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research-article2017
HPPXXX10.1177/1524839917726764Health Promotion PracticeBlenner et al. / Shifting the Culture Around Public Health Advocacy
Career Development
Shifting the Culture Around Public Health
Advocacy: Training Future Public Health
Professionals to Be Effective Agents of Change
Sarah R. Blenner, JD, MPH1
Cathy M. Lang, PhD, MPH1
Michael L. Prelip, DPA, MPH1
There is a critical need to build the capacity of our current and future public health workforce and the communities we serve to engage in public health advocacy.
Advocacy should be an integral piece of our intervention strategies and public health discourse. Incorporating
public health advocacy into public health training,
practice, and research serves as a long-term investment
for the public’s health. Advocacy can achieve systemic
change by addressing the social determinants of health.
We developed an advocacy training program that
embeds students in community-based organizations
(CBOs) for 9 months, providing students with experiential education through the application of advocacy
skills and CBOs with opportunities to expand and
broaden their advocacy efforts. We have three priority
populations: graduate students, CBOs serving Los
Angeles County, and the broader Los Angeles County
community, focusing on vulnerable populations. Our
multifaceted approach addresses the necessity of public
health advocacy among the health professions. Through
changing how we train students and how communities
and universities collaborate, we can strengthen the public health workforce and build healthier communities.
Keywords: advocacy; career development/professional preparation; partnerships/coalitions;
training;
college/community
partnerships; university/college health;
workforce development; environmental
and systems change; health disparities
Health Promotion Practice
November 2017 Vol. 18, No. (6) 785­–788
DOI: 10.1177/1524839917726764
© 2017 Society for Public Health Education
E
mbedding advocacy into public health training,
practice, and research serves as a long-term
investment for the public’s health and can effectuate systemic change by addressing the social determinants of health (Commission on Social Determinants of
Health, 2008). There is a critical need—now more than
ever—to build the capacity of our current and future
public health workforce and the communities we serve
to engage in public health advocacy. We define public
health advocacy broadly, as a mechanism to create
change that will influence population health. We
approach advocacy holistically, considering the many
avenues that can lead to change such as legislation and
regulations, judicial proceedings, institutional policies
and practices, community engagement, and media
interventions.
Despite tremendous health care spending, the United
States ranks poorly on key health indicators (Squires &
Anderson, 2015). While there have been major advances
in medicine, preventable diseases continue to be the
leading causes of morbidity and mortality (Johnson,
Hayes, Brown, Hoo, & Ethier, 2014). Health disparities
1
UCLA Fielding School of Public Health, Los Angeles, CA,
USA
Authors’ Note: This program would not be possible without the
generous support of The California Endowment. We would also
like to thank our partnering community-based organizations who
played a critical role in the success of this program. Address
correspondence to Sarah Blenner, JD, MPH, Public Health
Training Program on Population Health Advocacy, Office of the
Associate Dean of Public Health Practice, UCLA Fielding School
of Public Health, 650 Charles E. Young Drive, South, 26-071 CHS,
Box 951772, Los Angeles, CA 90095-1772, USA; e-mail: sblenner@
ph.ucla.edu.
785
are alarming. Disparities continue to exist and are
worsening for some health outcomes. Low-income
communities and communities of color experience a
disproportionate disease burden (Williams & PurdieVaughns, 2016).
While public health practitioners work toward
understanding and improving health of priority populations, many lack advocacy skills and experience and
therefore are reluctant to engage in advocacy around
important public health issues. Without advocacy,
health equity is difficult to achieve and public health
interventions’ outcomes will be difficult to sustain,
thus leaving communities vulnerable when projects
and funding conclude. Advocacy is so important that it
has been argued public health professionals’ failure to
engage in advocacy is akin to physicians’ medical
neglect (Tillmann, Baker, Crocker-Buque, Rana, &
Bouquet, 2014).
Yet future public health leaders have limited opportunities to learn and practice advocacy during academic training. Opportunities that exist usually occur
in isolated workshops, in short-term special events, or
as anecdotes in coursework and often focus narrowly
on legislative or policy advocacy. In a website search of
the top 25 schools of public health, few schools describe
having an advocacy program. While these experiences
can help encourage public health professionals to
engage in advocacy (see e.g., Rivera et al., 2016), it is
not enough. Public health advocacy should be an integral part of public health professionals’ scope of practices and encompass more than legislative advocacy.
Advocacy should be an integral piece of our intervention strategies and public health discourse.
The Advocacy Program
>>
To address this critical unmet need, the UCLA
Fielding School of Public Health developed the Public
Health Training Program on Population Health
Advocacy (Advocacy Program). The Advocacy Program
embeds students in community-based organizations
(CBOs) for 9-month long experiences that connect,
deepen, and augment their training through the application of advocacy skills, and provides opportunities for
CBOs to expand and broaden their advocacy efforts.
These Advocacy Fellows receive stipends, allowing
them to focus on advocacy while lessening financial
burdens. The program directly addresses barriers to
engage in advocacy, raising awareness, teaching skills to
engage effectively in advocacy, and providing a forum
to address perceived ethical dilemmas (see Chapman,
2001; Cohen & Marshall, 2016). Originally supported by
one foundation, the Advocacy Program recently received
786 HEALTH PROMOTION PRACTICE / November 2017
supplemental support from two additional local foundations to train additional students. This demonstrates
funders’ interest in strategic investments that make
advocacy sustainable, affecting population health
beyond specific programs and interventions.
Student Placement
>>
Advocacy cannot be learned in isolation, and advocacy skills cannot be taught solely from a book. It
requires hands-on, real-world experience and exposure.
Experiential education is a powerful framework by
which students build knowledge from the accrual of
experiences and the analysis of these experiences (Itin,
1999). To foster this action-oriented learning environment, Advocacy Fellows work on projects for approximately 650 hours, expanding the School’s traditional
400-hour summer field studies experience requirement.
Through extended field placement, hands-on training,
and professional development, fellows gain a valuable
skill set and help build the capacity for advocacy at
CBOs throughout Los Angeles. The goal is to foster a
community of advocates so that students not only learn
related skills but also develop a strong connection to
advocacy work and a deep appreciation of advocacy’s
importance to public health that will sustain their advocacy involvement throughout their careers.
The program is open to graduate public health students from all disciplines. Students can use the experience to satisfy applicable field studies requirements.
The presence of dedicated staff with the background
and experience to support Advocacy Fellows academically and professionally is essential to the success of individual students and the program generally.
Many of our students are from underrepresented
groups and the first in their families to attend college.
Working closely with these students establishes a
much-needed safety net and helps them learn how to
succeed in a professional environment and navigate
complex systems.
Community Partnerships
>>
Partnering CBOs play a critical role in training
Advocacy Fellows. Organizations propose advocacy
projects that benefit the organizations and the communities served, provide support and supervision to Advocacy
Fellows, communicate with program staff, and complete
field studies documentation. In our first year, there were
19 diverse opportunities for students. We halted CBO
recruitment efforts due to our inability to support all
organizations and projects, highlighting the need and
interest to reinforce CBOs’ advocacy efforts.
Career Development
Our first cohort of Advocacy Fellows worked on (1)
developing recommendations to improve an organization’s local advocacy efforts and engage volunteers and
community health workers in advocacy; (2) implementing an environmental education and advocacy training
program for middle school students; (3) engaging South
Los Angeles residents in the land use policy-making
process so that residents can help revitalize their community; (4) addressing federal tax incentives and food
bank practices around the donation of unhealthy food
items, including sugar-sweetened beverages; (5) evaluating advocacy efforts, including a youth advocacy
training program on violence and intimate partner violence; and (6) developing an advocacy curriculum that
will empower members of a leadership group to advocate for improved LGBTQ (lesbian, gay, bisexual,
transgender, queer) mental health services in Los
Angeles County. Other proposals covered immigrant
access to health insurance, Baby-Friendly Hospital policies, substance abuse prevention policies, and food as
medicine for chronically ill patients.
Some CBOs proposed projects where students would
launch a new advocacy effort, allowing the organizations to create or expand advocacy work, while other
projects were designed to reinforce existing advocacy
efforts. Projects required different skill sets, as advocacy
covers the spectrum of public health practice ranging
from developing research questions and survey tools, to
collecting and analyzing data, to building coalitions,
gathering support, and implementing educational and
advocacy campaigns. This diversity allows students of
various academic backgrounds, experiences, and skills
to engage in advocacy in different capacities, as we personalize the educational training to be appropriate and
meaningful for each individual student.
Programming and
>>
Multidisciplinary Collaborations
To provide continuing education, the Advocacy
Program sponsors monthly workshops, such as best
practices for meeting with elected officials and strategies for effectively working with the news media. Other
workshops focus on peer-to-peer learning and support,
providing a space for students to brainstorm, problemsolve, and share successes and challenges. Workshops
provide additional support to the Advocacy Fellows
and a forum for all Fielding School of Public Health
(FSPH) students to engage in the conversation around
public health advocacy, exposing students to important
topics and skill sets.
For advocacy to be successful, it often requires multidisciplinary collaborations. The Advocacy Program
identifies opportunities to bring together individuals
and groups from across disciplines to address public
health and encourages students to engage in multidisciplinary activities. In the field, students work closely
with team members, many of whom have different
academic and professional backgrounds. A joint effort
with the Section of Pediatric Dentistry at the UCLA
School of Dentistry exposed public health and dentistry students/residents to advocacy concepts, including the policy-making process and advocacy strategies.
Students explored pediatric oral health problems and
possible advocacy-related solutions. Students also
identified how solutions will ultimately have an impact
on population health, underscoring the nuances to
meaningful public health interventions. We further
enrich the program by connecting students with FSPH
faculty and staff who have relevant expertise and by
creating innovative programming.
Implementation and Lessons
>>
Learned
Each year, we spend approximately 2 months cultivating potential partnerships with local CBOs, developing advocacy proposals that will benefit CBO’s efforts
and meet field studies requirements, and formally
documenting proposals through a registration process.
Some partnerships build off of existing relationships,
while others are established through targeted outreach
to new contacts. Simultaneously, we launch a student
application cycle with an internal campaign designed
to inspire students to become public health advocates.
The student application includes grade reports, resume/
curriculum vitae, and cover letter outlining advocacy
interests and career goals. Public Health Advocacy
Fellows are selected by a committee based on goals,
aspirations, academic standing, demonstrated leadership, interest in advocacy, and experience.
Students are matched with CBOs based on a variety of
factors, including student interests and skill sets. Future
cohorts will undergo a matching process with additional
input from CBOs and students. Students are then fully
integrated into their assigned organizations and are
expected to complete all hours in the field. Students, in
collaboration with CBOs and field studies and Advocacy
Program staff, develop scopes of work establishing time
lines, student responsibilities, and learning objectives.
CBOs provide (1) formal preceptors meeting department
field studies requirements, (2) supervisory staff for dayto-day supervision, (3) professional development guidance, and (4) work space and needed equipment. The
School’s Advocacy Program representatives provide support and educational programming, mentor students, and
Blenner et al. / SHIFTING THE CULTURE AROUND PUBLIC HEALTH ADVOCACY 787
coordinate with the School’s field studies faculty and
staff. Students use timesheets to track hours and submit
deliverables, formal reports, and evaluations to field
studies and Advocacy Program staff after completing the
program, consistent with departmental field studies
requirements.
During outreach efforts, many CBOs initially viewed
advocacy narrowly—focusing on lobbying, legislative
advocacy, and risk to tax status. We worked with organizations to conceptualize advocacy holistically and
identify meaningful paths within the organization’s
infrastructure to engage in advocacy. Some smaller
organizations ultimately did not complete the registration process, expressing concern of allocating adequate
staff time to guide students, despite recognizing that a
student would greatly build organizational advocacy
capacity. It was challenging to find preceptors with the
minimum field studies requirement (advanced degree
in public health with 3 years minimum experience)
who could provide students with appropriate advocacy
guidance. As a result, we identified individuals with
educational backgrounds in other disciplines who
could build advocacy skills of students. In some cases,
students reported to multiple staff, the combination of
which provided the requisite experience, education,
and familiarity with the advocacy project.
Finally, we addressed challenges related to students’
professional growth. Some students struggled with
time management and balancing professional and student responsibilities. We used this as an opportunity to
develop skills crucial to succeeding in the public
health workforce. We learned that peer support was
one of the most effective tools in helping students
develop confidence related to engaging in advocacy
and broadening public health advocacy perspectives.
Impact
>>
Our multifaceted approach addresses the necessity
of public health advocacy among the health professions. We have three priority populations: FSPH graduate students, CBOs serving Los Angeles County, and the
broader Los Angeles County community, focusing on
vulnerable populations. The level of in-depth field
advocacy training our program provides is unique
among schools of public health. Advocacy Fellows
have improved skills and experience to engage in public health advocacy efforts. Because the program is
resource-intensive, we are able to provide in-depth
training only to select candidates. However, we have
found there is an increased awareness of public health
advocacy among the FSPH community. This program is
designed to have a ripple effect in the community,
788 HEALTH PROMOTION PRACTICE / November 2017
building the capacity for public health advocacy and
empowering the next generation of public health professionals to engage in advocacy.
Conclusions
>>
Through changing how we train students and how
communities and universities collaborate, we can
improve health knowledge and influence change—
strengthening the public health workforce and building
healthier communities. We teach students how to be
advocates: true agents of change. The Advocacy
Program goes beyond providing academic training,
grounding public health students in the heart of advocacy and exposing them to real-world, community
health issues including food insecurity, health care
access, poverty, and violence.
References
Chapman, S. (2001). Advocacy in public health: Roles and challenges. International Journal of Epidemiology, 30, 1226-1232.
doi:10.1093/ije/30.6.1226
Cohen, B. E., & Marshall, S. G. (2016). Does public health advocacy seek to redress health inequities? A scoping review. Health
and Social Care in the Community, 25, 309-328. doi:10.1111/
hsc.12320
Commission on Social Determinants of Health. (2008). Closing
the gap in a generation: Health equity through action on the
social determinants of health. Geneva, Switzerland: World Health
Organization. Retrieved from http://apps.who.int/iris/bitstream/
10665/43943/1/9789241563703_eng.pdf
Itin, C. M. (1999). Reasserting the philosophy of experiential education as a vehicle for change in the 21st century. Journal of
Experiential Education, 22, 91-98. doi:10.1177/105382599902200206
Johnson, N. B., Hayes, L. D., Brown, K., Hoo, E. C., & Ethier, K. A.
(2014). CDC national health report: Leading causes of morbidity
and mortality and associated behavioral risk and protective factors–United States, 2005-2013. Morbidity and Mortality Weekly
Report, 63(Suppl. 4), 3-27. Retrieved from https://www.cdc.gov/
mmwr/pdf/other/su6304.pdf
Rivera, L., Starry, B., Gangi, C., Lube, L. M., Cedergren, A., Whitney,
E., & Rees, K. (2016). From classroom to capitol: Building advocacy
capacity through state-level advocacy experiences. Health
Promotion Practice, 17, 771-774. doi:10.1177/1524839916669131
Squires, D., & Anderson, C. (2015). U.S. health care from a global
perspective: Spending, use of services, prices, and health in 13
countries. The Commonwealth Fund. Retrieved from http://www.
commonwealthfund.org/publications/issue-briefs/2015/oct/ushealth-care-from-a-global-perspective
Tillmann, T., Baker, P., Crocker-Buque, T., Rana, S., & Bouquet, B.
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the UK. The Lancet, 383, 213. doi:10.1016/S0140-6736(14)60064-7
Williams, D. R., & Purdie-Vaughns, V. (2016). Needed interventions to
reduce racial/ethnic disparities in health. Journal of Health Politics,
Policy and Law, 41, 627-651. doi:10.1215/03616878-3620857
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