Advocacy for Public Health

By Cayla Saret

Why advocate for public health issues? “It’s the only way to get anything done,” says Beth Rosenberg, MPH, ScD, Assistant Professor of Public Health and Community Medicine. In the absence of awareness and understanding by policymakers and the public, even impressive published research may have no effect.[i] Environmental, social, political, and personal factors contribute to public health problems. These factors also influence everything from research funding to program design. Therefore, many advocates are needed to champion interventions.

Advocates may conduct personal outreach such as visits (often most effective), send emails, write letters, or make phone calls to government officials. They may submit testimony for a legislative hearing or join a protest.[ii] Sue Gallagher, MPH, Director, MS in Health Communication Program and Assistant Professor of Public Health and Community Medicine, suggests making a clear request for action, such as asking a Congressional member to support a specific bill. Advocates should speak with representatives of their own district and share stories about their own experiences when possible. Although evidence should inform advocacy, she says, people “are not going to remember all of the data. They’re going to remember the personal story, and that may resonate with them.”

Advocacy can shape state policy such as the 2006 Massachusetts healthcare reform law. Amy Lischko, DSc Associate Professor of Public Health and Community Medicine, served as Commissioner of Health Care Finance and Policy and Director of Health Care Policy at the time. From her perspective, Governor Mitt Romney’s interest in reform emerged partly from his business experience, as well as from myriad visitors for whom “healthcare was their biggest issue.” Lischko listened to a range of advocates in her work. “I want to know why someone disagrees with certain policies,” she says. “I fundamentally think everyone is on the same page with the ultimate goals but they really disagree on how to get there.” She urges advocates to remain open-minded and to seek news from sources with differing opinions so they can best craft their messages such that policymakers will hear them.

One group that visited Governor Romney to support reform was the Greater Boston Interfaith Organization (GBIO), a social justice organization primarily composed of religious congregations of churches, synagogues, and mosques. Paul Hattis, MD, JD, MPH, Associate Professor of Public Health and Community Medicine and Sr. Associate Director for the MPH Program, is a member of GBIO’s Strategy and Healthcare teams. “We’re very relationship focused,” he explains. The organization may collaborate with officials and other groups on one project even while they have conflicting goals in another arena. “Sometimes we say ‘No, we don’t agree,’” says Hattis, “But we don’t believe that’s the end of the relationship.” GBIO was instrumental in collecting signatures for a ballot initiative that spurred the Governor and legislature to pass healthcare reform, as well as in lobbying for administrative rules that affected the way that subsidized insurance was priced for eligible low-income individuals. Hattis notes that it has been more impactful and personally satisfying to advocate on behalf of this “racially, religiously, socioeconomically diverse” organization than to do so as an academic. Similarly, Lischko says that a member of a larger group wields more influence than an independent individual.

Advocacy “isn’t just about legislators,” says Gallagher. “It’s also about heads of agencies at the state or federal level, foundations, and professional organizations.” It may involve bringing together people who support a change in their neighborhood, school, or workplace.[iii] For example, says Hattis, “students and faculty within universities, or coworkers at job,” can advocate for a transformation. “That’s vitally important,” he says, “Especially when you feel unempowered with respect to some hierarchy.”

Rosenberg says that individuals interested in advocacy should just try it. She recalls a colleague, Edith Balbach, PhD, former Director of the Community Health Program at Tufts, who wanted to ban smoking in casinos; only when she began her efforts did she learn that the strongest opponent was the heating ventilation and air conditioning industry, because casinos invest money in systems to filter smoke. “Start doing something, and you’ll see what you need to learn,” says Rosenberg. “That’s the only way to do it.”

[i] Chapman, Simon. Advocacy in Public Health: Roles and Challenges. Int J Epidemiol, 2001. 30(6): pp. 1226-1232.

[ii] Christoffel, Katherine K. Public Health Advocacy: Process and Product. Am J Public Health, 2000. 90(5): pp. 722-726.

[iii] Avery, Byllye and Bashir, Samiya. The Road to Advocacy – Searching for the Rainbow. Am J Public Health, 2003. 93(8): pp. 1207-1210.