While all accredited schools and programs of public health are teach graduate-level students how to advocate for policy change, lessons vary. A new task force project may change that.
Photo by Fat Camera, courtesy iStockphoto
“Often, health educators see policy as an end product; they don’t feel like they are participants in the process. We want to make them much more engaged and informed so that they can be actively involved in terms of policymaking.”
— Karen Mancera-Cuevas
From seat belts to smoke-free workplaces, advocacy is a cornerstone of public health policy and progress. But despite its essential role in improving public health outcomes, many public health professionals say they are underprepared to engage in advocacy at the federal, state and local levels.
The COVID-19 pandemic has underscored the need for the public health workforce to be skilled at engaging with policymakers, the public, community leaders and the media. But much of the workforce is more accustomed to focusing on what happens under a microscope or on epidemiological reports than speaking into a microphone.
“COVID taught us so many things,” said Heidi Hancher-Rauch, PhD, a professor at Butler University and president-elect of the Society for Public Health Education. “We learned we need to do a better job in public health training programs for our current and future students about how to advocate — not just talk about these things theoretically, but help them engage in actual, relevant advocacy.”
All public health schools and programs are required to teach graduate-level students how to advocate for policy change as part of their accreditation requirements, but studies show the training varies greatly from school to school, and public health professionals may still be underprepared to engage in advocacy.
According to the 2021 Public Health Workforce Interests and Needs Survey, which captured data from tens of thousands of state, city and local governmental health workers, 45% of public health department executives need more training in community engagement, a key advocacy skill.
The findings align with similar needs in the nonprofit arena, where many public health graduates find jobs. A 2023 report from Independent Sector, an organization dedicated to advancing nonprofits, found that the number of nonprofits that engage in advocacy has dropped significantly over the past two decades. In fact, less than one-third of U.S. nonprofits engage in advocacy or even know what advocacy activities they can legally do.
Having a workforce trained in advocating for public health policies and laws is critical to meeting both current and future public health challenges, but “very, very few schools or programs of public health have the kind of comprehensive advocacy training that’s needed,” said Shelley Hearne, DrPH, a public health advocacy professor and director of the Lerner Center for Public Health Advocacy at Johns Hopkins Bloomberg School of Public Health.
“The field knows that facts matter, but they don’t know how to make their facts matter to advance the policies they care about,” Hearne told The Nation’s Health. “And that’s what advocacy training is all about. It’s how to effectively make the case, how to effectively work with others, how to effectively engage policymakers of all stripes and colors.”
Since 2016, the Council on Education for Public Health has required all master of public health students enrolled in CEPH-accredited schools and programs of public health to be trained on how to advocate for political, social or economic policies and programs that will improve health in diverse populations.
However, a recent report in the Journal of Public Health Management and Practice, which analyzed current advocacy courses in programs and schools of public health, found that fewer than half cover the topics and skills needed in policy change advocacy campaigns, such as coalition building, community organizing, media advocacy, policy communication and lobbying.
Advocacy skills are typically covered within a broad range of public health course topics but are not a central topic, the study said. Only 7% of the courses had advocacy skills as a core theme of the course, and only 10% addressed how to advocate in an equitable way.
“We have to figure out a way to prepare our students for the challenges they now face in the field, and give them an advocacy toolbelt to do that,” Glenn Schneider, MPH, lead author of the JPHMP study, told The Nation’s Health.
Schneider is director of the new Public Health Advocacy Consensus Task Force, also known as PH-ACT. Launched by Johns Hopkins’ Lerner Center and the de Beaumont Foundation in collaboration with other national and state public health organizations, PH-ACT aims to come to agreement on the definition of public health advocacy, identify the essential advocacy skills needed to operationalize it and draft advocacy training guidance for schools and programs of public health, including advocacy-related continuing education.
PH-ACT’s activities will be guided by an advisory committee of public health and advocacy educators, experts and practitioners. Findings will be confirmed through surveys to achieve field consensus.
“We are not teaching advocacy in a way that will get us the results that we’re looking for, and part of the reason why is because we are lacking a definition that we can all stand behind, and the essential skills that can operationalize that definition,” Schneider said, noting that there are at least 70 different definitions for public health advocacy.
PH-ACT kicked off its activities in September with an online town hall. Public health practitioners, students and health education faculty participated in the event, which was sponsored by the Society for Public Health Education, Johns Hopkins’ Lerner Center and APHA’s Public Health Education and Health Promotion Section. In breakout sessions, attendees had the opportunity to share their thoughts for improving advocacy instruction in schools and programs of public health and advocacy-related continuing education.
PHEHP Section Chair Karen Mancera-Cuevas DrPH, MPH, MS, who helped lead the town hall and served as a speaker, said she was struck by participants’ passion for the topic.
“People were so energized with having this conversation,” Mancera-Cuevas, senior director for health equity at the National Health Council, told The Nation’s Health. “We really haven’t had this conversation before.”
Mancera-Cuevas said people she spoke to were inspired to hear town hall speakers talk about the possibilities of health educators becoming more multifaceted in their careers and being more engaged in the advocacy process.
“It was a really empowering event, particularly for PHEHP members to see what potentially they can do with their careers,” she said.
Mancera-Cuevas said the opportunity to collaborate with the Lerner Center and SOPHE was a natural fit.
“We have a lot of students who are learning about advocacy, and we want them to be front and center in terms of really being able to use that advocacy training as they graduate from health education programs, and apply that training in a variety of workplace settings to make successful change in their communities.”
Looking toward the future, Mancera-Cuevas envisions a time when public health educators are confident in using their voices and confident that their voices can be heard.
“Often, health educators see policy as an end product; they don’t feel like they are participants in the process,” she said. “We want to make them much more engaged and informed so that they can be actively involved in terms of policymaking, even at the grassroots level, when working with communities.”
Another town hall on the future of advocacy instruction will be held during APHA’s 2024 Annual Meeting and Expo at 10:30 a.m. on Monday, Oct. 28, during session 3148. To access the APHA 2024 program, visit www.apha.org/program.
For more information on the Public Health Advocacy Consensus Task Force, visit bit.ly/PH-ACT.
- Copyright The Nation’s Health, American Public Health Association
