Avoiding “Mission Shrink” at Health Centers

by Marc Wetherhorn; Project Director, Community Health Vote

Over a period of 15 years working for the National Association of Community Health Centers (NACHC), I went from not knowing what a health center was to becoming almost unbearably passionate about health centers. I never did the real work of delivering health care to people every day – of literally easing suffering and saving lives and changing communities so I was in many ways a cheerleader for what the people who work at health centers do. I took advocating for health centers very personally. I viewed every policy and legislative fight for health centers and their patients as a battle, not just a job, and I HATED TO LOSE. I am an advocate, not a policy expert or lobbyist. I am living proof of the old saying that if you are a hammer, the whole world looks like a nail and I operate on the theory that if at first you don’t succeed, get a bigger hammer!

During my time at NACHC, I often asked folks what they thought the mission of health centers is. Not surprisingly, I got different answers from different people – ranging from the narrow “to care for the medically underserved” to the broad “make the world and our communities a better place”. I am willing to concede that just as “When you have seen one health center — you have seen one health center”, the mission that each health center sees for itself may be a bit different at the margins, but at the core it is the same:

To eliminate disparities in our health care system by providing high quality, affordable health care for everyone who needs it (or as many people as we can), AND to be leaders in improving the life and well-being of our communities.

I am not old enough to have been involved in the early days of the health center movement, but I am old enough to remember the times in which the movement began. Over the years, I have had the privilege of hearing from, talking to and working with people who were there and who made it happen and it is clear to me that just as health centers grew out of the movement for civil rights and social justice in the 1960’s, you cannot have a mission for a health center today that does not include advocacy for your community and empowering your patients. Simply put, without powerful grassroots advocacy and the bi-partisan political support it earned, there would probably be few, if any, health centers as we know them today and the result would have been no “mission” at all.

More than a few times I have had health center leaders tell me that they are reluctant to make advocacy or voter engagement part of their work because they see that as “Mission Creep” or going beyond the real purpose of the health center. Yet, those who remember the early days of the program would say that if advocacy and civic engagement are not part of a health center’s work today, then that health center has actually suffered from Mission Shrink!

I have nothing but admiration for the people who lead and work at health centers today. I went to business school and understand the need to maximize staff productivity and to pay the bills. It is true that the challenges have never been greater and the political environment in which health centers have to face these challenges has never been more difficult. Yet, the mission of health centers has not changed and the importance of their achieving that mission – in its fullest sense – has never been more important. While Health Centers continue their work to shape a better health care system, they need to avoid allowing their mission to shrink so they can continue to help shape a healthier civic system as well.

Marc Wetherhorn  has over 30 years of political, organizing and advocacy leadership experience at the state and national levels. Marc served for 15 years as the National Advocacy Director and Senior Director of Advocacy and Civic Engagement for the National Association of Community Health Centers.

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