Working with Community Coalitions J. Gary Wheeler, MD, MPS Little Rock, Arkansas

Goals and Objectives Goal: – Appreciate the complex structure of community behavioral change and the role of community advocacy Objective: –Describe how physicians can collaborate with community coalitions to influence tobacco prevention and control policy

How things happen By choice By fiat/force By incentives Uncontrolled events

Choice Washing clothes

Fiat/force Speed Limits

Incentives Tax Code

Social Change: Ecologic Model MD RN

Models of policy change Outside initiative model –NGOs (policy entrepreneurs) –Bring pressure on policy makers Mobilization model –Government leaders who define terms –Seek broad support Inside Access Model –Those with easy access to policy makers –Slip in specific laws under the radar

Advantages/Disadvantages Inside Access Model –Efficient for technical issues; undemocratic, unsustainable Outside Access Model –Populist; cost and effort are huge Mobilization Model –Model of government; popularity/leadership of the governmental leader

The overlooked factor: community So, polls really are important

Benefits and Challenges of Coalitions Benefits –Strength in numbers –… relationships –….diversity –….resources Challenges –Autonomy –Different Goals –Efficiency

Steps to Coalition Success 1.Clarify/reaffirm vision & mission 2.Create ownership of coalition 3.Solidify coalition infrastructure & processes 4.Recruit & retain active, diverse membership 5.Develop transformational leaders 6.Market your coalition 7.Focus on action & advocacy 8.Evaluate your coalition

Why do coalitions need physicians? Most people trust their health care professionals Established, credible members of communities with significant influence We represent strong political allies (AMA, AAP, etc) We are the final word on the health science of a public debate We have personal contact with patients and can tell their stories

Why physicians? We are often the only advocates for patients We may have more freedom to speak compared to others

Effective interactions Attendance Contribute (resources) Help connect Schmooze Accept role as an equal partner Eye on the prize

Engage other physicians Professionals Create a “deeper story” by consolidating data from the clinical/patient perspective and community perspective Have a defined role for their participation. Have a realistic “ask” of them that builds off of their skills and talents. Be respectful of time constraints. Health care professionals are often juggling clinical care, academic work, after-hours call, administrative responsibilities, and family time.

Most important lessons Remember to say thanks