The health educator's role in advocacy and policy: principles, processes, programs, and partnerships

Advocacy skills are essential for the public health practitioner. Recognizing this need, two statewide public health organizations partnered for a series of advocacy trainings. Outcomes included an increased competence for such advocacy as providing expert testimony, writing position papers, forging stronger relationships with policy makers, and committing to ongoing advocacy. An increase in statewide initiatives also included a legislative scorecard, development of a model advocacy network by voting districts, advocacy policy for associations, fact sheets for legislators on pending public health issues, a new university advocacy course, and advocacy action by two associations' members to reach common goals. The trainings and subsequent initiatives provide a template for organizations and individuals to build advocacy skills and increase the role of public health professionals in setting state public health policy.     

Health impact assessment: a tool for healthy public policy

Healthy Public Policy is one of the key health promotion actions. Advancement of Healthy Public Policy requires that the health consequences of policy should be correctly foreseen and that the policy process should be influenced so that those health consequences are considered. Health Impact Assessment is an approach that could assist in meeting both requirements. Policies often produce health impacts by multiple indirect routes, which makes prediction difficult. Prediction in Health Impact Assessment may be based on epidemiological models or on sociological disciplines. Health Impact Assessment must be based on an understanding of, and aim to add value to, the policy-making process. It must therefore conform to policy-making timetables, present information in a form that is policy relevant and fit the administrative structures of policy makers. Health Impact Assessment may be used to inform health advocacy but is distinct from it. There is a danger that Health Impact Assessment could be misunderstood as health imperialism.     

Framework for the strategic and business planning of the Centre – School of Public Health, Belgrade

The science and practice of the New Public Health have a key role in the promotion of people’s health and in the reform of the health system. Serbia experienced many social and economic threats to public health during the 1990s when the health infrastructure both for curative and preventive services gradually deteriorated. Existing skills and knowledge of public health professionals are insufficient in virtually all fields of public health activities. The foundation of the Centre – School of Public Health, within the Medical School of Belgrade University has been a precondition for the improvement of professional training in public health. The objectives are described as (1) education of capable experts in the field of public health, (2) improvement of knowledge in the health sciences, (3) health promotion in cooperation with local communities, (4) training of competent researchers in the field of public health and (5) improvement of the process of decision making and policy formulation. The training programme covers five key areas of education in the domain of public health: (1) public health in Europe, (2) epidemiology and biostatistics, (3) health policy and management, (4) health promotion, health education and social sciences and (5) environment and health. In the first year, 27 students were admitted for the Master of Public Health programme and more than 350 participants attended various short courses for continuing education in public health and health management based on applied learning approach. The next developmental steps focus on sustainability of the programmes for continuing education and research and a wider national and international partnership.     

The Most Important Skills Required by Local Public Health Departments for Responding to Community Needs and Improving Health Outcomes

In 2017, Public Health 3.0 was introduced, providing recommendations that expand traditional public department functions and programs. Operationalizing the framework requires that local health departments invest in the requisite professional skills to respond to their community’s needs. The purpose of this paper is to determine the professional skills that are most important for local health departments to respond to large public health issues and challenges that are having a major impact on their communities. The study used a cross-sectional assessment of the education and training needs of local public health departments in Nebraska following the principles of practice-based systems research. The assessment was designed to assess the training and education needs of local health department staff members. The questions measured the perceived importance of and respondent’s capacity across 57 core competencies for public health professionals modified from the Council on Linkages Between Academia and Public Health Practice. A total of 104 staff members from seven local health departments were requested to complete the assessment and 100% of the individuals responded to and completed the assessment. Twenty-eight skills were identified as the most important skills needed for local health departments. The skills were themed and categorized into four domains. (1) Data, Evaluation, and Quality Improvement, (2) Community Engagement and Facilitation, (3) Systems Thinking and Leadership, and (4) Policy and Advocacy. The results from this analysis provide direction to strengthen and transform the public health system into one that is connected, responsive, and nimble. Additionally, it also highlighted a glaring omission that Equity, Diversity, and Inclusion should be included as the fifth domain.

     

25 years of public health leadership in Africa: the Ethiopian Public Health Association

This commentary discusses the historical development, organization and activities of the Ethiopian Public Health Association (EPHA), a professional civil society organization that operates on the principles of protection of public interest and professional standards in health in areas of health development in Ethiopia. The important roles played by the EPHA in health training, research and policy advocacy have been highlighted. Some of the important health system interventions that have been effected in the country through the influence and active participation of the Association have also been pointed out. As an active member of the Executive Board of the World Federation of Public Health Associations, EPHA serves as a role model for public health professional associations in the African Region with regard to increasing their influence in health policy and interventions within their respective countries.     

Advocacy for physical activity--from evidence to influence

Advocacy is an evolving and underdeveloped element of public health practice. Historically, it was used to describe activities undertaken by persons on behalf of the poor, the sick or oppressed. In the seventies, led by tobacco control advocates such as Pertschuk in the United States, Gray in Australia and Daube in the United Kingdom, public health advocacy became more focused on structural and policy change. Since the Ottawa Charter (WHO, 1986), the health promotion movement has embraced a broader view of the role of advocacy. The public health community now see advocacy as social action primarily aimed at effecting changes in legislation, policy and environments that support healthy living. Advocacy is defined by the World Health Organization as a combination of individual and social actions designed to gain political commitment, policy support, social acceptance and systems support for a particular health goal or programme (WHO, 1995). This paper describes a model for understanding and mobilising physical activity advocacy. It outlines a three step process: 1. Gathering and translating the most pertinent physical activity evidence. Why advocate for physical activity? 2. Developing from the evidence, a physical activity advocacy agenda and articulating a plan (or plans) of key actions that will increase population levels of physical activity. What should be advocated? 3. Implementing a mix of advocacy strategies to influence and mobilise support for the physical activity agenda. How should advocacy be implemented?     

Strengthening public health nutrition research and training capacities in West Africa: Report of a planning workshop convened in Dakar, Senegal, 26-28 March 2009

A three-day workshop was convened in Dakar, Senegal, to provide participants from West African and international academic and research institutions, public health agencies, and donor organisations an opportunity to review current public health nutrition research and training capabilities in West Africa, assess needs for strengthening the regional institutional and workforce capacities, and discuss appropriate steps required to advance this agenda. The workshop included presentations of background papers, experiences of regional and international training programmes and small group discussions. Participants concluded that there is an urgent need to: (1) increase the throughput of public health nutrition training programmes, including undergraduate education, pre-service and in-service professional training, and higher education in public health nutrition and related research skills; and (2) enhance applied research capacity, to provide the evidence base necessary for nutrition program planning and evaluation. A Task Team was appointed to inform the regional Assembly of Health Ministers of the workshop conclusions and to develop political and financial support for a regional nutrition initiative to: (1) conduct advocacy and nutrition stewardship; (2) survey existing training programmes and assist with curriculum development; and (3) develop a plan for a regional applied research institute in Public Health Nutrition.     

Survey of leadership skills needed for state and territorial health officers,United States, 1988.

As part of efforts to develop training and career development experiences to enhance leadership skills among public health officials, the Public Health Foundation, Association of State and Territorial Health Officials, National Association of County Health Officials, United States Conference of Local Health Officers, and Public Health Practice Program Office, Centers for Disease Control and Prevention, conducted a training needs assessment survey in 1988. Fifty-five State and territorial health officers were asked about potential knowledge, skills, and abilities (KSAs) that a prospective or new health officer might require in performing his or her job. Thirty-eight health officers returned completed questionnaires, a 69 percent response rate. For each KSA, respondents assigned scores from 1 (low) to 5 (high) to three different variables: the KSA''s importance to job, as an initial ability of a new health officer, and as a desired ability for someone in that job. Of 78 KSAs, those scoring in the top 25 percent for importance to job were identified, and individual composite scores were calculated using the formula: (importance to job) x (desired ability minus initial ability). The top 10 mean composite scores ranged from 7.55 to 10.40 and were in five competence areas: public image (working with the community) (3 KSAs); policy development and program planning (3 KSAs); interpersonal skills (2 KSAs); agency management (1 KSA); and legal issues (1 KSA). These skills are not commonly acquired in schools of medicine or public health. Public health agencies should develop programs to assure that persons with leadership potential are identified early and given guided experiences and mentors, as well as specific training and education. Additional studies of public health officers are needed to develop and strengthen leadership KSAs among new health officers.     

The role of health education in the policy change process: Lessons from tobacco control

The ‘new public health’ perspective urges a return to an agenda centred on the modification of the determinants of health, with a special emphasis on public policies. This enthusiasm for strategies focusing on the modification of policies may lead, however, to declining interest in health education interventions. The aim of the present analysis is to reflect on the role of health education in the process leading to the adoption of ‘Healthy Public Policies’ by drawing on theories from political science: Hall's Policy Paradigm approach and Sabatier and Jenkins-Smith's Advocacy Coalition Framework. Rejecting the traditional perspective that political actors’ choices and preferences are exclusively framed by an economic rationality, these two frameworks integrate the influence of ideas and values in the policy process. Applying these analytical frameworks to the case of tobacco control, we found that the policy change process is constrained by the worldview of a broad group of actors from the political and social spheres and that the dominant elite's worldview structures such a process. In addition, policies are derived from the ‘policy learning process’ and from events external to the policy domain. We conclude that health education through its health advocacy role and the sensitization of the public is a critical ingredient of the policy process. However, health educators should take part in the process not only by disseminating technical or scientific arguments but also by bringing forward arguments that take into account the fundamental values defended by the policy-makers and the public.     

The Oregon Public Health Policy Institute: Building Competencies for Public Health Practice

The Oregon Public Health Policy Institute (PHPI) was designed to enhance public health policy competencies among state and local health department staff. The Oregon Health Authority funded the College of Public Health and Human Sciences at Oregon State University to develop the PHPI curriculum in 2012 and offer it to participants from 4 state public health programs and 5 local health departments in 2013.The curriculum interspersed short instructional sessions on policy development, implementation, and evaluation with longer hands-on team exercises in which participants applied these skills to policy topics their teams had selected. Panel discussions provided insights from legislators and senior Oregon health experts.Participants reported statistically significant increases in public health policy competencies and high satisfaction with PHPI overall.Innovative policy solutions to address public health problems are becoming increasingly important, particularly because chronic diseases constitute a growing share of the disease burden in the United States. Public health policies increasingly aim to shape an environment that encourages healthy behaviors, such as physical activity or healthy eating.1,2Although traditional public health programs often target smaller groups, such as those infected with or at elevated risk of particular infectious diseases, public health policies can influence the behavior or environment of large populations. Such policies, which include laws, regulations, rules, or operational decisions intended to improve population health, can help jurisdictions meet population health goals because they work “upstream” of heath care services and even many traditional health promotion programs.The Public Health Division (PHD) of the Oregon Health Authority (OHA) is working to enhance the competencies of the state and local health agencies in Oregon to develop, implement, and evaluate public health policies; these competencies receive limited attention in existing degree programs or in-service training. The PHD funded Oregon State University (OSU) to develop a Public Health Policy Institute (PHPI) tailored to the state’s institutional and political environment, and designed to train public health professionals to address public health problems with upstream policy solutions. We describe the existing public health policy background and training resources nationwide and in Oregon, and outline the structure and content of the PHPI curriculum. We present the results from the evaluation of the first offering of PHPI and reflections on lessons for other states.     

Community Health Workers Promote Civic Engagement and Organizational Capacity to Impact Policy

Community health workers (CHW) have historically served to link structurally vulnerable populations to broad support systems. Emerging evidence suggests that CHWs engage in various forms of advocacy to promote policy and systems change. We assessed the impact of CHW community advocacy on community change, defined as civic engagement, organizational capacity and policy and systems change. Data are drawn from the 2014 National Community Health Worker Advocacy Survey (N?=?1776) aimed to identify the state of the CHW profession, and their impact on health disparities through community advocacy and policy engagement. Our primary analysis used multiple linear regression to assess the association between CHW advocacy and community change. As predicted, there was a significant, positive association between CHW advocacy and change in community conditions. Additionally, both adjusted and sensitivity models had similar standardized beta estimates for advocacy, and adjusted R ² statistics. CHW advocacy predicts positive change in community conditions and further advances the CHW Community Advocacy Framework designed to support and monitor CHW community advocacy to reduce health disparities through advocacy and policy change.     

The nature, scope, and development of the global tobacco control epistemic community

Over the past 50 years, tobacco control has been transformed from a national to a global issue, becoming institutionalized in the World Health Organization (WHO) Framework Convention on Tobacco Control, the first international public health treaty negotiated under the auspices of the WHO. The global tobacco control epistemic community, a worldwide network of professionals with a common interpretation of the science in tobacco use and control, has contributed to this transformation. We investigated the development, structure, and function of this community through interviews and archival documents. Professionals in the community are bound by values and consensual knowledge developed after years of contentious debates undergirded their activities. Although these professionals play multiple roles, they recognize that scientific evidence should inform advocacy and policy activities. Public health professionals should continue to strengthen the links between science and advocacy for policy while being vigilant against industry efforts to undermine the scientific evidence on tobacco use and control.     

Advocacy 2.0: advocating in the digital age

Advocacy for the individual health needs of others, for the health of the public, and for the profession have always been critical underpinnings of the field of health education. The explosion of technology and freedom of the Internet provide a multitude of possibilities for revitalized advocacy efforts. This article suggests just a few examples of how we might engage in Advocacy 2.0. Developing advocacy campaigns that use both tested and untested methods gives us an opportunity to achieve new victories in health education advocacy.     

Evaluating the effectiveness of public health leadership training: the NEPHLI experience

OBJECTIVES: We assessed the effect of public health leadership training on the capacity of public health leaders to perform competencies derived from the list of "Ten Essential Public Health Services" presented in 1994 by the steering committee of the Public Health Functions Project. METHODS: Graduating scholars of the Northeast Public Health Leadership Institute were surveyed to determine differences in skill level in 15 competency areas before and after training. Surveys were completed after program completion. RESULTS: The training program improved the skill levels of participants in all 15 competency areas. A relation also was detected between the frequency of use of the competency and the improvement experienced. CONCLUSIONS: Public health leadership training programs are effective in improving the skills of public health workers.     

Advocacy for Health Equity: A Synthesis Review

Context

Health inequalities are systematic differences in health among social groups that are caused by unequal exposure to—and distributions of—the social determinants of health (SDH). They are persistent between and within countries despite action to reduce them. Advocacy is a means of promoting policies that improve health equity, but the literature on how to do so effectively is dispersed. The aim of this review is to synthesize the evidence in the academic and gray literature and to provide a body of knowledge for advocates to draw on to inform their efforts.

Methods

This article is a systematic review of the academic literature and a fixed-length systematic search of the gray literature. After applying our inclusion criteria, we analyzed our findings according to our predefined dimensions of advocacy for health equity. Last, we synthesized our findings and made a critical appraisal of the literature.

Findings

The policy world is complex, and scientific evidence is unlikely to be conclusive in making decisions. Timely qualitative, interdisciplinary, and mixed-methods research may be valuable in advocacy efforts. The potential impact of evidence can be increased by “packaging” it as part of knowledge transfer and translation. Increased contact between researchers and policymakers could improve the uptake of research in policy processes. Researchers can play a role in advocacy efforts, although health professionals and disadvantaged people, who have direct contact with or experience of hardship, can be particularly persuasive in advocacy efforts. Different types of advocacy messages can accompany evidence, but messages should be tailored to advocacy target. Several barriers hamper advocacy efforts. The most frequently cited in the academic literature are the current political and economic zeitgeist and related public opinion, which tend to blame disadvantaged people for their ill health, even though biomedical approaches to health and political short-termism also act as barriers. These barriers could be tackled through long-term actions to raise public awareness and understanding of the SDH and through training of health professionals in advocacy. Advocates need to take advantage of “windows of opportunity,” which open and close quickly, and demonstrate expertise and credibility.

Conclusions

This article brings together for the first time evidence from the academic and the gray literature and provides a building block for efforts to advocate for health equity. Evidence regarding many of the dimensions is scant, and additional research is merited, particularly concerning the applicability of findings outside the English-speaking world. Advocacy organizations have a central role in advocating for health equity, given the challenges bridging the worlds of civil society, research, and policy.     

Public nutrition: Why,What, How?

Public Nutrition is a field of professional study and practice that has existed for many years without being named as such. It encompasses the disciplines that deal with factors affecting the food consumption and nutritional outcomes of populations, and goes beyond the definition of Public Health Nutrition by including the study of public policy in areas outside of health and nutrition as traditionally defined, that nonetheless can have profound effects on nutrition. Career paths in Public Nutrition exist at a variety of professional levels, including practitioners and direct service providers; administrators and planners; policy makers; and researchers and educators. The professional preparation of those working in Public Nutrition typically combines education and experience in nutritional science, social science, and sometimes management and planning. The field of Public Nutrition is important in providing a critical link between advances in understanding biomedical determinants of nutrition and the application of such understanding in programs and policies. However, the study of Public Nutrition goes beyond this: it represents an agenda of research and practice in its own right. Public Nutrition includes the study of how specific policies, in varying contexts, affect food consumption and nutrition outcomes; it includes the study of determinants of program effectiveness in improving these outcomes. Specific training programs in Public Nutrition do exist; the elements of a curriculum in Public Nutrition include social science research skills (data collection, management, analysis and interpretation), an understanding of economic, social, political, and behavioral determinants of food consumption, health and nutrition; a grounding in nutritional science. Field experience is an essential part of the preparation of Public Nutrition professionals.     

Connecting for health literacy: health information partners

This article describes a community-based health information partnership to address health literacy and health information inequalities in marginalized communities. Public health, medical, literacy, and library practitioners promote health literacy through outreach, training, and professional development activities in community settings. They create learning environments for people to develop the necessary knowledge and skills to better understand health information and health policy so they can make decisions concerning personal and community health. Outreach activities focus on visits to neighborhood health centers, health fairs, health exhibits at union meetings and conferences; training programs involve hands-on, peer-led computer classes for people living with HIV and for the general public; and professional development programs connect librarians, health providers, public health workers, and literacy teachers in joint planning and learning. Several learners currently participate in and lead community health education programs and HIV advocacy. The coalition's strength develops from strongly shared objectives, an absence of territoriality, and a core active leadership group.     

郑州大学公共卫生学院学生控烟能力课程干预效果评价

目的 探讨郑州大学公共卫生学院控烟能力课程开设前后学生控烟认知和态度,为培养具有专业控烟能力的公共卫生人员提供参考.方法 以“中国公共卫生控烟能力建设项目”为平台,采用统一发放的调查问卷,对郑州大学2009级本科预防医学专业全体学生进行课程干预前后调查,数据采用Ridit分析及x2检验.结果 控烟课程干预提高了该专业学生的控烟认知态度(公共场所控烟态度F=7.86,P=0.000;烟盒标准有害信息态度F=8.38,P=0.000)、控烟活动倡导兴趣和动机(从事控烟志愿活动态度F=4.52,P=0.012;控烟公共政策决定态度F=4.06,P=0.018),但对其劝阻他人吸烟(家人x2=1.82,P=0.403;亲朋x2=4.20,P=0.122)和终身不吸烟的态度(现在不吸烟将来吸F=0.11,P=0.901,从事社交性工作F=2.51,P=0.083)无明显影响.结论 控烟能力课程干预提高了公共卫生学院学生的认知水平和控烟能力,为以后控烟课程的实施提供了理论依据.     

AIDS, policy analysis, and the electorate: the role of schools of public health.

Current debates concerning appropriate policy to combat the epidemic of acquired immunodeficiency syndrome (AIDS) have raised critical questions regarding the role that schools of public health and individual public health professionals should play, if any, in AIDS-related policy analysis and social advocacy. In the summer of 1986, the School of Public Health at the University of California at Berkeley initiated a telegram sent by the Deans of all 23 schools of public health to protest US Department of Justice AIDS policy and, in the subsequent fall, the school expanded its public educational role in an unprecedented manner by initiating and issuing, with California's other three schools of public health, a policy analysis of Proposition 64, the LaRouche AIDS Quarantine Initiative. That analysis exposed the proposition's fallacious claims regarding casual transmission of AIDS and served to educate the electorate on the likely public health impact of this deleterious legislation. Based on these experiences, and in light of ongoing national controversy regarding AIDS, we believe schools of public health have an important role to play in policy analysis, and individual public health professionals have a role to play in social advocacy.