlier that people in this "alternative" constituency might not think the rest of the world has any shared beliefs around alternative medicine and organic food. But I am shocked when I walk into mainstream supermarkets and look at the magazine racks. There's Vitamin Guide A to Z, Body and Soul, Alternative Medicine. So what used to be sold at the natural food co-op is now at the big grocery stores.

      So it's out there, and it's broader and more prevalent than we think. And then research like the Eisenberg study is showing that Americans are using alternative medicines much more broadly than we may think. I think it's surprising many in the conventional establishment. The Eisenberg study was actually two studies done eight years apart by a Harvard professor. The studies found that something like 42 percent of Americans are using some sort of complementary or alternative medicine.

 

RD: But in the medical community, there's still a lot of skepticism, especially when change involves adding an entire category of professionals who are going to be paid by the insurance companies or the hospital.

AM: That's why I think the consumers have a really important role to play in all of this-how we are provided healthcare should be partly our decision, and not a monopoly decision. You only make those changes by getting active and involved, showing the data, asking for it, asking for it again, having your state rep ask for it. That's how it goes.

      The other thing is that the healthcare system is starting to fall apart. Doctors are no longer happy; they've lost the magic. When many of them entered the field of medicine, they had time to spend with patients and they had relative freedom; now they're forced to do what the hospital's CFO tells them to do. So there's a lot more openness among doctors to alternatives.

 

RD: So you're saying managed care is actually making physicians more open to alternative medicine because of their general state of disgruntlement with the status quo?

AM: I don't have data on that, but this is just from conversations I've had. There's a disenchantment with their role in the whole system, and that breaks down barriers. When it's not working for them, they can see how it's not working for other people, too.

 

RD: How do your organizations help create legitimacy for complementary and alternative medicine?

AM: I think it's just starting to happen, as more research comes out. I just spent a couple of days at the Aspen Institute, and some of the most compelling speakers were from mainstream institutions. Dr. Mehmet Oz, who has the Discovery health show called Second Opinion and is a leading cardiac surgeon, talks about the role integrative health can play. That adds a great deal of validity. And when supplements or other so-called alternatives are suddenly backed by research, it helps make the idea of alternative and complementary medicine more legitimate.

      For example, research validating the health benefits of omega-3 fatty acids has opened the eyes of a lot of conventional folks. Studies have shown that omega-3 plays a huge role in heart health, depression, diabetes and just about every cell function. Omega-3 is a standard supplement. Fish oil and flaxseed oil are the two most available sources in the stores. For years, the conventional wisdom has been that you can get all of your nutrition from food. You don't need to take supplements. Now, the Journal of the American Medical Association has not only said omega-3 is very important, but has also said everyone should take a daily multi-vitamin.

      So, people are starting to accept that we may not be able to get all the nutrients we need from food. The levels of omega-3 fatty acids in our diet are shockingly low. Something like 99 percent of Americans get less than 50 percent of the recommended levels of omega-3 in their diets. We get almost none, and it's causing huge problems. This is an example of something from the alternative community having a serious role to play in health and well-being.

      Chiropractic care is another major area of the alternative medicine community that's advanced into the mainstream community. Chiropractors fought for years with the American Medical Association and finally had to sue them for violating anti-trust laws. And they won. None of this has been easy, but it's really been marching along. The public is pretty far ahead of the medical establishment and way ahead of Congress. It's our job to change that, one check-out lane at a time, one vote at a time, one letter at a time.

 

RD: One of the biggest current dietary trends is the low-carb, high-protein diet. Where do your organizations stand on this?

AM: Our overall position is not in favor of carbohydrates or in favor of proteins, but in favor of eating closer to the earth-that is, organic, whole foods, as unpolluted as possible. We're also in favor of taking into account what works for you. For some people, it may be the low-carb, high-protein diet. Some people need a more varied diet. We try to help people see what they need. It's more of an individualistic approach.

      We don't take the position that research has all the answers; we believe that individuals know what works or doesn't work for them. So the mechanism we're putting in place is to have consumers and individuals respond to how they think the food pyramid best suits their purposes. Our main position is that the food pyramid should be based on what's best for health, not what's best for commodity crops.

 

RD: Is that how prior pyramids were determined?

AM: Well, it comes from the USDA, which is not a health organization. And there are major influences on the agencies that make these decisions. The biggest winners tend to be grain and corn. The food subsidies are bigger health concerns than the food pyramid. Subsidies are why corn syrup is so cheap that it can be in everything. The same thing with grains.

      We're not taking an official position on the low-carb/high-carb diet. It varies for each person based on their individual needs. Our stand is that whole grains are much preferable to refined grains; that you need to have a lot of green, leafy vegetables; you need to have vegetables of other colors-red vegetables like beets, and orange vegetables like carrots; you need to have adequate fruit. These are the fundamental issues for health. And you should probably keep away from refined foods, whether you eat more carbohydrates or less.

 

RD: Are you concerned that the current low-carb/high-protein trend puts people at the top of the food chain and concentrates even more toxins and chemicals in our bodies?

AM: Yes. I think our country's approach to raising animal products is a big concern. Toxins and chemicals do tend to build up in the body. But our concern isn't just about bioaccumulation. It's also about the overall approach to how we raise meat, how animals are treated, how much food they consume, how much water they use, how much fuel and energy they take to raise and process. So it's a much broader issue than the impact on individual health. It's also about the impact on the environment and society as a whole.

      We encourage people to look for locally grown and raised meat and produce, free-range animal products, organic foods. And as I said earlier, we do support individual choice. Although I don't know that we should be eating steak every day, animal protein is the best alternative for many people.

 

RD: So what's your diet like?

AM: Mine? Well, I'm working on it. I'm a standard mom with a two-year-old who works full-time and commutes two hours a day. My family eats all organic. We buy most of our meat from the farmer's market, or sometimes from an organic store. I tend to eat lower-carb than higher-carb, simply because I've never liked bread, so it's way easier. But I'm not perfect. Far from it.

 

RD: What would you change to be perfect?

AM: I would eat breakfast. I would stop drinking coffee every day. I'd eat lunch, instead of just cruising through my day. All of a sudden it's 4pm and I'm like, "Oh, I haven't eaten a damn thing today except my latte." Political campaigning is just the most unhealthy lifestyle you could lead. You start the day with coffee, bagels if you're lucky. You're working 18 hours a day, and drinking for the last three of them. It's really bad. So on a scale, I'm eating relatively well, and I'm working on it.

 

RD: You have a daughter. Are you concerned about chemicals in the environment which disrupt hormones [see Nexus, January/February 2003]?

AM: We're very careful in our own household, but you can't really escape it completely. Life right now is toxic. I'm in a working group study showing that we all walk around with an average of 99 different known toxic chemicals each day.

 

RD: Is this one of the issues your organizations deal with?

AM: We're quite concerned. Many people have environmental sensitivities, and the number is on the increase. I think indoor air pollution-like outgassing from paint and carpets-is a big concern. As we develop and grow, we'd like to examine the issue of healthy homes and workplaces, and help promote using environmentally sound materials on walls and carpets. We would probably partner with existing organizations doing that kind of work. We're looking for a partnership model in a lot of our activities, so we can add energy to existing efforts, rather than create a whole new agenda or project.

 

RD: Who are the primary funders of your organizations?

AM: Our funding is fairly equally distributed among the founding partners-the individuals or the organizations they represent. All have a financial stake of some sort, depending on what they can do, or they've helped raise money. For example, some of our founding partners include Bastyr University, East West Academy of Healing Arts, Deepak Chopra's foundation, the National Foundation for Alternative Medicine, The Center for Mind-Body Medicine and Andrew Weil Enterprises.

 

RD: What's your budget for the year?

AM: It's $600,000.

 

RD: Is that a little or a lot compared to other organizations like yours?

AM: It's not as much as the other advocacy groups that have been around for 20 years or 30 years, but it's enough for a strong start, especially with technology. One of our main investments so far has been in our website technology, not just the design, but what's called the "engagement tool kit." It easily gives individuals the ability to send either a letter or a fax to a decision maker, like a state rep or a federal member, and it allows us to keep everything updated, respond to requests and notify people of different information.

 

RD: Is that common for political action websites?

AM: Many groups are now developing interactive websites. For example, NRDC (National Resources Defense Council) has an activist site; MoveOn.org, probably the best-known advocacy model, does everything online. We think it's important to have both online and offline activities for folks.

 

RD: And how big is your staff?

AM: We have five people. Well, four and a half.

 

RD: Your budget sounds like an absolute bare-bones minimum. How do you make it work?

AM: It's doable in Washington. We're a startup organization, and there's no other equivalent start-up organization, so it's hard to compare.

      We're not a corporate entity. We're a grassroots organization, and our power is in getting people to take action in their communities. To do that, we have to be able to reach a consumer base; we work with publications with a major consumer base, or we go through the health food stores. We also have a built-in distribution network that many groups don't have, because of our partnerships. We really work on a partnership leveraging model, and try to save resources that way.

 

RD: Who got Campaign for Better Health together? Was it one person or two people? Was it planned around a conference table, or with somebody jotting down notes on a napkin?

AM: It started with a series of events last April and May, 2003. It was my idea, but I don't want to claim authorship. Our beginnings involved some well-known voices like Deepak Chopra, Andy Weil, and Judy Brooks and Roy Walkenhorst from Healing Quest, a wonderful new show on alternative medicine that's just starting on PBS. The National Foundation for Alternative Medicine had done an event, a black-tie dinner, honoring Berkley Bedell, their founder. These people had some other connections and some ideas, and we met some folks who said they wanted to help us have a bigger voice. A lot of this just started dropping into my lap. I also started recognizing, from my organizing perspective, that we need to have a bigger 501C-3, a larger, non-profit umbrella group, to help build a bigger platform.

      It all happened quickly. We didn't even decide to do our October 2003 launch event until July. Our website just launched January 10, 2004.

 

RD: Wow. It all sounds so easy.

AM: Yes, and it's been fun. I think one of the reasons this organization is coming together so effortlessly is because there's a desire for it. I had nothing to start with. I simply put the idea out, and people were attracted to it. I think it's a sign that the time has come.

      For more information, visit Citizens for Health at www.citizens.org, or Campaign for Better Health at www.betterhealthcampaign.org.