Through an inclusive, rigorous, consensus-driven process, we can redefine our advocacy instructional model and better prepare public health students to engage in policy advocacy.

Do you remember playing “telephone” as a kid? Everyone sits in a circle and the first person whispers something to the next in line who whispers it to the next and so on. At the end of the game, the last person in line reveals what they were told. Typically, what they repeat has little resemblance to what was spoken or intended at the start.

In many ways, public health has been playing “telephone” with the concept of advocacy. In some schools and programs of public health, advocacy may be interpreted to mean lobbying. In others, advocacy means policy analysis. Still others, advocacy may be the same as media advocacy or community organizing. As a result, we are failing to train our future leaders on essential skills needed to make our nation a more equitable, healthy place for all.

I’ve seen how this plays out. For 30+ years, I’ve worked to improve laws, policies, and governmental budgets at the state and local level. I’m proud to have worked on some of our nation’s biggest public health challenges. Over the years, I’ve mentored hundreds of public health students and early grads who wanted to learn how to advocate for policy change. Though the enthusiasm for policy advocacy has grown, I can still count on one hand those who had even a basic understanding of how to be an effective change agent. They may have heard about one or more elements of advocacy but not how to string them all together to have an impact.

Change takes time and much has been done to begin addressing this issue. Since 2016, the Council on Education for Public Health (CEPH) has required all accredited schools and programs of public health (SPPH) to teach students how to advocate.¹ Further, the Council on Linkages also issued public health workforce advocacy competencies in 2021 stating that all public health practitioners should know how to advocate for public health, health equity, and social and environmental justice.²

“Charting the Advocacy Landscape: A Qualitative Content Analysis of Syllabi in Public Health Graduate Education” in the May 2024 issue of the Journal of Public Health Management and Practice analyzes for the first time the current state of advocacy instruction in schools and programs of public health. Overall, our study confirms that our Advocacy 1.0 instructional model needs some work.

We did a qualitative content analysis of 98 SPPH syllabi from 2019-2021 that satisfied CEPH’s advocacy competency.

We found that:

• Advocacy content is most often delivered as a part of survey, policy, or health care administration course which limits the comprehensiveness of advocacy skills covered.
• Only 7% of courses had advocacy content and skills as their main focus.
• Only 10% of courses taught students how to take action to address health equity and/or reduce or eliminate racism in their advocacy work.
• Courses included skills from 2.43 advocacy skill categories on average (e.g., coalition building, media advocacy, community organizing, lobbying, policy communication, health equity, and policy-related skills).
• Courses varied widely on what individual advocacy skills were emphasized.
• Less than half of courses contained advocacy skills used most often in policy change campaigns with the exception of policy-related skills like policy analysis.

How can we evolve our current Advocacy 1.0 instructional model into a more effective Advocacy 2.0 instructional model? In our research, we found that there is no widely accepted definition of public health advocacy, nor a description of the essential skills needed by public health practitioners to operationalize it. If you can’t define public health advocacy, explain its component parts, demonstrate it, and practice it, you can’t learn it or fully engage in it.

Our study team calls for an inclusive, rigorous, field consensus process to set a new direction towards Advocacy 2.0. Once complete, we can draft guidance for schools and programs of public health on how to implement the new model.   

Key leaders in the field recently came together to launch such an effort. The Lerner Center for Public Health Advocacy at the Johns Hopkins Bloomberg School of Public Health, along with the de Beaumont Foundation, CEPH, Association of Schools and Programs of Public Health (ASPPH) and the Public Health Foundation, recently announced the formation of the Public Health Advocacy Consensus Task Force (PH-ACT). Over the next year, we will form an advisory committee, conduct town hall meetings, hold focus groups, engage in an expert consensus study, and draft guidance for schools and programs.

We NEED leaders like you to participate. Visit PH-ACT to learn more about our joint efforts and how to participate. Give us your feedback on how to best improve advocacy instruction.

If we want to tackle our nation’s most intractable public health problems, we need public health practitioners who know how to engage in policy advocacy. Improving our telephone game performance (aka coming to consensus on the definition of public health advocacy and the advocacy skills needed by all MPH graduates) is job #1 and an important first step towards improving health outcomes for all. Please check out our full publication for additional suggestions on how to improve advocacy instruction.

References

1. Council on Education for Public Health. 2016 accreditation criteria [Internet]. 2016 [cited 2022 Oct 3]. Available from: https://ceph.org/about/org-info/criteria-procedures-documents/criteria-procedures/

2. Council on Linkages Between Academia and Public Health Practice. Core competencies for public health professionals [Internet]. 2021 [cited 2022 Oct 3]. Available from: http://www.phf.org/resourcestools/Pages/Core_Public_Health_Competencies.aspx

WE ALSO RECOMMEND

• Carter A, Dorfman L, Iton T, Snyder H. “Public health advocacy must be taught.” Health Affairs Forefront blog. Posted February 7, 2022. https://www-healthaffairs-org.proxy.cc.uic.edu/do/10.1377/forefront.20220202.653661/full.
• Cohen BE, Marshall SG. Does public health advocacy seek to redress health inequities? A scoping review. Health Soc Care Community. 2017;25(2):309–328.
• Hearne SA, Pollack Porter KM, Forrest KS. Policy Engagement. Washington, D.C.: APHA Press; 2023. 100 p. (Strategic Skills for Public Health Practice). Available from: https://secure.apha.org/imis/ItemDetail?iProductCode=978-087553-3384&CATEGORY=BK
• Hearne S, Jernigan, DH. “Who Will Advocate to Keep the Public Healthy? Establishing Competency-Based Advocacy Training for the Public Health Field.” Journal of Public Health Management and Practice, vol. 30, no. 1, 2024, pp. 3–7, https://doi.org/10.1097/PHH.0000000000001839.

---

Co-authors:

Alexandra DiOrio, MPH, CHES® is a PhD student in the Department of Family Sciences at the University of Maryland, College Park School of Public Health.

Yuka Asada, PhD, RD, is a Registered Dietitian and Clinical Assistant Professor of Community Health Sciences in the School of Public Health at the University of Illinois Chicago.

Shelley A. Hearne, DrPH, is the Deans Sommer & Klag Distinguished Professor of the Practice and director, Lerner Center for Public Health Advocacy at Johns Hopkins Bloomberg School of Public Health.

Series Navigation

<< Mississippi’s Pioneering Path of an Age-Friendly EcosystemStrengthening Rapid Response Protocols for Prescription Opioid Disruptions: ASTHO Shares Considerations for State and Territorial Health Agencies >>