PHN Research Agenda

06 September 2013

Moving Across Country

My absence for the blogosphere has ended. Happily.  As of August 1, I started a new position at University of North Carolina at Charlotte, as Director of a new PhD program in public health sciences. I'll write more about starting a new job in my next post. This week, I want to reflect on what it means to move across the country.

I had lived in Chicago for 16 years. The longest I had ever lived anywhere. Illinois was the 5th state I had lived in, after Texas, Oregon, Washington, and California. I had a home and a house, and felt settled and, in some ways, living on cruise control. Accepting a new position meant selling my house and buying a new house.  Going through each of those events felt nerve racking for a day or two.  Once I had a new address, the move began in earnest. 

Physically packing and unpacking, making the change of address on innumerable websties, waiting in lines to get new forms and licenses, all heightened my awareness of the federalism that is the United States. Federalism rarely surfaces in our daily lives. I hold a passport from the USA, not from the state I live in. Federalism surfaces in ways  that may be too obvious to actually notice. Consider who is listed on the ballots we mark; local, state and federal candidates.

When I give talks to international audiences, as I did in Italy last year and Ireland last month, I compare the United States to the European Union. Until you have live in more than one state, the comparison may seem peculiar. The reality is that federalism is alive and quite healthy in the United States. Witness the licensure laws. Each state governs my practice as a registered nurse. Yes, there is a national examination, but you are licensed  by the state, not the federal government. Each state has its own driving laws and collects fees for being licensed in that state. Each state dictates drinking age and selling of liquor.  Each state has its separate retirement system for its state employees, which includes me. The national retirement system, Social Security, barely provides income "security."

Federalism has deep, obvious as well as hidden public health implications.The breadth of those implications would take more than a 3 semester hour course to fully address. For me, the tension  between state and federal government, the ways that we as a nation acknowledge and deal with those tensions, and the subsequent range (some might say disparities) in availability of services and supports across this nation can serve an international model. The USA and the EU stand as exemplars as ways to achieve economies of scale while maintaining local autonomies.  Yes, it is a royal pain to get relicensed, but I'll suffer those very transitory inconveniences for the vast benefits of living in a healthy federalism.

In this light, from this perspective, what does it really mean to "move across the country?"

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