J. Gary Wheeler, MD, MPS
Little Rock, Arkansas

Understand the different spheres of advocacy at the practice, community, and state levels.
Identify at least two qualities physicians bring to strengthening advocacy campaigns and partnerships
Identify tools for advocacy, especially stories

• Public not private health

Individual behavior
Trigger: Paper in
Pediatrics re: magazines and tobacco promotion
Action: Removing all magazines from your waiting room areas which promote tobacco use (e.g. Sports
Illustrated)

• Trigger: observation of increased numbers of patients in your practice using tobacco
• Action: Join the school district health committee to improve the curriculum about tobacco use and second hand smoke

• Trigger: death of non-smoking restaurant worker who is a parent of a child in your practice from
Lung Cancer (squamous cell carcinoma)
• Phone your representative on the state legislature in support of a smoke free workplace regulation. Participate as a “science” expert on
SHS for the legislative committee

• Professional tradition
– …it is not enough, however, to work at the individual bedside in the hospital.. In the near or dim future, the pediatrician is to sit in and control school boards, health departments, and legislatures. He is the legitimate advisor to the judge and the jury, and a seat for the physician in the councils of the republic is what the people have a right to demand.
– Abraham Jacobi, 1904

• Don’t know how to do
• No time
• Can’t sell prevention
• I’m not that kind of person
• Won’t make a difference
• My medical school will fire me
– Galer-Unti, RA.Health Prom Pract 2004:280

11:40: surfing web for best nicotine replacement therapy (NRT) prices.
11:43: Discover following link after description of a nicotine replacement patch: “Additional Information CLICK HERE for Quit Assist website from
Philip Morris USA”
11:44: To self: “Did PM [Philip Morris] actually pay for that? If so it’ll never get removed —what the heck, it’s easy to click Contact Us and point out the incongruence”.
11:45: Message sent: “The last place people who are trying to quit smoking need to be clicking for assistance is a tobacco company website. There are multiple online assistance programs, (I listed some). Please consider replacing or at least eliminating the link to Philip Morris”.
13:31: (Same day!) Message received:
“Having read your message, I instructed the sales department to change all of the listings to reflect a link to www.becomeanex.com
as I personally felt that this website was extremely well designed and geared to helping the smoker quit without linking them to any preferential, alternate websites.
Please feel free to re-examine our website. I think it will help ensure our personal motto of “Be Well” not just in theory, but in practice. Thank you for your concern and we appreciate your input”.
13:33: Revisit site —every smoking cessation product on the site has new link.

•More than 5 million children alive today will die prematurely from smoking-related illnesses?
•Nearly every adult who smokes (almost 90 percent) took his or her first puff at or before the age of 18?
•Or, that increasing tobacco taxes is an effective way to prevent and reduce smoking, especially among kids?
The tobacco industry spends more than $12.8 billion per year advertising and marketing its lethal products
More than 5 million children alive today will die prematurely from smoking-related illnesses
Nearly every adult who smokes (almost 90 percent) took his or her first puff at or before the age of 18
Increasing tobacco taxes is an effective way to prevent and reduce smoking, especially among kids

Advocacy: the political process
Christopher Kush
• Write effective letter
• Send effective e-mail
• Phone call
• Persuade others to contact representatives

Advocacy: the political process
Christopher Kush
• Get out the vote
• Contributions to candidates

Advocacy: the political process
Christopher Kush
• Press clippings file
• Write a letter to the editor
• Write an op-ed
• Meet the editors
• TV interview

Advocacy: the political process
Christopher Kush
• Meet your representative
• Testify at a public hearing
• Protest/march/activity
• Run for office

Health Advocacy Toolbox http://www.cthealthpolicy.org/toolbox/
• Always be polite
• Always say thank you
• Get your story straight
• Never, ever make up an answer
• Trust your champion
• Patience
• You are not the only fish in the pond

• Preparation
• Persistence
• Opportunity

• ACH and a conversation about the “hut”
• Chancellor-Michigan Smoke free hospitals
• COPH data
• Public Health Rep. 2007 Nov-Dec;122(6):744-52.
• Impact of a smoke-free hospital campus policy on employee and consumer behavior.
• Wheeler JG , Pulley L , Felix HC , Bursac Z , Siddiqui
NJ , Stewart MK , Mays GP , Gauss CH .

• The ledge
• The value of data
• Act 134 of 2005
• Published
– Making Hospital Grounds Smoke-Free: A Case Study of Arkansas Act 134 of 2005 :Journal of Public Health
Management and Practice: March/April 2009 -
Volume 15 - Issue 2 - p E9-E15 doi:
10.1097/01.PHH.0000346020.12641.92
•
Felix, Holly C. PhD; Wheeler, J. Gary MD; Pulley, LeaVonne
PhD; Stewart, M. Kathryn MD; Bursac, Zoran PhD; Mays, Glen
P. PhD; Mackey, Diane S. JD

• Infighting/Outfighting-nuances of the bill
• The coalition/lobbyists/nationals
• Role of data- passive smoke and MIs-
Helena, Montana and Colorado
• Try, try and try again-ACT 8 of 2006

• Act 13 of 2006

Dream the Impossible, but work in the realm of the Possible
Sometimes losing is better than winning
Never negotiate with the tobacco industry
Work with the pros for legislative goals
Assume someone has tried what you are trying and can teach you something

• Work hard/be nice (don’t be righteous)
• Learn how to negotiate (don’t view people with polarized lenses)
• Money is the root of most behavior
• Always say thanks

• Expert
• Make the theoretical palpable
• Own the data
• Be the face but rely on the pros for strategy until you are a pro
• Link to a coalition or non-profit
• Stay informed (ANR, CTFK, Richmond Center)
• Manage your time