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Advocacy is an Essential Skill in Health Justice

Summary: Advocacy is a skill set usually overlooked in public health training. A new blog makes the compelling case that advocacy courses should be mandatory, if we want to achieve health equity and justice.

Public Health Advocacy Must be Taught
Health Affairs Forefront
By Alexandra Carter, Lori Dorfman, Tony Iton, and Harry Snyder
February 7, 2022

The COVID-19 pandemic gave contemporary meaning to 19th-century physician Rudolf Virchow’s famous observation that medicine is bound by politics. We have long understood that the solutions to public health problems lie not only with the best available science but also in bold policies for social reform. Indeed, the field’s greatest achievements—from sanitation infrastructure and workplace safety to seat belt laws and tobacco control—are all products of policy change, informed by public health research and catalyzed by the concerted efforts of advocates. Yet, in the decades preceding the pandemic, public health and our academic institutions have increasingly distanced themselves from their roots in political activism and accepted a more neutral, scientific identity.

As our society struggles through the evolution of COVID-19, the crucial question is: Are we preparing the next generation of public health practitioners to not only investigate what harms health but also to advocate affirmatively for what is needed to advance health, particularly for groups plagued by structural inequities?

Policy development and the ability to “create, champion, and implement policies, plans, and laws that impact health” are among the 10 Essential Public Health Services (EPHS) that outlines the activities necessary to protect and promote public health. … Schools and programs of public health in the US are accredited based on criteria [which include] students’ ability to “advocate for political, social, or economic policies and programs that will improve health in diverse populations.”

The EPHS represents an important guiding vision, but there is a clear disconnect between what public health professionals should be able to perform to be effective and what is currently being taught and fostered in our schools of public health. … [R]equired courses in policy and media advocacy are markedly absent from most graduate-level curricula. Schools … of public health in the US excel in teaching rigorous research methods … [They] routinely map [required advocacy] competencies to general courses on community health, public health leadership, and health administration, which may or may not include discrete advocacy skill building. This is a mistake.

Success for most public health academics is defined not by their demonstrable contributions to improving public health but by their numbers of peer-reviewed publications in high-impact journals.

[T]he [2020 EPHS] revision centers health equity where it once revolved around research. … The positioning of equity as a core value explicitly calls on the field to “actively promote policies, systems, and overall community conditions that enable optimal health for all.”

If we want health equity to be more than an aspiration on a teaching diagram, advocacy must be taught and required as a core skillset for graduation from accredited schools of public health.

It’s imperative that our academic public health institutions be held accountable to their accreditation standards and equip the next generation of practitioners with the skills to … address the root causes of inequity through policy change.

We can start by designing and requiring policy and media advocacy breadth courses, distinct from health care administration, to train students to bring public health science to bear on public policy. We should require our faculty to demonstrate how their research has contributed to improving health and health inequities.

Comment by: Jim Kahn

This superb blog drives home a crucial point: achieving health justice is a multi-faceted endeavor. Of course good analysis is essential (that’s my main gig), as is strong program management. But another critical part of the toolbox is advocacy – how to fight for what is right. It’s a skill that can and must be learned. And therefore must be taught in schools of public health. Required, per accreditation standards.

I can’t make the pitch better than this elegant commentary, so I won’t try.

But two comments:

1) Normally HJM shows only the first author, but this time I listed all four because of the astounding breadth they represent. The first is an advocate, the second a media expert, the third a health foundation leader, and the fourth a longstanding advocacy leader. I don’t mean to omit their other terrific roles and credentials, just to highlight their impressive expertise and perspective.

2) Lest you think “public health” is only about community health promotion and disease control programs, please reconsider. Achieving universal high quality health insurance – single payer – is a huge part of the US public health mission. As the blog urges, let’s improve our advocacy for this noble goal!

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