Community Community AdvocacyAdvocacyPatricia Tellez- Giron M.D.Patricia Tellez- Giron M.D.

Associate Professor Associate Professor Department of Family MedicineDepartment of Family Medicine

University of Wisconsin School of Medicine and University of Wisconsin School of Medicine and Public HealthPublic Health

Chair, Latino Health Council, Madison, WI Chair, Latino Health Council, Madison, WI November 13, 2010November 13, 2010

ObjectivesObjectives

• Define Community AdvocacyDefine Community Advocacy• Name examples of Community Name examples of Community

Advocacy Advocacy • Identify the importance of Community Identify the importance of Community

Advocacy in health careAdvocacy in health care• Describe the skills needed for effective Describe the skills needed for effective

Community Advocacy in health careCommunity Advocacy in health care• Lead a Community Advocacy in health Lead a Community Advocacy in health

care intervention care intervention

BackgroundBackground

• American Board of Internal MedicineAmerican Board of Internal Medicine

““Commitment to the promotion of public Commitment to the promotion of public health and preventive medicine, as well of health and preventive medicine, as well of public advocacy on the part of each public advocacy on the part of each physician”physician”

• American Medical AssociationAmerican Medical Association

““Physicians most advocate for the social, Physicians most advocate for the social, economic, educational, and political economic, educational, and political changes that ameliorate suffering and changes that ameliorate suffering and contribute to human well-being”contribute to human well-being”

• ACGME ACGME

Requires Advocacy training and Requires Advocacy training and experience for all pediatric residentsexperience for all pediatric residents

• Canadian Medical Education Canadian Medical Education Directives for SpecialistDirectives for Specialist

Communicator, collaborator, Communicator, collaborator, manager, scholar, professional and manager, scholar, professional and health advocatehealth advocate

Core general issuesCore general issues

• Physician advocacy core component of Physician advocacy core component of medical professionalismmedical professionalism

• Not many medical schools/residency Not many medical schools/residency programs require community advocacy programs require community advocacy teaching currentlyteaching currently

• Undefined in concept, scope and practiceUndefined in concept, scope and practice

• Undefined advocacy competenciesUndefined advocacy competencies

DefinitionDefinition

• The act of pleading or arguing in favor of The act of pleading or arguing in favor of something, such as a cause, idea, or policy; something, such as a cause, idea, or policy; active support. active support.

• AdvocacyAdvocacy by an individual or by an advocacy by an individual or by an advocacy group normally aims to influence public-policy group normally aims to influence public-policy and resource allocation decisions within and resource allocation decisions within political, economic, and social systems and political, economic, and social systems and institutions; it may be motivated from moral, institutions; it may be motivated from moral, ethical or faith principles or simply to protect ethical or faith principles or simply to protect an asset of interest. an asset of interest.

Examples of community Examples of community advocacyadvocacy

• Budget advocacy :Budget advocacy : Ensures proactive engagement of Civil Society Organizations with Ensures proactive engagement of Civil Society Organizations with the government budget to make the government more accountable to the people and the government budget to make the government more accountable to the people and promote transparency. Budget advocacy also enables citizens and social action groups 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 to compel the government to be more alert to the needs and aspirations of people in general and the deprived sections of the community. general and the deprived sections of the community.

• Bureaucratic advocacy:Bureaucratic advocacy: people considered “experts” have more chance to succeed at people considered “experts” have more chance to succeed at presenting their issues to decision-makers. presenting their issues to decision-makers.

• Ideological advocacy:Ideological advocacy: in this approach, groups fight, sometimes during protests, to in this approach, groups fight, sometimes during protests, to advance their ideas in the decision-making circles. advance their ideas in the decision-making circles.

• Interest-group advocacy:Interest-group advocacy: lobbying is the main tool used by interests groups doing lobbying is the main tool used by interests groups doing mass advocacy. mass advocacy.

• Legislative advocacy:Legislative advocacy: legislative advocacy is the “reliance on the state or federal legislative advocacy is the “reliance on the state or federal legislative process” as part of a strategy to create changelegislative process” as part of a strategy to create change

• Mass advocacy:Mass advocacy: is any type of action taken by large groups (petitions, demonstrations, is any type of action taken by large groups (petitions, demonstrations, etc.) etc.)

• Media advocacy:Media advocacy: is “the strategic use of the mass media as a resource to advance a is “the strategic use of the mass media as a resource to advance a social or public policy initiative”social or public policy initiative”

DefinitionDefinition

• Health advocacyHealth advocacy encompasses direct encompasses direct service to the individual or family as well service to the individual or family as well as activities that promote health and as activities that promote health and access to health care in communities and access to health care in communities and the larger public. Advocates support and the larger public. Advocates support and promote the rights of the patient in the promote the rights of the patient in the health care arena, help build capacity to health care arena, help build capacity to improve community health and enhance improve community health and enhance health policy initiatives focused on health policy initiatives focused on available, safe and quality care. available, safe and quality care.

DefinitionDefinition

• AMAAMA

““Action by a physician to promote Action by a physician to promote those social, economic, educational those social, economic, educational and political changes that ameliorate and political changes that ameliorate the suffering and threats to human the suffering and threats to human health and well being that he or she health and well being that he or she identifies through his or her identifies through his or her professional work and expertise”professional work and expertise”

Physician atribuites Physician atribuites

• Unique positionUnique position– Understanding of medical issuesUnderstanding of medical issues– Understanding of health social Understanding of health social

determinants determinants – High public trust: credible source of High public trust: credible source of

informationinformation– Unusual degree of access to policy makers, Unusual degree of access to policy makers,

local and national leaders and to citizenslocal and national leaders and to citizens– High power influencing public processes High power influencing public processes

and prioritiesand priorities

Physician barriersPhysician barriers

• Medical schools favor high academics Medical schools favor high academics vs. service oriented studentsvs. service oriented students

• Medical training isolates and removes Medical training isolates and removes individuals from the community while individuals from the community while they attain clinical competencythey attain clinical competency

• Contrast between competence/control Contrast between competence/control in clinical settings vs. uncertainty of in clinical settings vs. uncertainty of advocacy roleadvocacy role

• Busy clinical demanding lives (no time Busy clinical demanding lives (no time for community advocacy)for community advocacy)

Physician barriersPhysician barriers

• Not well delineated boundaries as in Not well delineated boundaries as in clinical encounterclinical encounter

• Agenda may conflict with the Agenda may conflict with the priorities of institutionspriorities of institutions

• Culture of medicine: Culture of medicine: science/evidence based /data drivenscience/evidence based /data driven

• No adequate trainingNo adequate training

DANE COUNTYDANE COUNTY

LATINO SUPPORT LATINO SUPPORT NETWORKNETWORK

LATINO HEALTH COUNCIL

LATINO CHILDREN AND FAMILY COUNCIL

SPANISH MEDIACENTRO HISPANOCENTRO GUADALUPEFAITH BASE ORGANIZATIONSHARAMBEEUNITED WAY

LATINO EDUCATION COUNCIL

LUCHA

Latino Health CouncilLatino Health Council

The mission of the LHCThe mission of the LHC is to promote is to promote andand

support the health and well being of support the health and well being of thethe

Latino community through education,Latino community through education,

advocacy, consulting, and networking.advocacy, consulting, and networking.

HEALTH FAIRHEALTH FAIR

LATINO HEALTH FAIRLATINO HEALTH FAIR

• This is the only event of its kind in Dane This is the only event of its kind in Dane County and throughout Wisconsin. The County and throughout Wisconsin. The event offers a great opportunity for event offers a great opportunity for Latinos to learn about various community Latinos to learn about various community services. Additionally, free screenings services. Additionally, free screenings are provided for very important, are provided for very important, preventable diseases like hypertension, preventable diseases like hypertension, diabetes, lipid disorders, and HIV, among diabetes, lipid disorders, and HIV, among others. The attendance to this event is others. The attendance to this event is usually 600 to 700 people. usually 600 to 700 people.

NUESTRA SALUD RADIO NUESTRA SALUD RADIO PROGRAMPROGRAM

CHRONIC DISEASE CHRONIC DISEASE CONFERENCECONFERENCE

LATINO TEEN HEALTH LATINO TEEN HEALTH BASHBASH

Community AdvocacyCommunity Advocacy

• Empirically without much trainingEmpirically without much training

• Trial and errorTrial and error

• Based on already developed expertiseBased on already developed expertise

• Connected to current job description Connected to current job description

• LocalLocal

• A few extra hours dedicated to thisA few extra hours dedicated to this

Community AdvocacyCommunity Advocacy

• CA needs to be promoted and taught, not CA needs to be promoted and taught, not

left to chanceleft to chance• Every physician should learn/do/teach Every physician should learn/do/teach

CA at least to a basic levelCA at least to a basic level

• Undergraduate/graduateUndergraduate/graduate

• CA opportunities for practicing CA opportunities for practicing

physiciansphysicians

Advocacy cycleAdvocacy cycle

SkillsSkills

• Identifying a problemIdentifying a problem• Defining the problem and its scopeDefining the problem and its scope• Identifying and engaging strategic Identifying and engaging strategic

partnerspartners• Developing a strategic action planDeveloping a strategic action plan• Communicating an effective Communicating an effective

messagemessage

Attributes of health Attributes of health advocateadvocate

• KnowledgeableKnowledgeable• AltruisticAltruistic• HonestHonest• AssertiveAssertive• ResourcefulResourceful• Up-to-dateUp-to-date

• ExpertExpert• ProfessionalProfessional• CommunicatorCommunicator• CollaboratorCollaborator• ManagerManager• ScholarScholar

Community AdvocacyCommunity Advocacy

• Understanding of the social Understanding of the social determinants of healthdeterminants of health

• Training in leadership, social and Training in leadership, social and organizational change (system based organizational change (system based practice)practice)

• Team building (Groups and coalitions)Team building (Groups and coalitions)• Develop and practice delivering clear Develop and practice delivering clear

messages and using the media messages and using the media effectivelyeffectively

Community AdvocacyCommunity Advocacy

• Policy making (own institution, the Policy making (own institution, the community and the government)community and the government)

• Opportunity to practice skills Opportunity to practice skills through service learning activitiesthrough service learning activities

• Role modeling of skills by mentors Role modeling of skills by mentors who know/truly value CA who know/truly value CA

Community AdvocacyCommunity Advocacy

• Accrediting bodies should define and endorse Accrediting bodies should define and endorse CA competenciesCA competencies

• Campuses need to develop stronger and more Campuses need to develop stronger and more productive partnerships with communitiesproductive partnerships with communities

• Physicians/Medical educators should devote Physicians/Medical educators should devote (be given) time to learn/practice/teach skills (be given) time to learn/practice/teach skills necessary for CAnecessary for CA

• Deans and other administrators need to Deans and other administrators need to encourage and reward faculty advocacy encourage and reward faculty advocacy activitiesactivities

EXAMPLESEXAMPLES

Examples of Advocacy Examples of Advocacy issuesissues

• Family issue = Provision available Family issue = Provision available but not accessed but not accessed

• Within agency issue = System fails Within agency issue = System fails individual or familyindividual or family

• Interagency issue = Interaction Interagency issue = Interaction between agencies failsbetween agencies fails

• Inadequate or absent provisionInadequate or absent provision• DiscriminationDiscrimination

Breast feedingBreast feeding

ACTIVITYACTIVITY

SUMMARYSUMMARY

Patricia TPatricia Tééllez-Girllez-Giróón MDn MDptellez@fammed.wisc.edu

(608)263-3111(608)263-3111