Sarah England's year in the legislative trenches

"When I was invited to work on Sen. Hillary Clinton's health policy team as part of my Robert Wood Johnson (RWJ) Health Policy Fellowship, I was very excited," said Sarah England, PhD, associate professor of molecular physiology and biophysics in the UI Carver College of Medicine. "I remember thinking how odd it was to be walking down the hall to my laboratory one week, and then walking through the senate office building the next."

Sarah England, PhDEngland is a member of the 2005-2006 class of the RWJ Health Policy Fellowships Program. The program provides opportunities for mid-career health professionals, allowing them to gain understanding of the health policy process, contribute to the creation of new policies and programs, and develop as leaders in academic health centers and in health policy.

Initially, England applied to the program hoping to explore how health policies affect educational policies. "There is a current focus on eliminating health disparities, yet there is very little training of students on this issue. I thought the intersection of health and educational policies was an interesting aspect to explore," said England.

In September 2005, she began a four-month orientation where she met with experts in health policy in Washington, D.C. She began her work in Sen. Clinton's office in January 2006.

Working for a high-profile woman, with demands on her that are higher than most senators, England found the most challenging aspect of her fellowship was to stay current on all of the health policy issues that Sen. Clinton was trying to tackle. England juggled about 10 different issues, maintaining detailed knowledge on each of them. Every issue surfaced during the year.

"The learning curve is very steep and the schedule is unpredictable in the Senate," says England. "You have to become a generalist instead of specialist, which was challenging since scientists are much more specialized."

England's year has consisted of drafting legislation, developing health initiatives, meeting with constituent groups on health-related policies, writing scholarly articles, and arranging briefings.

She has spent a large portion of her time drafting three unique pieces of health-related legislation. They are: 1) The SHINE Act (Screening for Health of Infants and Newborns), developed to help states increase their newborn screening capabilities so that all babies have the opportunity for early diagnosis and lifesaving treatment; 2) The GEDI Act (Gestational Diabetes Act), aimed at lowering the incidence of gestational diabetes, a disease which puts women at risk for complications during childbirth, and children at risk for developing Type 2 diabetes as adolescents or adults; and 3) The Nursing Education and Quality of Health Care Act (NEQHC), structured to increase the number of nurses who become faculty and develop initiatives to integrate patient safety practices in nursing education, and it also provides funding for rural nurse training programs.

By participating in the development of health-related legislation, England feels she has gained more perspective about how her research fits into the bigger picture. "My research at Iowa focuses on the basic science of premature labor. Interestingly, there was a bill being considered about the high rate of prematurity in our country. The bill passed the Senate and was referred to the House," explained England. "It's nice to see the tie between basic science research and legislation."

"My interest in health policy has greatly increased, and the knowledge I've gained is invaluable. I'd like to use my experience to strengthen the College and University by continuing to develop new health initiatives at the local, state and federal level," said England.

Her fellowship also has shed some light on how the federal government makes decisions about funding NIH and other organizations that provide grants to researchers. NIH reauthorization was one of the issues to which she was assigned, and it opened her eyes to the difference between authorizing funding and appropriating funding. She tracked the NIH reauthorization through the House and became entrenched in the process of how NIH is structured and funded and how the budgeting process works.

England also learned that policy and politics are very different things. The health legislation that she developed and worked on during the year was mostly bipartisan. "The senators often want the same things though their ideas about implementation are different," said England. Working in the minority party this year, she learned that having differing views at the table at the onset really does make the process go much more smoothly and teaches negotiation skills.

She was able to find similarities between working in the senator's office and in an academic environment. The staff was a very motivated, talented and collaborative group, explained England. The health issues that she addressed crossed interoffice boundaries, so she was able to interact with the education, agricultural, and judicial staff during the year.

Of course, many may wonder what it was like working for Sen. Clinton.

"It is truly amazing. She is incredibly intelligent, hard-working, and devoted to her job as a senator from New York and holds her staff to a very high standard. She gives her staff and fellows a lot of credit, which is nice," says England.

Her fellowship concluded in mid-December, and she has fully enjoyed her time in Washington, D.C.

"It's been incredible, I can't explain what it's like to be working where so much history has been made," she said. "I've enjoyed addressing policy issues that will help women and children. It's been a life-changing experience and I am sure it will enhance my career."