Community Advocacy
Patricia Tellez- Giron M.D.
Associate Professor
Department of Family Medicine
University of Wisconsin School of Medicine and Public Health
Chair, Latino Health Council, Madison, WI
November 13, 2010
Objectives
• Define Community Advocacy
• Name examples of Community Advocacy
• Identify the importance of Community
Advocacy in health care
• Describe the skills needed for effective
Community Advocacy in health care
• Lead a Community Advocacy in health care
intervention
Background
• American Board of Internal Medicine
“Commitment to the promotion of public health and
preventive medicine, as well of public advocacy on the
part of each physician”
• American Medical Association
“Physicians most advocate for the social, economic,
educational, and political changes that ameliorate
suffering and contribute to human well-being”
• ACGME
Requires Advocacy training and experience for all
pediatric residents
• Canadian Medical Education Directives for
Specialist
Communicator, collaborator, manager,
scholar, professional and health advocate
Core general issues
• Physician advocacy core component of medical
professionalism
• Not many medical schools/residency programs require
community advocacy teaching currently
• Undefined in concept, scope and practice
• Undefined advocacy competencies
Definition
• The act of pleading or arguing in favor of something,
such as a cause, idea, or policy; active support.
• Advocacy by an individual or by an advocacy group
normally aims to influence public-policy and resource
allocation decisions within political, economic, and
social systems and institutions; it may be motivated
from moral, ethical or faith principles or simply to
protect an asset of interest.
Examples of community advocacy
•
Budget advocacy : Ensures proactive engagement of Civil Society Organizations with the government budget
to make the government more accountable to the people and promote transparency. Budget advocacy also
enables citizens and social action groups to compel the government to be more alert to the needs and
aspirations of people in general and the deprived sections of the community.
•
Bureaucratic advocacy: people considered “experts” have more chance to succeed at presenting their issues
to decision-makers.
•
Ideological advocacy: in this approach, groups fight, sometimes during protests, to advance their ideas in the
decision-making circles.
•
Interest-group advocacy: lobbying is the main tool used by interests groups doing mass advocacy.
•
Legislative advocacy: legislative advocacy is the “reliance on the state or federal legislative process” as part of
a strategy to create change
•
Mass advocacy: is any type of action taken by large groups (petitions, demonstrations, etc.)
•
Media advocacy: is “the strategic use of the mass media as a resource to advance a social or public policy
initiative”
Definition
• Health advocacy encompasses direct service to
the individual or family as well as activities that
promote health and access to health care in
communities and the larger public. Advocates
support and promote the rights of the patient in
the health care arena, help build capacity to
improve community health and enhance health
policy initiatives focused on available, safe and
quality care.
Definition
• AMA
“Action by a physician to promote those social,
economic, educational and political changes that
ameliorate the suffering and threats to human
health and well being that he or she identifies
through his or her professional work and
expertise”
Physician atribuites
• Unique position
–
–
–
–
Understanding of medical issues
Understanding of health social determinants
High public trust: credible source of information
Unusual degree of access to policy makers, local and
national leaders and to citizens
– High power influencing public processes and
priorities
Physician barriers
• Medical schools favor high academics vs. service
oriented students
• Medical training isolates and removes individuals
from the community while they attain clinical
competency
• Contrast between competence/control in
clinical settings vs. uncertainty of advocacy role
• Busy clinical demanding lives (no time for
community advocacy)
Physician barriers
• Not well delineated boundaries as in clinical
encounter
• Agenda may conflict with the priorities of
institutions
• Culture of medicine: science/evidence based
/data driven
• No adequate training
DANE COUNTY
LATINO SUPPORT
NETWORK
LATINO HEALTH
COUNCIL
LATINO
EDUCATION
COUNCIL
LATINO CHILDREN
AND FAMILY COUNCIL
LUCHA
SPANISH MEDIA
CENTRO HISPANO
CENTRO GUADALUPE
FAITH BASE
ORGANIZATIONS
HARAMBEE
UNITED WAY
Latino Health Council
The mission of the LHC is to promote and
support the health and well being of the
Latino community through education,
advocacy, consulting, and networking.
HEALTH FAIR
LATINO HEALTH FAIR
• This is the only event of its kind in Dane
County and throughout Wisconsin. The event
offers a great opportunity for Latinos to learn
about various community services. Additionally,
free screenings are provided for very important,
preventable diseases like hypertension, diabetes,
lipid disorders, and HIV, among others. The
attendance to this event is usually 600 to 700
people.
NUESTRA SALUD RADIO
PROGRAM
CHRONIC DISEASE
CONFERENCE
LATINO TEEN HEALTH
BASH
Community Advocacy
• Empirically without much training
• Trial and error
• Based on already developed expertise
• Connected to current job description
• Local
• A few extra hours dedicated to this
Community Advocacy
• CA needs to be promoted and taught, not left to
chance
• Every physician should learn/do/teach CA at
least to a basic level
• Undergraduate/graduate
• CA opportunities for practicing physicians
Advocacy cycle
Skills
•
•
•
•
•
Identifying a problem
Defining the problem and its scope
Identifying and engaging strategic partners
Developing a strategic action plan
Communicating an effective message
Attributes of health advocate
•
•
•
•
•
•
Knowledgeable
Altruistic
Honest
Assertive
Resourceful
Up-to-date
•
•
•
•
•
•
Expert
Professional
Communicator
Collaborator
Manager
Scholar
Community Advocacy
• Understanding of the social determinants of
health
• Training in leadership, social and organizational
change (system based practice)
• Team building (Groups and coalitions)
• Develop and practice delivering clear messages
and using the media effectively
Community Advocacy
• Policy making (own institution, the community
and the government)
• Opportunity to practice skills through service
learning activities
• Role modeling of skills by mentors who
know/truly value CA
Community Advocacy
• Accrediting bodies should define and endorse
CA competencies
• Campuses need to develop stronger and more
productive partnerships with communities
• Physicians/Medical educators should devote (be
given) time to learn/practice/teach skills
necessary for CA
• Deans and other administrators need to
encourage and reward faculty advocacy activities
EXAMPLES
Examples of Advocacy issues
• Family issue = Provision available but not
accessed
• Within agency issue = System fails individual or
family
• Interagency issue = Interaction between
agencies fails
• Inadequate or absent provision
• Discrimination
Breast feeding
ACTIVITY
SUMMARY
Patricia Téllez-Girón MD
ptellez@fammed.wisc.edu
(608)263-3111