Results-Driven Governing | Q&A With Senator Elizabeth Steiner Hayward

Iris Hentze 3/29/2021

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Evidence-Based Policymaking Q&A Series

An Interview with Oregon Senator Elizabeth Steiner Hayward

NCSL sat down with Oregon Senator Dr. Elizabeth Steiner Hayward (D) in fall 2020 to learn how data and evidence have helped guide policymakers’ budgetary and public health decisions in her state. A recognized champion of evidence-informed policymaking, Steiner Hayward, who practices family medicine at Oregon Health and Science University, sponsored SB 526 in 2019, which established a Universally Offered Home Visiting (UoHV) program in Oregon for all families after the birth of a new child.

The legislation allows the state to partner with an evidence-based nurse home visiting program, which, in combination with hospitals and birth attendants, provides new parents with critical services and supports for their newborn in the first weeks of life. This can include up to three optional home visits.

In this interview, which has been edited for length, Steiner Hayward discusses how she uses and communicates about evidence-based policymaking (EBP), and how it has helped lawmakers prioritize funding to achieve better outcomes for Oregonians.

What brought you to advocate for data-driven decision-making—and what has kept you so engaged?

As a physician by profession, I’ve spent my entire career trying to find the best available evidence to treat patients and to educate myself and other physicians. I came to the legislature with that mindset nine years ago and since then have had the opportunity to serve as chair for a few committees, including the Senate Health Care Committee and the Ways and Means Committee. Whether in my policy-promoting roles or fiduciary roles, making sure we’re using the best available evidence and adapting to changes in evidence over time are the smartest things we can do.

We hear a lot about the importance of communicating clearly and realistically about evidence. How do you explain to other legislators why this matters and how do you bring them along?

Framing really matters for messaging and different stakeholders will respond to different approaches. It is not usually an issue of “I don’t care about the evidence” as much as it is figuring out what part of the evidence is going to resonate most. For some of my colleagues, appealing to their desire to have as much confidence in government as possible to get the desired outcome is effective. Having evidence and tracking what we are doing so we can make sure there’s fidelity means that any government intervention we try is actually going to be effective. For others, it’s more appealing to emphasize the fiscal impact and how evidence-informed policy can help us maximize the outcomes of every state dollar we spend. And still for others, you can present the data and science-heavy stuff and they’ll find that approach most appealing. It is important to always present data in ways that aren’t overwhelming.

We employed all of these messaging strategies to pass Oregon’s Tobacco 21 law back in 2017, which raised the minimum age to purchase tobacco and vaping products from 18 to 21. There were other legislators who objected to the law initially for a variety of reasons, but we were able to get them on board by making sure we integrated many different types of data into our messaging. For some, the evidence showing that raising the age to 21 could drastically decrease the number of people who smoke in the state overall was enough. For others, we shared the fiscal implications showing how much smokers cost the state’s health system and presented the economic analysis for what the state would spend on long-term care for smokers versus non-smokers.

In the midst of the COVID-19 pandemic, how do you and your counterparts across Oregon state government rely on data and evidence to help you make budget and policy decisions? How can the tools of EBP help you navigate through the current economic and public health crises?

Although we do have many public health principles on effectively dealing with infectious diseases that we can pull from, this whole pandemic has been challenging because there is so much we don’t know. On the fiscal side, in May 2020, we had a terrible budget forecast, and the governor asked our legislative fiscal staff to show cuts of up to 15% across state government. Our legislative fiscal analysts, who are top-notch and who know the agencies really well, were able to pull a list of all state programs for us. We began looking for those that haven’t yet been implemented and that we didn’t necessarily know would save us money in the longer term. We were able to use that to delay implementation of some of those programs to save us money for now, without having to pull as many resources from existing programs that we know are a benefit to the state.

The Universally Offered Home Visiting program that I sponsored, for example, did not take a cut because we had the evidence that it would save us money in the long term. We authorized $50 million in general obligation bonds as well for a public-private partnership, low-to-middle-income housing program that has been wildly successful at generating stable housing as well as construction jobs in Oregon.

This is good because it meets multiple needs that are in the state’s interests. We’re addressing our housing crisis and also creating construction jobs―and these are real, living wage jobs. That means people are not dealing with the housing crisis and their kids are not dealing with all the trauma that comes from having to move or from food insecurity. That’s an evidence-based use of money. Overall, we were taking the time and care to make sure we were cutting evidence-based programs as little as possible and were strategically choosing to spend our money based on the evidence.

Where do you and your colleagues obtain data to drive decisions? What about programs that don’t necessarily have an evidence base?

We use tons of different sources, including organizations like NCSL, The Council of State Governments, the U.S. Preventive Services Task Force and Guidelines.gov. We like to use databases of evidence such as Pew’s Results First Clearinghouse and even consult with scientists and specialists who analyze data for a living. So, we look all over the place. And we know that data can be different in terms of quality―some can be high quality while others can be less helpful―so I always try to look at it with a skeptical eye. Some of the questions I like to ask myself while reviewing data include, “Are there any questions that are left unanswered or that weren’t considered?” and “Could this data be skewed or biased in some way that hasn’t been accounted for?”

With our promising programs, or those we don’t yet have the evidence for, we look to implement on a small scale at first so we can build up an evidence base. We’ll start small and require vigorous data collection and analysis, we’ll put in place reporting expectations and build our own evidence over a period of time. We’re then able to use this sort of pilot program on an ongoing basis to make decisions about whether an experimental program is working and whether it’s worth expanding. 

What have been the keys to success, or the most important lessons you can share with other state policymakers who want to use evidence or data to inform their decisions?

External validators, or proxies, matter a lot. If you can find someone or an organization who has credibility with colleagues that you’re trying to convince, it can be helpful to set your own ego aside and have that third party involved instead.

Not overwhelming people with data is really important, as is understanding how adults learn. I’ve found that graphics can be really useful, as opposed to a lot of words. When colleagues come to you with a question, it is important to tailor the data and answer the question you’ve been asked, rather than assuming what the underlying motivation is. Then, if colleagues still have questions after you’ve given them that initial answer, they can ask and you can keep the dialogue open. Keeping yourself open and accessible and not expressing any frustration about answering lots of questions is important, too.

What’s next? Do you have plans or ideas for strengthening the use of evidence in the years ahead? What more do you hope to achieve in Oregon?

I’m always going to push hard for us to look at the evidence in Oregon. I plan to continue to ask everyone who asks [the legislature] to spend money to show us the evidence that proves why their program works and why we should be spending money in that way. I am going to continue to ask people to really track the results they’re getting and present those results to the legislature. I plan to continue to ask for rigorous data gathering and program evaluation.

Incorporating evidence into policymaking is an ongoing, incremental process and you have to keep chipping away. It’s important to recognize that evidence can evolve and change over time and that we have to be open to evolving with it.

Ultimately, everyone benefits when states use more evidence-based policy. When we incorporate evidence into policy, we actually help who we’re trying to help and we save money in the short and long terms. Incorporating evidence makes government smarter, and smarter government works better for the people.