Category Archives: Student post

A blog post from a current MPP student

From there to here: A year on the Cambridge MPP

Kate Owen, MPP

This time last year I was feeling both excited and nervous about what my year on the Cambridge MPP would have in store. I soon found myself in a room with the 22 fellow students who would be my companions through statistics, philosophy, policy analysis, formal halls, countless fascinating talks, pub trips, class excursions and so much more. On that first day I quickly realised that I was surrounded by people who were not only exceptionally intelligent but who also possessed a diverse range of experiences of public service on which to draw. Within a matter of weeks I knew that these people would become some of my closest friends (bonds forged over statistics and enough sugar and coffee to sink a small ship are unlikely to be broken!).

One of the best things about the Cambridge MPP is the range of subjects studied. Having studied law I had little previous academic experience of most of the material we covered. This was on many occasions highly challenging but also hugely rewarding. The seminar nature of classes gave us the opportunity to discuss the weekly reading in a free and open way which enhanced our learning experience whilst the open door policy of our academic supervisors facilitated deeper and wider learning in the form of our independent papers. Professionally, the vast array of talks, events and societies at Cambridge means that the challenge is not in finding something to do to fill your time but working out the areas on which you want to focus and how to fit it all in.

Much of what I have described above is likely to be found at any leading MPP. One thing that sets Cambridge apart however is the collegiate system. Every student is a member of both a college and the University. The college is the student’s home for the year and represents another community of which students become a part. By way of example, most days I ate either with my housemates (scientists, an archaeologist and a historian) or in my college’s hall with other graduate students. This broadened my horizons significantly and on occasion provided a welcome distraction from MPP papers! Each college also has its own societies and library, both of which I made full use of in my college. I regularly attended my college’s economics society which gave me access to economists working in a range of interesting fields, whilst its library was well stocked with most of the books I needed for the MPP. Students develop a real affinity with their college; not just living there but contributing to seminars, playing sport, serving on committees and attending formal hall (three course dinner in formal dress – one of the highlights of the Cambridge experience). The opportunity to do so is of enormous benefit to students on the Cambridge MPP.

One week after submitting my final papers for the MPP I found myself in Tanzania running a water, sanitation and hygiene project in Bwakila Chini, a remote community in the Morogoro region, for youth and sustainable development charity, Raleigh International. With the benefit of hindsight attempting to submit my final MPP papers, leave Cambridge, give a presentation on the extent to which offshoring is impacting the UK manufacturing sector at the Department for Business, Innovation and Skills and fly to Tanzania for a summer job with an NGO all within the space of six days was somewhat ambitious.

The aim of the project was to support a local NGO by running community outreach sessions with the local school and women’s group on the importance of clean water practices in combating diarrhoeal illnesses. I was responsible for overseeing an international team of 15 young people in delivering this work. In a very short space of time I found myself directly applying concepts I had learnt on the MPP such as stakeholder engagement, communication, management and different forms of policy analysis, delivery and evaluation.

Our project was a success, we built strong links with the local NGO and key community stakeholders which ensured that we had a solid base from which to reach out to the most difficult to access sections of the community. All told we reached 400 members of the community directly and far more indirectly. In particular, it was hugely satisfying to see tippy taps (a way of washing hands in the absence of running water) spring up all around the village and the messages we had conveyed become part of everyday use.

Whilst my six day turnaround between MPP student and NGO worker was more than a little sleep deprived, it served as a valuable reminder of how small the world is, what can be achieved in a short space of time and the ways in which the skills learnt on the MPP can be applied in a wide range of environments.

When I started the MPP my professional goal was to secure a place on the British Civil Service Fast Stream.  After a six month recruitment process, I was successful and join the Fast Stream in October almost one year after I started the MPP. A lot happened in between but I learnt a huge amount along the way, had some amazing experiences and met some people who I am sure will be friends for life. Would I do it again? Yes, in a heartbeat.

A Cambridge MPP at the WHO

This blog post was written by Evan Goldstein, a 2014 candidate for the MPP, as a reflection on his time with the World Health Organisation (WHO) as part of the work placement programme for the MPP. Our thanks again to the WHO for their support of our programme and for supporting our students so well.

The clock on my desktop read 11:08 a.m. – yet still no call. I was anxious and checked my Outlook calendar to make sure had I marked the right time and date for my call with a senior-level policy director from the Bill and Melinda Gates Foundation. Ding! At 11:11 a.m. an email came through:

“Hi Evan! I am so sorry! It has been a crazy week and Bill is travelling with us in Europe. Could we speak on Monday or Wednesday next week?”

Bill was Bill Gates, one of the most powerful men in the world. And yet I was being sincerely apologized to for a mere postponed phone call. Such is the life of a World Health Organization (WHO) intern.

And such was life during my time at the WHO on loan from the Cambridge MPhil in Public Policy (MPP) programme.

WHO foyer sign

WHO foyer sign

As a dedicated health policy nerd, my experience with the WHO has been surreal. Nestled amidst the Swiss Alps, peaceful Geneva served as the perfect place to live, play, and get down-and-dirty with real-world policy challenges – the type of policy challenges that have global ramifications. While in Geneva, I worked within the Prevention of Noncommunicable Diseases (PND) Department on the issue of global tobacco control and advocacy strategy. In particular, within the department, I:

  • Analyzed global advocacy strategy successfully implemented by global TB, HIV/AIDS, polio and other major global health stakeholders to decide which were most relevant for tobacco control – and especially as they relate to the international tobacco treaty (FCTC), UN noncommunicable disease (NCD) strategy and the post-Millennium Development Goals health focus; and
  • Gained advocacy strategy insight and learned best practices (e.g., communications and social media, celebrity endorsement, leadership, UN political mechanisms, economic policy, policy linkage, fund development) from mid-to-senior level experts from the Bill and Melinda Gates Foundation, Bloomberg Philanthropies, Stop TB, UN Task Force on NCDs, CDC, UNAIDS, Global Polio Eradication Initiative, and GAVI for a final project to be shared with the WHO, CDC, and contributing organizations.

The WHO’s greatest assets are the people who work within its office walls. My supervisors were as friendly as they were humble, always ready to help. One of my supervisors was even a former public health director for the country of India, so even passing conversations proved to be much-appreciated learning moments for the avid policy nerd!

The WHO also has a dynamic formal internship programme and community, comprised of health-related professionals from across the globe. Despite my status as an atypical “special” intern, the intern community welcomed me with open arms – to the programme, seminars, events with Director-General Margaret Chan, and even intern dinners and social events. From day one, I met fellow interns who will no doubt be lifelong friends and professional peers. I am continuing my work with the WHO Executive Intern Board as a fundraising coordinator for its Low-and-Middle Income Country Intern Scholarship Programme.

Needless to say, my MPP work placement experience was both enjoyable and enriching.

Evan Goldstein is a native of Cleveland, Ohio and a graduate of Tulane University in New Orleans, Louisiana, where he received his BA in economics, Phi Beta Kappa. After his graduation in 2011, Evan worked in the field of US health care policy and administration. Evan served as Urban Health Fellow for both the Cuyahoga Health Access Partnership (CHAP), a public-private consortium of health care entities that works to bring health access to the uninsured via the Affordable Care Act of 2010; and Care Alliance Health Center, a leading US institution for the provision of health care for the homeless.

Putting housing first instead of last in homelessness policy

This blog post is authored by current MPP student Fiona Wilson, who prior to coming to Cambridge worked for a senior cabinet minister in Alberta, Canada.

The MPP provides several opportunities for students to explore areas of policy outside of the regular curriculum. These include the opportunity to customize research topics for two policy analysis papers, choose a work term organization, and attend lectures and seminars across the university. This flexibility has encouraged me to explore an interesting area of social policy – homelessness policy.

Before embarking on the Cambridge MPP, I worked for a senior cabinet minister responsible for human services in Alberta, Canada. Social policy has been a particularly interesting field in which to be involved, as it brings with it a set of special considerations. Policymakers may need to spend on preventative interventions that address the underlying causes of social problems, as opposed to costly remedial spending. Furthermore, a balance must be struck in policy development between providing the continuum of support clients require to transition to independence and preventing abuse of the system. At a time when many governments are particularly cautious with their finances, social policymakers must think outside the box to deliver policy solutions that make economic sense. In light of the above, the Government of Alberta has re-assessed its approach to homelessness policy by adopting a ‘Housing First’ approach. For this jurisdiction, and many others, this policy choice has marked an important transition from managing the issue to ending it.

The Housing First model was developed in New York City in the early 1990s, and has since spread due to its success in effectively housing homeless individuals with complex needs, and supporting them as they work towards independence. A distinction must be made between those who are chronically homeless and those who are homeless on an episodic basis, with the former group being the primary target of the Housing First approach. This approach provides chronically homeless individuals with permanent housing, whether it be a private rental or a unit in a purpose-built complex. Clients are then supported with services to address the underlying causes of their chronic homelessness, including employment assistance and mental health and addiction counselling.

The economic case for a Housing First approach is promising. Utah’s Housing First program has reduced homelessness in the state by 78% since its inception in 2005. The $11,000 cost of housing a client for one year has more than offset the $16,670 annual cost of publicly funded services for a chronically homeless individual, including emergency room admissions and policing costs [5]. In many other jurisdictions, including those with a high cost of living such as New York, the cost-benefit analysis has proved similarly strong [1].

The Housing First approach is developed based on two key principles: ‘that 1) housing is a human right, not a reward for clinical success and 2) once the chaos of homelessness is eliminated from a person’s life, clinical and social stabilisation occur faster and are more rewarding’ [1].  A feature of the Housing First model is its lack of stringent qualifying conditions for entry into the program, recognizing that the assessment of housing readiness before housing provision is a feature of alternative models that has served to perpetuate the cycle of homelessness.

Homelessness policy often constitutes a ‘housing readiness’ staircase, or continuum of care model, whereby homeless individuals are progressed through a system of emergency shelters and transitional housing programs, with each level moving them closer to independent living [1]. Housing First, by contrast, recognizes that stable housing is the most urgent and primary need for a homeless individual. The approach acknowledges that the very requirements of housing readiness, which often require clients to address addiction, employment and mental health concerns before moving up the staircase, are extremely difficult to address when the client is battling homelessness [1]. The challenges faced by the chronically homeless population can take years to overcome, and housing readiness policies can serve to make the end goal of permanent housing an impossible one. The immediate transition to permanent, independent housing has several structural advantages. One such advantage of the approach is that it does not encourage clients to mix with others at different stages of their recovery, thereby preventing relapse by association or cue. Furthermore, the approach does not base continued tenancy on coercion, including mandating abstinence from drugs or alcohol, recognizing that a harm-reduction approach to addiction is the most appropriate one for difficult and complex cases. Furthermore, a four-year longitudinal study has found that the cost of traditional housing readiness programmes is nearly double those of housing first initiatives, at $40K to $50K compared to $22.5K per annum [1].

Creative thinking in policy acknowledges and examines prevailing paradigms, and encourages new ways of approaching an issue. The housing readiness model seemed like a logical, risk-averse approach to homelessness policy. In hindsight, it has contributed no substantial reduction in homelessness. Perhaps the dominance of this programme is accentuated by the fact that the suggestion of giving homeless individuals housing with no strings attached has historically been met with considerable opposition. Housing First is a possibly permanent solution with a growing body of evidence to support its effectiveness– yet it is a policy option that many jurisdictions are reluctant to implement.

The MPP has encouraged us, as future policy professionals, to engage ourselves both creatively and critically at all stages of the policy process. When approaching a policy issue, we are learning to ask a number of probing questions. Are we applying evidence to policy too late in the process, in support of a predetermined ideology, or with improper causation? Is the current approach ignoring the true needs of the end user or suffering from an optimism bias? Are we confusing a means with an end, or asking the wrong question altogether?

In the case of homelessness policy, many jurisdictions have been missing the mark by failing to address the root cause of homelessness: the fact that an individual does not have a home. Perhaps the most ineffective policy choice adopted thus far has been the criminalization of homeless activity. This often occurs at the municipal level, in which ordinances are passed that prohibit activities such as sleeping or begging in public spaces by imposing criminal sanctions, such as fines or jail time, on offenders [2]. These policies have exacerbated the issue, as criminal records and fines create barriers to the ultimate goal of independence and re-employment. Further, they shift homeless populations away from services and create new costs associated with criminalization, including correctional and policing outlays.

A key feature of Housing First is its ability to empower and enable. I will not forget the day I accompanied my boss to the opening of a supportive housing facility. After touring the carefully designed complex, we met one of the tenants. At 60 years old, he had spent the majority of his life on the streets. For the first time, he told us, he had been treated with the dignity and trust that energized him to make a change. This sense of pride was something he had developed a fighting determination to keep. It was not until he had the stability of a place to retire to each night that he was able to deal with the issues from his childhood that led to his cycle of addiction, and ultimately kept him on the streets. It was difficult in the past, he said, to focus on the long-term when he had to concern himself with the short-term: his safety or where he would sleep that night. This first-hand account lends support to the notion that the ability to tackle difficult issues need not be a precursor to housing provision, but may indeed flow from it.

A 2006 article in the New Yorker by Malcom Gladwell drew attention to a misconception about the nature of homelessness by recounting the story of a chronically homeless man in Nevada struggling with alcoholism. ‘Million-Dollar Murray Barr,’ as he was called, was estimated to have run up hundreds of thousands of dollars in health care, social care and policing bills during his years on the streets [3].  Members of the local police force had reported that they routinely spent half of their days tracking cases like Murray. As Gladwell points out, the homelessness issue is often thought to be analogous with a normal distribution, in which the majority of the homeless population is in a ‘state of semi-permanent distress’, requiring policy interventions that would ‘raise the performance of the middle,’ including temporary shelters and soup kitchens. However, it has become clear over the years that the issue is more appropriately analogous to a power-law distribution, whereby a small population of the homeless population described as chronically homeless (often accounting for 10% of the total), weigh disproportionately on high-cost, publicly funded services [3]. A study by the University of California San Diego tracked 15 chronically homeless individuals over a period of a year and a half, recording 487 emergency room admissions for the group within that time period: a figure that equated to nearly 100,000 dollars in medical bills per person [3]. Medical professionals report that the chronically homeless often seek medical help for complex pneumonia or physical injury, exacerbated by addictions issues and weather conditions. From an economic standpoint, it makes sense to permanently house these individuals but from a moral standpoint, as Gladwell makes clear, the solution often seems unfair as millions of individuals across the country work, and at times struggle, to pay their own rent.

Nevertheless, if fairness were the only factor at play, we would have to ignore promising evidence and continue to invest in the management of homelessness. The fact remains that permanent housing is the only permanent solution, and by offering housing first instead of last, there is hope that we can end the cycle.

The MPP, with its makeup of international students and opportunities for individualized research, encourages the cross-jurisdictional and international comparison of policy approaches. Although Housing First is largely recognized as a best practice in North America, the concept is comparatively underdeveloped in a UK context. As I begin research for my second policy analysis paper, I look forward to examining the potential for Housing First to complement or replace existing provisions for homelessness policy in the UK.

References

[1] http://www.endhomelessness.org/library/entry/supportive-housing-is-cost-effective

[2] http://nationalhomeless.org/publications/crimreport/CrimzReport_2009.pdf

[3] http://www.newyorker.com/archive/2006/02/13/060213fa_fact

[4] http://england.shelter.org.uk/professional_resources/policy_and_research/policy_library/policy_library_folder/housing_first_-_a_good_practice_briefing

[5] http://www.nationofchange.org/utah-ending-homelessness-giving-people-homes-1390056183