1. Community Advocacy Patricia Tellez- Giron M.D. Associate Professor Department of Family Medicine University of Wisconsin School of Medicine and Public Health Chair, Latino Health Council, Madison, WI November 13, 2010

2. Objectives Define Community AdvocacyDefine Community Advocacy Name examples of Community AdvocacyName examples of Community Advocacy Identify the importance of Community Advocacy in health careIdentify the importance of Community Advocacy in health care Describe the skills needed for effective Community Advocacy in health careDescribe the skills needed for effective Community Advocacy in health care Lead a Community Advocacy in health care interventionLead a Community Advocacy in health care intervention

3. Background American Board of Internal MedicineAmerican Board of Internal Medicine “Commitment to the promotion of public health and preventive medicine, as well of public advocacy on the part of each physician” American Medical AssociationAmerican Medical Association “Physicians most advocate for the social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being”

4. ACGMEACGME Requires Advocacy training and experience for all pediatric residents Canadian Medical Education Directives for SpecialistCanadian Medical Education Directives for Specialist Communicator, collaborator, manager, scholar, professional and health advocate

5. Core general issues Physician advocacy core component of medical professionalismPhysician advocacy core component of medical professionalism Not many medical schools/residency programs require community advocacy teaching currentlyNot many medical schools/residency programs require community advocacy teaching currently Undefined in concept, scope and practiceUndefined in concept, scope and practice Undefined advocacy competenciesUndefined advocacy competencies

6. Definition The act of pleading or arguing in favor of something, such as a cause, idea, or policy; active support.The act of pleading or arguing in favor of something, such as a cause, idea, or policy; active support. Advocacy by an individual or by an advocacy group normally aims to influence public-policy and resource allocation decisions within political, economic, and social systems and institutions; it may be motivated from moral, ethical or faith principles or simply to protect an asset of interest.Advocacy by an individual or by an advocacy group normally aims to influence public-policy and resource allocation decisions within political, economic, and social systems and institutions; it may be motivated from moral, ethical or faith principles or simply to protect an asset of interest.

8. Examples of community advocacy Budget advocacy : Ensures proactive engagement of Civil Society Organizations with the government budget to make the government more accountable to the people and promote transparency. Budget advocacy also enables citizens and social action groups to compel the government to be more alert to the needs and aspirations of people in general and the deprived sections of the community.Budget advocacy : Ensures proactive engagement of Civil Society Organizations with the government budget to make the government more accountable to the people and promote transparency. Budget advocacy also enables citizens and social action groups to compel the government to be more alert to the needs and aspirations of people in general and the deprived sections of the community. Bureaucratic advocacy: people considered “experts” have more chance to succeed at presenting their issues to decision-makers.Bureaucratic advocacy: people considered “experts” have more chance to succeed at presenting their issues to decision-makers. Ideological advocacy: in this approach, groups fight, sometimes during protests, to advance their ideas in the decision-making circles.Ideological advocacy: in this approach, groups fight, sometimes during protests, to advance their ideas in the decision-making circles. Interest-group advocacy: lobbying is the main tool used by interests groups doing mass advocacy.Interest-group advocacy: lobbying is the main tool used by interests groups doing mass advocacy. Legislative advocacy: legislative advocacy is the “reliance on the state or federal legislative process” as part of a strategy to create changeLegislative advocacy: legislative advocacy is the “reliance on the state or federal legislative process” as part of a strategy to create change Mass advocacy: is any type of action taken by large groups (petitions, demonstrations, etc.)Mass advocacy: is any type of action taken by large groups (petitions, demonstrations, etc.) Media advocacy: is “the strategic use of the mass media as a resource to advance a social or public policy initiative”Media advocacy: is “the strategic use of the mass media as a resource to advance a social or public policy initiative”

9. Definition Health advocacy encompasses direct service to the individual or family as well as activities that promote health and access to health care in communities and the larger public. Advocates support and promote the rights of the patient in the health care arena, help build capacity to improve community health and enhance health policy initiatives focused on available, safe and quality care.Health advocacy encompasses direct service to the individual or family as well as activities that promote health and access to health care in communities and the larger public. Advocates support and promote the rights of the patient in the health care arena, help build capacity to improve community health and enhance health policy initiatives focused on available, safe and quality care.

11. Definition AMAAMA “Action by a physician to promote those social, economic, educational and political changes that ameliorate the suffering and threats to human health and well being that he or she identifies through his or her professional work and expertise”

13. Physician atribuites Unique positionUnique position –Understanding of medical issues –Understanding of health social determinants –High public trust: credible source of information –Unusual degree of access to policy makers, local and national leaders and to citizens –High power influencing public processes and priorities

14. Physician barriers Medical schools favor high academics vs. service oriented studentsMedical schools favor high academics vs. service oriented students Medical training isolates and removes individuals from the community while they attain clinical competencyMedical training isolates and removes individuals from the community while they attain clinical competency Contrast between competence/control in clinical settings vs. uncertainty of advocacy roleContrast between competence/control in clinical settings vs. uncertainty of advocacy role Busy clinical demanding lives (no time for community advocacy)Busy clinical demanding lives (no time for community advocacy)

15. Physician barriers Not well delineated boundaries as in clinical encounterNot well delineated boundaries as in clinical encounter Agenda may conflict with the priorities of institutionsAgenda may conflict with the priorities of institutions Culture of medicine: science/evidence based /data drivenCulture of medicine: science/evidence based /data driven No adequate trainingNo adequate training

16. DANE COUNTY LATINO SUPPORT NETWORK LATINO HEALTH COUNCIL LATINO CHILDREN AND FAMILY COUNCIL SPANISH MEDIA CENTRO HISPANO CENTRO GUADALUPE FAITH BASE ORGANIZATIONS HARAMBEE UNITED WAY LATINO EDUCATION COUNCIL LUCHA

17. Latino Health Council The mission of the LHC is to promote and support the health and well being of the Latino community through education, advocacy, consulting, and networking.

18. HEALTH FAIR

19. LATINO HEALTH FAIR This is the only event of its kind in Dane County and throughout Wisconsin. The event offers a great opportunity for Latinos to learn about various community services. Additionally, free screenings are provided for very important, preventable diseases like hypertension, diabetes, lipid disorders, and HIV, among others. The attendance to this event is usually 600 to 700 people.This is the only event of its kind in Dane County and throughout Wisconsin. The event offers a great opportunity for Latinos to learn about various community services. Additionally, free screenings are provided for very important, preventable diseases like hypertension, diabetes, lipid disorders, and HIV, among others. The attendance to this event is usually 600 to 700 people.

20. NUESTRA SALUD RADIO PROGRAM

21. Spanish health education radio program. Now on its eight season, this program has an audience of over 40,000 people. We are able to reach not only Latinos in Madison, but also in all of the surrounding communities. This monthly two-hour program includes a variety of the most important health topics affecting Latinos and is presented by Spanish-speaking health professionals and includes topic-pertinent resources available in the community. Calls with questions from the audience are encouraged.Spanish health education radio program. Now on its eight season, this program has an audience of over 40,000 people. We are able to reach not only Latinos in Madison, but also in all of the surrounding communities. This monthly two-hour program includes a variety of the most important health topics affecting Latinos and is presented by Spanish-speaking health professionals and includes topic-pertinent resources available in the community. Calls with questions from the audience are encouraged.

22. CHRONIC DISEASE CONFERENCE

23. LATINO CHRONIC DISEASE SUMMIT Realizing the importance and prevalence of chronic diseases among Latinos, the Latino Health Council, with generous support from the Wisconsin Women’s Health Foundation, started this program in 2006. The event has over 250 participants. A plenary on diabetes is presented and then multiple workshops are offered on a variety of topics such as cardiovascular disease, nutrition, exercise, stress release, and understanding the U.S. health care system.Realizing the importance and prevalence of chronic diseases among Latinos, the Latino Health Council, with generous support from the Wisconsin Women’s Health Foundation, started this program in 2006. The event has over 250 participants. A plenary on diabetes is presented and then multiple workshops are offered on a variety of topics such as cardiovascular disease, nutrition, exercise, stress release, and understanding the U.S. health care system.

24. LATINO MENTAL HEALTH SUMMIT Initiated in 2008 and based on the growing need for mental health services/education in the Latino community, this program follows a similar format to the Chronic Disease Summit, previously mentioned. Mental health education topics are presented to a 200 participant audience.Initiated in 2008 and based on the growing need for mental health services/education in the Latino community, this program follows a similar format to the Chronic Disease Summit, previously mentioned. Mental health education topics are presented to a 200 participant audience.

25. LATINO TEEN HEALTH BASH

26. LATINO TEEN HEALTH BASH LATINO TEEN HEALTH BASH Started in 2009 as an original idea of Latino Health Council, this event is organized by a collaboration of several community organizations including the Latino Health Council, the Latino Children and Family Council and the UW Professional Association of Latinos for Medical School Access (PALMA). This event aims to reach out to Latino teens on important health issues presented in a culturally, linguistic, and age appropriate format.Started in 2009 as an original idea of Latino Health Council, this event is organized by a collaboration of several community organizations including the Latino Health Council, the Latino Children and Family Council and the UW Professional Association of Latinos for Medical School Access (PALMA). This event aims to reach out to Latino teens on important health issues presented in a culturally, linguistic, and age appropriate format.

27. Community Advocacy Empirically without much trainingEmpirically without much training Trial and errorTrial and error Based on already developed expertiseBased on already developed expertise Connected to current job descriptionConnected to current job description LocalLocal A few extra hours dedicated to thisA few extra hours dedicated to this

28. Community Advocacy CA needs to be promoted and taught, not left to chanceCA needs to be promoted and taught, not left to chance Every physician should learn/do/teach CA at least to a basic levelEvery physician should learn/do/teach CA at least to a basic level Undergraduate/graduateUndergraduate/graduate CA opportunities for practicing physiciansCA opportunities for practicing physicians

29. Advocacy cycle

30. Skills Identifying a problemIdentifying a problem Defining the problem and its scopeDefining the problem and its scope Identifying and engaging strategic partnersIdentifying and engaging strategic partners Developing a strategic action planDeveloping a strategic action plan Communicating an effective messageCommunicating an effective message

31. Attributes of health advocate KnowledgeableKnowledgeable AltruisticAltruistic HonestHonest AssertiveAssertive ResourcefulResourceful Up-to-dateUp-to-date Expert Professional Communicator Collaborator Manager Scholar

32. Community Advocacy Understanding of the social determinants of healthUnderstanding of the social determinants of health Training in leadership, social and organizational change (system based practice)Training in leadership, social and organizational change (system based practice) Team building (Groups and coalitions)Team building (Groups and coalitions) Develop and practice delivering clear messages and using the media effectivelyDevelop and practice delivering clear messages and using the media effectively

33. Community Advocacy Policy making (own institution, the community and the government)Policy making (own institution, the community and the government) Opportunity to practice skills through service learning activitiesOpportunity to practice skills through service learning activities Role modeling of skills by mentors who know/truly value CARole modeling of skills by mentors who know/truly value CA

34. Community Advocacy Accrediting bodies should define and endorse CA competenciesAccrediting bodies should define and endorse CA competencies Campuses need to develop stronger and more productive partnerships with communitiesCampuses need to develop stronger and more productive partnerships with communities Physicians/Medical educators should devote (be given) time to learn/practice/teach skills necessary for CAPhysicians/Medical educators should devote (be given) time to learn/practice/teach skills necessary for CA Deans and other administrators need to encourage and reward faculty advocacy activitiesDeans and other administrators need to encourage and reward faculty advocacy activities

35. EXAMPLES

36. Examples of Advocacy issues Family issue = Provision available but not accessedFamily issue = Provision available but not accessed Within agency issue = System fails individual or familyWithin agency issue = System fails individual or family Interagency issue = Interaction between agencies failsInteragency issue = Interaction between agencies fails Inadequate or absent provisionInadequate or absent provision DiscriminationDiscrimination

37. Breast feeding

38. ACTIVITY

39. SUMMARY

40. Patricia Téllez-Girón MD ptellez@fammed.wisc.edu (608)263-3111