To regain its influence, the public health field needs a workforce trained in, skilled, and proficient at how to advocate for policy change.

Have you ever been frustrated watching critical public health budgets get cut? Puzzled by why politicians or agency officials fail to follow public health evidence in decision-making? Or outraged that a law, a rule, or a policy perpetuates inequitable results, causing poorer health for vulnerable populations? We all have. The article, Who Will Advocate to Keep the Public Healthy? Establishing Competency-Based Advocacy Training for the Public Health Field, offers a pathway forward to move us from the sidelines to the decision-making table.

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The public health field was once a highly engaged, influential force in setting healthier policies for the nation. From the mid-1800 heydays of social reforms involving sanitation, tenement housing, and labor laws to the great successes of tobacco control, public health successfully employed advocacy tools and policy engagement to vastly improve population health. But for the past few decades, in much of the field these skills have atrophied, due to misconceptions and lack of institutional training.

“Who Will Advocate to Keep the Public Healthy? Establishing Competency-Based Advocacy Training for the Public Health Field” in the Jan 2024 issue of the Journal of Public Health Management and Practice helps map out where we are and what needs to be done to strengthen these critical policy engagement muscles. In this article, we define public health advocacy as “strategic actions taken to drive political, social, or economic policies and programs that will improve health and equity in diverse populations.” 

Some falsely equate advocacy with lobbying. Rather, advocacy is a comprehensive set of skills and knowledge on how to effectively inform policy decision-making and public debates with public health evidence. The Council on Linkages Between Academia and Public Health Practice (COL)–which is responsible for translating public health’s essential services into specific competencies—has updated the field’s list of core competencies to embed advocacy skills and knowledge into all domains of activity. However, even in their list, advocacy is more implied than explicit, and in our field, it is more hoped for than taught.

How do we make public health advocacy training a reality that speaks to the situations we currently face? An important step happened when the Council on Education for Public Health (CEPH) required public health schools and programs to assure that MPH graduates have basic advocacy abilities. This is the good news: the Academy is moving to teach advocacy. The bad news: preliminary analysis indicates this training is too often minimal. Not surprising, few professors are rewarded or encouraged to be out translating their research for policymakers or running policy campaigns to pass new laws, create support for health agencies, or even support non-governmental organizations who lobby for policy improvements. And little clarity exists on what should be taught.

That is what we spell out in this article—the need for an iterative process to establish a national consensus on instructional guidance for teaching public health advocacy. As a starting roadmap, the article builds out the specific skills and knowledge consistent with COL’s eight domains for public health competencies. For example, in data analysis and assessment, our workforce needs to be able to identify the key data, analysis and assessment needs for driving specific policy changes. In community skills, public health workers need to be able to engage communities in mapping power centers to advocate for change. And in leadership and systems thinking skills, they need to know how to build and maintain relationships across cultural, political, geographic, and other divides.

We invite you to be a part of an open, inclusive, and highly iterative effort to define public health advocacy and the essential advocacy skills needed by every graduate-level public health student. We aim to start this process at the 2024 Association for Schools and Programs for Public Health annual meeting. If you are interested in participating, please visit the Lerner Center Consensus website and fill out the form.

“Who Will Advocate to Keep the Public Healthy? Establishing Competency-Based Advocacy Training for the Public Health Field” spells out these issues and the next steps toward ensuring the field has the “right stuff” to succeed in making good policy happen. The more we build comprehensive curricula, clarify the skills and knowledge that should be taught, and develop greater resources, support, and incentives for public health advocacy, the more we can expect to be an effective force in advancing the policies and programs that will achieve the public health mission.

Shelley Hearne, DrPH, MPH, 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. Previous roles include leading CityHealth, Big Cities Health Coalition, Pew Charitable Trusts’ Health Group, and founding Trust for America’s Health.

David H. Jernigan, PhD, is the Assistant Dean of the Practice and Professor in the Department of Health Law, Policy and Management at Boston University School of Public Health. Dr. Jernigan is best known for his action-research approach to the issue of alcohol advertising, marketing, and promotion and its influence on young people. His work has led to better advertising regulations and a clearer understanding of the evolving structure of the alcohol industry. His work is policy relevant and scientifically rigorous. Dr. Jernigan has been very active in translating research findings into policy and practice. He testifies regularly at city, state, and national levels around alcohol advertising and youth, alcohol availability, and taxation. He also trains advocates around the world using the best evidence.