PERSPECTIVE: Small Business Owner Does Not Equal Entrepreneur, And That’s Okay

by Anthony Price My universe was shaken to its foundation, like a building crumbling to the ground under the force of a 9.0 earthquake, after reading Ben Lamm’s guest column in Entrepreneur magazine: “Stop Calling Everyone an Entrepreneur—They Aren’t.”

I thought this was typical Silicon Valley propaganda, from a hotshot in a hoodie and jeans. But after my less-skeptical self emerged, I began to think there was merit to what Ben was espousing. Ben, the founder of several companies and CEO of a startup, believes that the “entrepreneur” label has become as ubiquitous as Nikes on NBA-wannabes. He says that a lot more people are qualified to manage a “Jamba Juice than take companies from inception, through market traction (paying customers), funding, growth and eventual IPO or exit.”

I full-heartedly agree. Ben comes from a world where solving big “hair-on-fire” problems and scaling a business as fast as possible are crucial to owning a market and attracting OPM: Other People’s Money. This business template requires a steady stream of capital to be pumped into the business as fuel, which most businesses don’t have.

The money that your small business burns through is yours, or if you are lucky, your family’s, friend’s or the bank’s. In reality, a startup business has a limited amount of time to build a business with paying customers, or it will fail. Think of Chobani yogurt in your refrigerator—it’s expiration date is a constant reminder that it will not last forever.

The pressure comes from investors. When you play with OPM, investors are the house, they make the rules, and they want to make lots of money (10, 20, or 30x return or more) from a liquidity event (an exit from your business within five to seven years as a result of selling or going public).  In Ben’s view, the mission is the domination of an industry from the playbooks of Facebook, Google and Amazon.

Entrepreneurs Take Big Risks

Entrepreneurs view problems from a unique perspective. George Bernard Shaw, the playwright, said, “The reasonable man adapts himself to the world: the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man.” Entrepreneurs are the unreasonable men (and women), risk-takers, but not gamblers. To them, gambling is working at a job they don’t like, with no future for advancement, for a boss who doesn’t value them. Entrepreneurs are confident in their abilities to solve big problems, assemble a team and scale. They are a special group of people who believe in their vision, talent, version of reality and work ethic.

The biggest differentiator between an entrepreneur and a small-business owner is that the former wants to solve big problems, grow quickly and takes huge risks. Think Facebook, Google, and Tesla. Facebook has over two billion monthly users, and its mission is: “Give people the power to build community and bring the world closer together.” Google is the most visited website on the Internet. Its mission is: “To organize the world’s information and make it universally accessible and useful.” Founded in 2003, Tesla Motor’s mission is: “To accelerate the advent of sustainable transport by bringing compelling mass market electric cars to market as soon as possible.”

Small and Powerful

A business consists of coordinated activities that deliver value to customers with the intent of generating a profit to its owners. There are twenty-nine million small businesses in the U.S., which represent 99.9 percent of all businesses.

The U.S. Small Business Administration (SBA) defines a small business as having fewer than 500 employees; organized for profit; has a place of business in the U.S.; operates primarily in the U.S.; is independently owned and operated, and is not dominant in its field on a national basis. Michael Gerber, the author of The E-Myth states, “There is a myth in this country—I call it the E-Myth—which says that small businesses are started by entrepreneurs risking capital to make a profit. This is simply not so.”

Most small business owners make the misguided assumption that because they know the technical work of the business, they understand the business that does the technical work.  These are two different things, just as being a home baker doesn’t make one competent to run a neighborhood bakery or a corporate chain of bakeries.  Small business owner does not equal entrepreneur.

Compare Ben Lamm’s vision of a startup business on steroids with how most small businesses start. Look at your favorite small business. For example, the guy (Jim) who owns the automobile repair garage down the street probably started because he either worked in the family business or got tired of working for someone else. Jim doesn’t have a grand vision to be as ubiquitous as Pep Boys. Sure, he wants to make money, but the love of his craft, freedom from a boss, quality of life, and a sense that he can shape his destiny are all reasons that usually motivate someone to start or buy a business.

Just Do It

Customers determine winners in business. But a decisive factor for your future success comes down to how you answer this question: Will you be an entrepreneur or a small-business owner? Entrepreneurs take big risks to create something new, while small-business owners provide goods and services that the market needs right now. Each has its own value.

Life as a small-business owner is appealing. There’s no disputing its impact on the American psyche. In our winner-take-all society, we need balance between big-risk takers and steady small businesses. Ben states, “Entrepreneurs, at their core, are rare, transformative and risky. They are going to propel the society forward with big leaps of creative disruption. Small-business owners give us a stable base that de-risks the moonshots and protects us from the fallout of failures.” Our economy needs both the entrepreneur and the small-business owner.

To succeed in business, you have to know whether you’re playing as an entrepreneur who is ready to change the game, the industry, the world, or as a small-business owner seeking to make an impact on a smaller scale. If you’re trying to change the game, put on a pair of Shaquille O’Neal’s size 22, because that’s what changing the game feels like. Your choice whether to be an entrepreneur or small-business owner will affect how you start, fund, manage, and grow your business.

Takeaway: Decide what you will be. Choose one.

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This is an edited excerpt from Get the Loot and Run: Find Money for Your Business, by Anthony Price of Hartford.  Price is founder and CEO of Lootscout, and an entrepreneur, speaker, panelist, and judge for business competitions. A trusted adviser to startups and growing businesses, his expertise is sourcing growth capital for entrepreneurs. This excerpt is published with permission of the author.

PERSPECTIVE: Dyslexia and Persistence Can Be Route to Achievement

Dan Malloy overcame tremendous challenges to build a successful career in public service and law. Born with severe dyslexia and motor-control problems, he was unable to walk steadily or to execute simple tasks like tying his shoes and buttoning his clothes. As a young student, Malloy couldn’t read, spell, or do mathematical problems. But his mother, a public-health nurse, didn’t buy into the idea that her son was slow, says Malloy. “She made a definitive decision to stress the things that I was good at and not bother with the things I wasn’t good at. My mother pushed me to develop my strengths, to focus on my leadership and oral-communications skills. Concentrating on those skills, which were my strengths, helped me meet the challenges of college, law school, and my career.”

Malloy’s mother also encouraged his listening skills by giving him a radio, so he went to bed each night tuned in to the news and other programs. At school, he found little encouragement. One of his teachers labeled him “mentally retarded” as a fourth grader; another hung his failed spelling tests on the wall beside those of “A” students. “It’s a tribute to my mother that I never envisioned that I wouldn’t be successful; I just didn’t know how I’d do it,” he says.

By the end of fifth grade, Malloy could button his clothes and tie his shoes, and by eighth grade, he was a much-improved reader. “I developed some compensatory skills and had halfway decent grades,”€ he says. “I also had a good level of academic success in high school and remembered everything I read, although reading was still arduous.” Luckily, Malloy attended a supportive high school, which waived the foreign language requirement and any math class beyond Algebra I, in which he scored a D. “That allowed me to take courses I was good at, like social studies and history,” says Malloy, who also had access to books on tape.

“The real point where my future was decided was when I had a serious injury in high school,”€ says Malloy. Sidelined by a compressed vertebra during football practice, he ended up in pancreatic failure as a result of undiagnosed ulcers. He lost sixty pounds and was not expected to live, until an advanced X-ray machine detected the ulcers and put him on the road to recovery” and to thoughts of college. Early in 1974, he wrote a candid letter to several colleges. “I told them that I almost died and that I had learning disabilities, and I asked them to take a look at me. I was lucky some schools were willing to take a chance on me,” says Malloy, who describes his SAT scores as “abysmal.”

Another byproduct of his dyslexia is Malloy's ability to listen and absorb information, an asset to anyone, but especially to a candidate for public office. At Boston College, his reading skills improved steadily, and his reading retention and comprehension were “off the charts,” says Malloy. “I got very good grades and the school was behind me.” His professors granted him extra time on multiple-choice tests and allowed him to answer essay questions orally or to dictate them to a third person.

He also wrote papers orally, dictating them to his future wife, Cathy, whom he met as a freshman. While Malloy is a fluent reader, reading aloud is difficult, so he plans speeches in his head and delivers them without consulting a written text. Another byproduct of his dyslexia is Malloy’s ability to listen well and absorb large amounts of information, an asset to anyone, but especially to a candidate for public office.

These assets certainly paid off in the November 2010 Connecticut gubernatorial election. In a tight race, Dan Malloy edged out his opponent to take the seat as Connecticut’s 88th governor. He was sworn into office on January 5, 2011. [He will have served two terms when he leaves office in January 2019.]

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This perspective appears on the website of The Yale Center for Dyslexia & Creativity (YCDC).  YCDC is a source of research, advocacy and resources to help those with dyslexia reach their full potential. Dyslexia is defined as an unexpected difficulty in learning to read. Dyslexia takes away an individual’s ability to read quickly and automatically, and to retrieve spoken words easily, but it does not dampen their creativity and ingenuity.

The Center’s tools and resources are used widely by parents, educators and those with dyslexia to advocate for greater recognition and support for dyslexic children and adults. YCDC builds awareness in all communities and mobilizes grassroots efforts to close the reading-achievement gap for all students.

The Center also showcases the success stories of adults with dyslexia, including writers, scientists, celebrities, and government and business leaders.  Malloy is one of two current Governors featured on the YCDC website.  The other is John Hickenlooper of Colorado, a graduate of Wesleyan University in Middletown.  California Lieutenant Governor Gavin Newsom, now a candidate for Governor, and former Connecticut Congressman Sam Gejdenson are also among the political leaders profiled.

It was recently announced that Gov. Malloy will be a visiting professor at the Boston College Law School in 2019. 

PERSPECTIVE: Clearing A Path to Better Health

by Arielle Levin Becker Hartford’s Northeast neighborhood is about four miles from West Hartford Center. Yet living in one place or the other can mean a 15-year difference in life expectancy.

That’s according to recently released data that identifies the life expectancy for nearly every census tract in the country, offering a stark illustration of the disparities that exist even between neighborhoods in the same city or region.

In Northeast Hartford, the life expectancy of 68.9 years is more than 11 years below the average life expectancy in Connecticut – 80.8 years. West Hartford Center tops that, at 84.6 years.

Similar patterns hold true across the state. There’s a nearly 14-year life expectancy gap between parts of Bridgeport and neighboring Fairfield. A baby born in Westport has a life expectancy that’s more than 20 years longer than a baby born in Northeast Hartford.

There is variation within cities and towns. In New Haven’s Newhallville neighborhood, life expectancy is 71.7 years. In the neighborhood next door, Prospect Hill, life expectancy is more than a decade longer: 82.3 years.

Depending on the neighborhood, life expectancy in New London ranges from 69.8 years to 83.3 years (a 13.5-year difference), while in Norwalk, it ranges from 76.3 years to 87.9 years (11.6 years). Life expectancy in Torrington ranges from 71.6 years to 85.6 years – a 14-year gap.

The data comes from the United States Small-Area Life Expectancy Estimate Project, an effort of The Robert Wood Johnson Foundation, National Association for Public Health Statistics and Information Systems, and the National Center for Health Statistics, which is part of the Centers for Disease Control and Prevention. The numbers are estimates of average life expectancy at birth for 2010 to 2015 – that is, how long, on average, a person can expect to live.

“It is truly unsettling to see how small differences in geography yield vast differences in health and longevity. In some places, access to healthy food, stable jobs, housing that is safe and affordable, quality education, and smoke-free environments are plentiful. In others, they are severely limited,” Donald F. Schwarz, senior vice president, program at the Robert Wood Johnson Foundation, wrote in a recent blog post. “Data can help us better understand the health disparities across our communities and provide a clearer picture of the biggest health challenges and opportunities we experience.”

All of this new data is consistent with a longstanding challenge in health in Connecticut: While Connecticut is among the healthiest states in the country, there are significant disparities in health outcomes by race and ethnicity – a sign that not everyone has the opportunity to be as healthy as possible.

Here are three examples:

• Babies born to black women in Connecticut are nearly three times as likely to die before turning 1 as babies born to white women, while among Hispanic mothers, babies are twice as likely to die in their first year.
• The rate of cancer deaths among black Connecticut residents was 9 percent higher than among white residents in 2016 – even though black residents were far less likely to be diagnosed with cancer.
• Hispanics in Connecticut were twice as likely to be uninsured than white state residents in 2016.

At the Connecticut Health Foundation, our work is centered on eliminating racial and ethnic health disparities and assuring that all Connecticut residents have access to affordable and high-quality care. We focus on ensuring that all state residents have access to health care coverage and a regular source of health care, as well as ensuring that the health care people receive is high-quality and connected to the many non-clinical factors that affect health.

The strategies that can help to eliminate health disparities will benefit everyone. They can also help move Connecticut closer to our vision of a state in which everyone – regardless of race, ethnicity, or socioeconomic status – has the opportunity to be as healthy as possible.

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Arielle Levin Becker is Communications Director for the Connecticut Health Foundation, which focuses on improving health outcomes for people of color and ensuring that all Connecticut residents have access to affordable and high-quality care. Through public policy, grantmaking, and leadership development, the Connecticut Health Foundation works to make lasting changes that improve lives.

PERSPECTIVE: A Needed Credential to Advance Infant and Early Childhood Mental Health

by Abby Alter and Heidi Maderia Professionals who care for young children play an important role in promoting social-emotional development, positive mental health, and relational health, as well as identifying problems early and connecting young children to intervention and treatment services when necessary. Unfortunately, most pre-professional education and training programs lack specific courses or modules related to infant and toddler mental health, and many professionals lack the critical skills needed to work with very young children.

Many states, including Connecticut, are taking steps to ensure that professionals working with infants, toddlers, and their families are well-trained to promote optimal mental health, promote preventive strategies, and facilitate linkage to early intervention or treatment.

Attention to the Mental Health of Young Children is Critical for their Healthy Development

Infant and early childhood mental health is defined as a young child’s capacity to regulate and express emotions, form close and secure relationships, safely explore their environment, and learn. Young children develop these capabilities within the context of their family, environment, community, and culture, as well as through relationships with their primary caregivers. Infants and toddlers who develop healthy and strong social and emotional competency are better prepared for school and have healthier and more prosperous lifelong outcomes.

A System of Professional Endorsement is Improving Connecticut’s Workforce

The Connecticut Association for Infant Mental Health (CT-AIMH) purchased a license in 2010 from the Michigan Association of Infant Mental Health to provide the Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant Mental Health®. The license was purchased with support from the Children’s Fund of Connecticut, the Connecticut Head Start State Collaborative Office, and others. Since obtaining the license, CT-AIMH has built a statewide competency system known as the CT-AIMH Endorsement® for providers caring for children up to age 3. The system provides professional development through training and education programs with a goal of building a more skilled workforce.  In 2017, with help and guidance from a national workgroup, the endorsement system was expanded to include professionals working with children from 3 to age 6.

Becoming endorsed demonstrates that an individual has completed specialized education, related work, in-service training, and reflective supervision/consultation experiences that have led to competency in the promotion and/or practice of infant or early childhood mental health. The credential does not replace licensure or certification, but is meant as evidence of a specialization in the promotion and practice of infant and/or early childhood mental health within each professional field, such as child development, early care and education, pediatrics, psychiatry, psychology, social work, and others. To date, 56 professionals in Connecticut are endorsed in Infant Mental Health through this system, and three providers have earned the Early Childhood Mental Health Endorsement® (currently in its pilot phase). CT-AIMH plans to revise the endorsement program based on lessons learned during this pilot, and offer the Early Childhood Mental Health Endorsement® to professionals in 2019.

Additional Measures to Build a More Competent Infant and Early Childhood Workforce

Connecticut agencies and stakeholders have taken several steps to build a more competent infant and early childhood workforce. Examples include: increasing support for reflective supervision/consultation groups in Birth to Three and home visiting programs; committing to having at least one endorsed infant mental health professional on staff for every Birth to Three operated program; and providing a bi-annual infant mental health training series for child welfare and Head Start staff through a partnership with Head Start, the Department of Children and Families, and CT-AIMH.

While these measures are expanding the capacity of the early childhood workforce in Connecticut to address the social and emotional needs of young children, more can and should be done. Recommendations for Connecticut include:

• Increase public funding to support endorsement activities, including funding for: infant and early childhood mental health training, release time for staff to attend training, reflective supervision/consultation, deployment of a university-level cross-discipline Faculty Infant Mental Health Training Institute with accompanying materials.
• Ensure that all State and/or public agencies serving the most vulnerable children and their families have infant/early childhood mental health endorsed staff in every region.
• Follow Michigan’s practice requiring Endorsement® in infant and early childhood mental health for practitioners who bill Medicaid for mental health services provided to infants and toddlers. Additionally, Medicaid and commercial insurers should pay for infant and early childhood mental health services delivered to young children birth to 6 years who show signs of risk (without a diagnosis) if delivered by a professional holding the Endorsement.
• Require state institutions of higher education to include infant and early childhood mental health competencies in their infant, young child, and family related courses (e.g., nursing, social work, education, psychology) and/or support an Endorsement requirement to develop a pipeline of professionals who can pursue endorsement within their careers. Use the Faculty Infant Mental Health Training Institute to help faculty across disciplines to incorporate infant mental health into existing courses.

These additional actions can advance and sustain a statewide system of professionals who are endorsed and credentialed in infant and early childhood mental health. In that way, we can best promote optimal mental health and preventive strategies, and facilitate, as needed, early intervention or treatment.

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Abby Alter is Senior Associate for Early Childhood Initiatives at the Child Health and Development Institute, and Heidi Maderia is Executive Director of the Connecticut Association for Infant Mental Health. To learn more, visit www.ct-aimh.org or read "The Infant Mental Health Workforce: Key to Promoting the Healthy Social and Emotional Development of Children."  This article was adapted from an Issue Brief developed for Child Health and Development Institute of Connecticut, Inc, a catalyst for improving the health, mental health and early care systems for children in Connecticut.

PERSPECTIVE: Legalizing Marijuana Would Jeopardize Safety on Connecticut Roads

By Amy Parmenter A poll by AAA of almost a thousand drivers across Connecticut found earlier this year that 50 percent do not support the legalization of recreational marijuana. Of younger respondents (ages 18-24) opposed to legalization, 40 percent expressed ‘concern that marijuana is a national public health issue’.

As the advocacy organization for all motorists, AAA opposes the legalization of marijuana for recreational purposes because of a broad range of traffic safety concerns including, but not limited to, the following three factors detailed in the testimony below:

• A significant increase in drugged driving and marijuana-involved fatal crashes
• An inability to simply and accurately measure impairment
• The complexities and challenges legalization would present to law enforcement, our courts and state agencies

Increase in Drugged Driving and Marijuana-involved Fatal Crashes

Recent research by the AAA Foundation for Traffic Safety found that in the year following the legalization of recreational marijuana in Washington State, the number of drivers in fatal crashes who had recently used Marijuana more than doubled.

We know drugged driving, and driving under the influence of marijuana in particular, is on the rise across the country.

According to a 2013-2014 survey by the National Highway Traffic Safety Administration (NHTSA), drug use among nighttime weekend drivers increased 25 percent since the previous study in 2007. The drug showing the greatest spike was marijuana, with an increase of almost 50 percent.

This trend is particularly disturbing among our younger drivers.

A AAA poll conducted in 2016 found that, of those between the ages of 18-29, almost 25 percent admitted that within the past year they ‘regularly’ or ‘fairly often’ drove after using marijuana – whereas only about 15 percent admitted to driving drunk during the same time frame.

Inability to Accurately Measure Impairment

While there is the understandable temptation to measure impairment by alcohol and marijuana in the same way, it cannot be done.

Unlike with alcohol, the amount of active THC (the psycho-active ingredient in marijuana) in the blood has NO scientific correlation with a driver’s level of impairment or propensity to crash. Active-THC, is fat soluble and is metabolized differently than alcohol, which is water soluble. To accurately predict driver impairment or crash risk as a function of how much active-THC a person has in their body would require us to measure how much of the drug is in the fatty tissue of the brain—not the blood.

While roadside drug tests may soon be available, even the most accurate of these tests will be of no use in determining impairment. They will only show the presence of THC in the blood.

Challenges to Law Enforcement and Courts 

Because of the inability to accurately determine impairment at the roadside as described above, law enforcement and the court system face unique challenges and complexities when it comes to marijuana that do not exist for alcohol.

One of the most common ways lawmakers in marijuana states have attempted to address traffic safety concerns is to establish an impairment threshold for marijuana, a ‘per se’ standard for it, (similar to the 0.08 BAC standards in every state for alcohol).

After analyzing data from nine states, the AAA Foundation published a report last year in which researchers concluded that ‘to establish a per se standard for marijuana is meaningless as a tool to address impaired driving’.

Additional considerations:

• This is not the marijuana of previous generations. The concentration of the impairing chemicals in most marijuana range from 25-30% in plant form – 10 TIMES as much as in the 70's and 80's.
• There have been two systematic reviews of multiple studies on the impact of marijuana on driving. Both determined that, conservatively, marijuana at least doubles the risk of causing a traffic crash.

It has taken many years to change attitudes about drinking and driving, and we must now begin the same process of educating the public about drugged driving.

Legalizing marijuana before we are prepared to manage the potential highway safety consequences, before we have prepared our law enforcement officers with all the training and resources they need to address this issue, endangers the Public Health of our state.

While some people are focused on revenue to be generated, AAA is focused on traffic safety and the unintended consequences of legalization, for which we believe Connecticut and other states are ill-prepared.

Legalization of marijuana will, without question, increase the number of people who use it and get behind the wheel and drive. That puts all of us at greater risk on the road.

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Amy Parmenter is Manager of Public and Government Affairs for the AAA Allied Group.  This was provided as testimony to the state legislature’s General Law Committee during the 2018 session, when the legislature was considering a proposal to legalize marijuana in Connecticut. It is on behalf of both AAA clubs in Connecticut, the AAA Allied Group and AAA Northeast, which together represent more than a million members.

PERSPECTIVE: Unhealthy Options Persist in Fast Food; Voluntary Efforts Falling Short

Fast-food consumption is associated with poor diet quality in youth. Therefore, improving the nutritional quality of fast-food meals consumed by children is an important public health objective. In response to public health concerns, several of the largest fast-food restaurants have introduced policies to offer healthier drinks and/or sides with their kids’ meals. However, few research studies have examined the menu items that parents purchase for their children at fast-food restaurants or their attitudes about healthier kids’ meal offerings.

The primary purpose of [a study by the UConn Rudd Center for Food Policy & Obesity] was to document parents’ reported fast-food purchases for their children (ages 2-11) and examine changes over time.  [The] findings indicate numerous reasons for continued concern about the impact of fast-food consumption on children’s diets and health.

In 2016, we identified 10 different fast-food restaurants where at least one-quarter of parents reported that they purchased food for their child(ren) weekly or more often. In addition, more than 90% of parents surveyed reported that they visited at least one of the four largest fast-food restaurants to purchase lunch or dinner for their child (ages 2-11) in the past week, and they purchased food for their child at 2.4 of these restaurants on average.

These numbers are high, but they correspond to previous research showing that on any given day, one-third of children consume fast-food… Furthermore, parents’ purchases of fast-food for their children increased significantly during the years examined, with parents reporting increased frequency of visits to most individual fast-food restaurants from 2013 to 2016…

These results also suggest that healthier kids’ meal policies could result in unintended public health consequences if they lead parents to view the restaurants more positively and increase their visits, but continue to order the unhealthy items for their child.

These findings indicate numerous opportunities for restaurants to enhance their efforts to improve the nutritional quality of fast-food consumed by children.

First, restaurants should introduce healthier kids’ meals that are also appropriate and appealing to older children… In addition, restaurants must discontinue the increasingly common practice of offering unhealthy sides together with healthier sides, and/or they should remove unhealthy sides from their kids’ meal menus altogether, as they have pledged to do with kids’ meal drinks…

Finally, since parents often choose restaurants that are convenient and that their kids like (more than for healthy options), restaurants should make the healthier items the most appealing options for children to choose. They should also make the healthier items the easiest options for parents to order, for example, by making them the default for kids’ meals. Given parents’ positive attitudes about healthier kids’ meals, there appears to be a substantial marketing opportunity for restaurants to introduce and promote healthier kids’ meals that appeal to both parents and children…

If restaurants do not implement further improvements voluntarily, advocates should continue to work with state and local municipalities to introduce public policies to improve the healthfulness of kids’ meals. Policy makers should follow the lead of communities in California and Colorado and consider legislation or regulation to require that all restaurants serve healthier kids’ meals…

Unhealthy options, including main dishes, sides, and desserts, remain on kids’ meal menus at most restaurants, and purchases of a kids’ meal plus another menu item for their child have increased. Although future research is required to explain the reasons for these trends, they do indicate that restaurants’ voluntary pledges, as currently implemented, are unlikely to substantially reduce children’s fast-food consumption overall, or increase their selection of available healthier drink and side options.

Furthermore, parents’ positive attitudes about restaurants’ healthier kids’ meal policies indicate that such policies could backfire for public health and increase the frequency of purchasing fast-food for their children without increasing healthier purchases. These findings demonstrate that restaurants must implement more effective healthier kids’ meal policies to avoid additional state and local regulations that would mandate healthier options for children.

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This is an excerpt from Parents’ Reports of Fast Food Purchases for Their Children:  Have They Improved?, published in September 2018 by the Rudd Center for Food Policy & Obesity at the University of Connecticut.  The report’s authors are Jennifer L. Harris, Maia Hyary, Nicole Seymour and Yoon Young Choi.  The full report is available here.

https://youtu.be/2Ng_X4D4SSA

PERSPECTIVE: Patient Protections Fall Short in Proposed Plan for Pre-existing Conditions

Our 33 organizations, representing the interests of the millions of patients and consumers who live with serious, acute, and chronic conditions, have worked together for many months to ensure that patient voices are reflected in the ongoing Congressional debate regarding the accessibility of health coverage for all Americans and families. In March 2017, we identified three overarching principles to guide and measure any work to further reform and improve the nation’s health insurance system. Our core principles are that health care must be adequate, affordable, and accessible. Together, our organizations understand what individuals and families need to prevent disease, manage health, and cure illness. Individuals and families with pre-existing conditions rely on critical protections in current law to help them access comprehensive, affordable health coverage that meets their medical needs. Unfortunately, the arguments of the plaintiffs in Texas v. U.S. – a lawsuit brought by 20 states and two individual plaintiffs – represent a serious threat to these protections. In this case, the plaintiffs argue that the court must invalidate the entire Affordable Care Act (ACA) due to Congress’ repeal of the individual mandate. We are further troubled that the Department of Justice has also declined to defend the constitutionality of many of the ACA provisions that directly protect people with pre-existing conditions.

While we are pleased to see that you share our concerns about the potential impact of Texas v. U.S. on people with pre-existing conditions, as evidenced by your recent introduction of the Ensuring Coverage for Patients with Pre-Existing Conditions Act (S.3388), the safeguards presented in this legislation fall far short of the patient protections encompassed in existing law. This bill as written is far from an adequate replacement for the protections for individuals with pre-existing conditions that are provided under current law.

Current law requires issuers to comply with a set of provisions which work together to promote adequate, affordable, and accessible coverage for people with pre-existing conditions. Specifically, community rating, guaranteed issue, essential health benefits, cost-sharing limits, and the ban on pre-existing condition exclusions protect people with serious health care needs from discriminatory coverage practices. These policies are inextricably linked and removing any of them threatens access to critical care for people with life-threatening, disabling, chronic, or serious health care needs.

Adequacy

Health care must be adequate, covering the services and treatments patients need, including patients with unique and complex health care needs. It is paramount that protections including the Essential Health Benefit (EHB) requirement, the ban on annual and lifetime caps, caps on out-of-pocket costs, and restrictions on premium rating be preserved in all health care plans to which they currently apply.

We were particularly disappointed that S. 3388 fails to include an outright ban on pre-existing condition exclusions. While a consumer with pre-existing conditions can gain coverage, the bill would allow issuers to underwrite plans to exclude any type of care based on medical history or health status. For example, under S. 3388 a patient with a history of cancer may be able to gain coverage, but an issuer would still be allowed to exclude coverage for screenings or treatment for a reoccurrence. Continuing to allow issuers to sell plans that undermine access to comprehensive coverage directly contradicts the presumed intent of this legislation, puts consumers at risk for catastrophic healthcare costs or being forced to delay care, and creates additional confusion for consumers and patients.

Affordability

Our second principle recognizes that illness and disease impacts individuals across the economic spectrum. We believe that everyone – regardless of their economic situation – should be able to obtain the treatment they need to manage, maintain, or improve their health. This means that coverage should be affordable, including reasonable premiums and cost-sharing, and that individuals with pre-existing conditions should be protected from being charged more for their coverage.

Although this legislation protects against higher rates based on health status, we remain concerned that it leaves patients and consumers exposed to higher premiums based on other factors that can be used as proxies for health status, such as age, gender, or occupation. For instance, there is no limit on how much more insurers in the individual market could charge a 50-year-old with heart disease because of his age. Insurers could also charge higher rates to a woman of childbearing age because of her gender. This legislation would exacerbate the affordability challenges facing many Americans today by neglecting to maintain current protections and subjecting patients to even higher premiums should the ACA be completely invalidated.

Accessibility

Lastly, health care coverage must be accessible. All people, regardless of employment, health status or geographic location, should be able to gain coverage without waiting periods or undue barriers to coverage. While we appreciate that the legislation would continue to prohibit insurers from denying coverage to individuals with pre-existing conditions, we are deeply troubled that, absent other quality and financial protection standards, this provision would offer only minimal assurance to consumers.

Conclusion

While we do not yet know the outcome or scope of the ruling in the Texas v U.S. case, failure to preserve key ACA provisions could have catastrophic implications for both the insurance markets and the millions of patients who rely on them. Partially restoring only two (guaranteed issue and some rating protections) of the multiple provisions that currently protect patients is inadequate and would leave many people without the level of coverage they need and deserve. Should the ACA be struck down and this legislation implemented as a replacement, consumers with pre-existing conditions would face significant financial and coverage barriers. In short, for people with pre-existing conditions, the bill would provide access to coverage in name only.

We share your interest in continuing to make health insurance accessible to Americans with pre-existing conditions and appreciate your efforts to preserve certain protections in law, regardless of the outcome of Texas vs. US. However, the “Ensuring Coverage for Patients with Pre-Existing Conditions Act” as currently drafted, falls far short of providing coverage and security to your constituents, including those who are or will face significant health care needs. We urge you and your Senate colleagues to reconsider your approach to S. 3388 and ensure that any future legislation provides protections for people with pre-existing conditions that are the same or better than those included in current law.

Our organizations stand ready to work with you on solutions that serve the patients we represent and would be pleased to meet with you about how this legislation can be improved to meet the needs of people with pre-existing conditions.

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This is the complete text of correspondence sent on September 19, 2018 to 16 members of the U.S. Senate, on behalf of 33 organizations including Danbury-headquartered National Organization for Rare Disorders (NORD) and many others with active chapters in Connecticut. Signatories also included Adult Congenital Heart Association, Alpha-1 Foundation, ALS Association, American Cancer Society Cancer Action Network, American Diabetes Association, American Heart Association, American Liver Foundation, American Lung Association, Arthritis Foundation, Chronic Disease Coalition, COPD Foundation, Crohn’s & Colitis Foundation, Cystic Fibrosis Foundation, Epilepsy Foundation, Family Voices, Global Healthy Living Foundation, Hemophilia Federation of America, Leukemia & Lymphoma Foundation, Lutheran Services in America, March of Dimes, Mended Little Hearts, Muscular Dystrophy Association, National Alliance on Mental Illness, National Coalition for Cancer Survivorship, National Health Council, National Hemophilia Foundation, National Kidney Foundation, National Multiple Sclerosis Society, National Patient Advocate Foundation, Susan G. Komen, United Way Worldwide, and WomenHeart: The National Coalition for Women with Heart Disease.

PERSPECTIVE – Nonprofit Board Members: Take Off Your “Stupid Hats”

by Jack Horak The National Association of Nonprofit Organizations and Executives (NANOE) is a relatively new and modest organization, but that hasn’t stopped it from challenging nonprofit sector dogma at the most fundamental level. A case in point is its suggestion that the “volunteer governing board” model should be upgraded to a “paid board” model.

As NANOE sees it, nonprofits adopting this practice would have a line item for “directors fees” in both their budget and their fund-raising literature – and they would do this proudly to let the world know that they are so committed to the mission that they have raised the money necessary to attract and retain the best talent available to fill seats on their governing boards.

The objective is not simply to start paying current volunteers to attend board meetings, but to induce very talented people to join the board where they will be expected to do real work in return for the money. After all, nonprofits pay their management team in exchange for work, so why not follow the same protocol with board members?

This is a sweeping reversal of sector orthodoxy — which presupposes that directors donate both their time and their money to the organizations they serve. Consequently, it’s no surprise that some of the more prominent sector voices were quick to dismiss NANOE’s message as it was rolled out. See, for example, the March 30, 2017 Chronicle of Philanthropy (New Nonprofit Puts Money over Mission and Ethics) and the April 18, 2017 Nonprofit Quarterly (NANOE’s Approach to Nonprofit Leadership: An Insult to your Intelligence).

The negative reaction is understandable to some extent. NANOE’s paradigm turns conventional wisdom on its head so criticism in defense of the status quo is expected. However, after nearly 40 years as a legal and business advisor in the sector, I respectfully disagree with NANOE’s critics. I suggest that if they take their analysis to a deeper and broader level they will find considerable insight in NANOE’s suggestion, and perhaps conclude, as I have, that the paid professional board model may be the optimal choice for some, but not all, organizations.

Here’s why.

We start with a fundamental question — what is a board of directors – and answer it with some history. The concept (and law) of what we commonly refer to as “charity” emerged in medieval England as part of the law of trusts. A charitable trust is an organization governed by a board trustees who hold and manage assets in their names for the benefit of a charitable purpose.

The trust form was predominant for centuries. While it still works well for organizations with activities limited to grant making, it is poorly suited for operating organizations which have service contracts, payrolls, real estate, borrowed money, licensure requirements, and much more. Consequently, as the sector grew and modernized in the middle of the last century, the trust form was pushed aside in favor of the corporate form because corporations have a bifurcated governance structure specifically designed for operating activities.

Corporations have both a board of directors (our topic), and a group of officers who comprise management (such as the CEO or CFO). Corporate law vests all power and authority of the organization in the board, which then delegates power and responsibility to management to conduct operations, but with the board overseeing management’s performance. In other words, the board of directors is at the top of the chain of command. It is not there for show.

Second, operating a nonprofit has become amazingly complicated over the last fifty years. The complexity has fallen on the backs of management, which must deal daily with everything from public expectations, to the morass of state and federal regulation which touches upon everything from HR policy and plans, credentialing, licensing, financial reporting and other challenges that are simply part of the modern turf. Management cannot take this on without board members rolling up their sleeves and doing some real work. Talented CEOs have told me how they long for a strong board to back them up -while expressing their frustration with the common fare offered by “volunteer board recruitment” efforts that don’t always deliver what is needed.

Finally, there is the “Stupid Hat Syndrome.” I first heard this expression from a successful businessman, famously generous with both his money and his volunteer board service. He coined the phrase to express his frustration after years of observing “some of the smartest and most successful business people he knew join a nonprofit board and immediately put on their Stupid Hat.” In other words, they habitually checked their immense brain power and experience at the door. The Stupid Hat metaphor may be hard edged, but the phenomenon is real and all too commonplace in the sector. It’s the 800-pound gorilla in the corner, and it’s as true as the truism that in general “you get what you pay for.”

In contrast, when you pay someone, even a modest amount, you demonstrate respect for what they have to offer; and in return you can comfortably tell them that they are expected to do real work -show up at meetings, read the circulated minutes and financial reports before the meetings, ask informed questions and offer ideas, chair important committees, have calls and meetings with management between meetings to discuss how things are going, and more as necessary. Paying someone for their service is a commercial exchange of value, not an expense. The brain power, experience and work of talented directors who keep their smart hat on at board meetings is worth the money.

I’ll close by saying that there is a lot more to this question than space permits, and by noting that modern nonprofit corporation law is very flexible and allows for use of committees, advisory boards, and other structures that would keep an organization tightly bound to its community while giving this alternative model a chance in appropriate cases —indeed, NANOE’s New Guidelines for Nonprofits may revealed what could be the wave of the future and we should be willing to give it a chance.

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Jack Horak joined The Alliance for Non-Profit Growth and Opportunity (TANGO) in 2016 after a 36-year legal career at the Hartford office of the law firm Reid and Riege, P.C. He was a member of the firm’s Business Law Practice, where he created the firm’s Nonprofit Organization Practice Group. He was the principal author of the Reid and Riege Nonprofit Organization Report, a quarterly publication distributed throughout the United States; and also regularly published articles and editorials on legal and policy issues in Philanthropy Magazine, The Hartford Courant, Connecticut Law Tribune, and the Hartford Business Journal, where he writes a regular editorial column entitled “Rule of Law.”  This column first appeared in InsideCharity and the TANGO newsletter.

PERSPECTIVE: CT's Small Towns Receptive to Regional Resource-Sharing

by Leo Paul Connecticut’s small towns and cities support initiatives to encourage voluntary regional cooperation to provide programs and services to meet the needs of local residents in a more efficient, cost-effective manner. As Connecticut’s small towns and cities struggle to do more with less, many communities are exploring new opportunities to share resources to meet these growing needs.

Connecticut’s Regional Councils of Government (COGs) have been instrumental in developing programs to assist towns in delivering services more cost effectively through shared services agreements and regional partnerships. These programs include a wide range of services and functions, including:

• Regional Dispatch Centers
• Regional Animal Control Facilities
• Consolidation of Back Office Functions, i.e. IT, human resources, accounting
• Regional Transfer Stations/Solid Waste Management
• Regional School Districts
• Regional Health Districts
• Group Purchasing of Goods and Services
• Shared Back Office Functions
• Regional online permitting, GIS mapping, and property revaluation.

Programs such as the Regional Performance Incentive Program and Intertown Capital Equipment (ICE) Sharing program have been successful in encouraging communities to utilize regional approaches to delivering services and purchasing equipment to stretch limited municipal dollars. The ICE program, for example, provided state support for the shared purchase of capital equipment, an initiative that allowed towns to share the cost of new/replacement equipment needed to perform critical town services, such as plowing, mowing and fire trucks, etc.

Several years ago, town leaders in Litchfield County implemented a program to share heavy equipment. Ten towns in the area benefit from this program, the Litchfield Hills Public Works Equipment Cooperative, which allows the towns to share major equipment for road maintenance. Two street sweepers and one catch basin cleaner were purchased through the program, which was made possible by a $700,000 grant the council received from the state’s Regional Performance Incentive Program.

Unfortunately, funding for RPIP has been significantly reduced over the years and the ICE program has been eliminated. This is unfortunate because regional sharing programs that allow towns to reduce costs without undermining efficiency are certainly a win-win for the towns and taxpayers.

Regionalism is no Silver Bullet

COGs have been successful in fostering collaborate shared service programs because they work with member towns to identify needs and perform feasibility studies to determine how regional approaches will impact costs and service delivery. This approach recognizes that regional approaches don’t always save money or ensure that services will be delivered more efficiently. According to a 2008 study by Dr. Steve Lanza, editor of The Connecticut Economy, “Municipal consolidation or other service-sharing plans offer no silver bullet for the problem of costly, local public services.”

Too often, legislation promoting regionalism is proposed without fully analyzing whether regionalizing certain programs or services makes sense from an economic and/or service delivery standpoint. A prime example of this is the proposal from the state Department of Public Health to consolidate health districts. This was a top down approach to regionalism that failed because it would have consolidated health districts without regard for cost or for the impact on service delivery to residents. COST attended meetings along with representatives from towns, cities, health districts and health professionals and not one person in the room supported the consolidation proposal.

Unless it can be demonstrated through a thoughtful and comprehensive policy analysis that regional proposals will provide significant benefit or savings, the state should not push towns to rush headlong into such arrangements. Fortunately, COGs are actively working with member towns to determine when regionalism and shared service programs make sense and what it takes to get there.

Successful State/Local Partnerships

In promoting regionalization of services, policymakers should recognize the value of strong state/local partnerships in providing critical services to residents in a cost-effective, value added manner. For more than 60 years, the Resident State Trooper program has been a successful model of a strong state/local partnership that allows towns to share resources and provide critical public safety services to our communities. Not only does the program assist small towns in maintaining a public safety presence, resident state troopers are routinely dispatched from their towns to respond to state police matters outside of their community. The program is a win-win for the state and our small towns and residents.

Unfortunately, towns have had to pay an increasing amount to continue to participate in the program and we are concerned that any additional increases in costs will make it too costly for municipalities to maintain their resident troopers. Towns have explored options to create stand-alone police departments or regional police departments, but these programs are much more costly than the resident trooper program. The towns of Roxbury and Bridgewater have entered into an arrangement to share a resident trooper, which has proven beneficial for both communities, which are very small.

In addition to regional and shared service models, towns have been exploring opportunities to consolidate non-educational expenditures and functions within their communities. For example, the Town of Canton recently entered into an agreement with its Board of Education to share a Finance Director. Other towns have consolidated back office functions under the state’s Nutmeg Network, consolidated maintenance, Human Resource, and other functions. COST supports efforts to assist towns and boards of education in consolidating non-educational expenditures and functions.

Barriers to Regionalism

COGs have worked with towns to successfully identify and support municipal opportunities to regionalize services and improve efficiencies and, as mentioned, there are a number of success stories. However, consolidating services can be difficult and towns often require assistance in 1) undertaking feasibility studies to determine whether consolidation is cost-effective; 2) addressing liability issues that may arise due to sharing arrangements; 3) negotiating contracts for shared services; and 4) addressing collective bargaining/union issues that may undermine savings associated with regional efforts.

COST stands ready to work with lawmakers to develop and support common sense proposals that facilitate the ability of municipalities to

• regionalize certain programs and functions in ways that make sense for the communities involved and for our property taxpayers;
• maintain strong state/local partnership approaches to the delivery of services, such as the Resident Trooper program;
• support the consolidation of non-educational expenditures and functions to improve municipal efficiencies;
• enhance the management of regional school districts; and 5) address barriers to regionalization, including collective bargaining agreements and statutory requirements.

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Leo Paul is First Selectman of the Town of Litchfield, and President, Connecticut Council of Small Towns.  This is an excerpt of testimony submitted to the Connecticut state legislature’s Planning and Development Committee at an Informational Forum on Shared Services and Regional Efficiencies held during the legislative session, earlier this year.

PERSPECTIVE - Discovering Common Ground, Developing Friendships and Creating Impact: A Teenage Sisterhood Driven by Faith

by Olivia Rotter and Layan Alnajjar Around the time of the presidential election of 2016, we embarked on a journey to find peace and unity amidst high tension in our society and government. Coming from moderately conservative Jewish and Muslim homes, we were encouraged to raise our voices during this time of bigotry.

We have been friends throughout high school and were both passionate about social justice issues. Specifically, we were concerned about the hate speech and discriminatory language that was being used to target faith groups - including our own.

With this knowledge, we decided to form the first official teen chapter of the Sisterhood of Salaam Shalom, an international organization that aims to eliminate stereotypes and celebrate the power of friendship and compassion between Muslim and Jewish women. Historically, these two religions have had turmoil in reference to the Israeli-Palestinian conflict. However, this empowering sisterhood distances themselves from any opinionated topics and instead focuses on the similarities of the Jewish and Muslim practice.

The nonprofit organization Civil Politics conducted a study of participants in the Sisterhood. They concluded that “having more in common with members of each faith, more improvement in their comfort with others, and greater commitment to speaking out against divisive rhetoric,” is an extremely powerful agent for change. In correlation with our chapter’s success, this Civil Politics study proved that friendship and acceptance can overcome misunderstanding and misconceptions.

After a lot of hard work in recruitment and creating lesson plans, we had our first meeting in September of 2017. We were both excited and anxious that this day had finally arrived and that our hard work had paid off.

The excitement stemmed from our curiosity and hope that this one chapter could change our local community’s outlook. Our angst was in regards to the possibility that these fourteen high school girls - seven Jewish and seven Muslim - might not get along. To our pleasant surprise, the first meeting went exceptionally well and early friendships quickly began to form. Despite our previous concerns, the girls truly found comfort and confidence as they identified common ground with each other.

Since then, these friendships have taken flight and evolved through the process of giving back to our community. Our first charitable act was around the holiday season when we collected food cans, toiletries, and books for a local family shelter in Hartford. We unloaded and stocked hundreds of supplies that would be given to various families in need. This experience was a gateway to many more acts of service that brought us even closer as a sisterhood.

Soon after, we partnered with the Muslim Coalition of Connecticut to serve those in need of a healthy meal and a place to relax at Mercy Shelter in Hartford. Some of us were in charge of plating the food, while others waitressed. The facilitator for Mercy Shelter was so happy to have us all there and commented that we had the best teamwork he had ever seen. We look forward to going back this year and to gaining even more perspective.

The highlight of our year was teaching our own curriculum to 5th grade students at Beth El Hebrew School in West Hartford. For months our group spent time together creating an intricate lesson plan to teach these young students. The curriculum had a few different components, beginning with a Venn diagram activity that demonstrated the ways that Muslims and Jews are alike. The students soon caught on that every element was a part of both religions, falling into the center section of the diagram.

After many insightful discussions with the students, we then moved on to passing out a coloring page with the Jerusalem skyline on it. During that time, we played music in both Arabic and Hebrew. Lastly, we had each student write on a poster what they thought before versus what they know now, after the activity.

One student wrote on the before side of the poster that they feared “we might not be able to get along.” However, after our lesson they wrote on the after side of the poster that now they know “we are so similar and can be close friends.” It was truly inspiring to see how much new knowledge they acquired regarding the similarities between the two religions in just one short hour. The kids were so excited to learn this material and fascinated by the common ground.

A few weeks ago we were contacted by the coordinator of the Hebrew school and asked to officially be a part of the curriculum for 5th grade students. We feel so fortunate that we will be able to make an even greater impact this year.

In just a few short weeks our chapter will reunite for the first meeting of this new school year! We look forward to another successful year full of friendship, knowledge, and service.

Next year, we are beginning another chapter in our lives as we head off to college. We both plan on bringing all we have learned to our universities, and hopefully starting the first Salaam Shalom college chapter! We urge you to begin making an impact by starting a new chapter of the sisterhood in your own community.  For us, this has been the most rewarding and empowering experience of our entire lives; we hope that you will join us on our journey towards peace and acceptance!

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Olivia Rotter and Layan Alnajjar are seniors at William H. Hall High School in West Hartford; dedicated students and active leaders within their community. This year, they will continue helping to start new chapters across Northern America and will mentor future teen leaders, giving them advice and ideas for meetings. They will be honored for their hard work and devotion to the Sisterhood at the organization’s annual conference in November.

 For more information about the sisterhood, visit https://sosspeace.org, follow the organization on facebook at the Sisterhood of Salaam Shalom, and follow their new teen-run instagram@sossteens.