for Prevention

Making Your Voice Heard: How to be an Effective Health Advocate

July 2019

Kyle Ragins, MD, MBA

Joshua Bobrowsky, JD, MPH

Julia Heinzerling, MPH

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Advocacy is a powerful tool that can improve the health of patients and populations. Physicians and other clinicians are uniquely positioned to advocate for issues they see impacting their own patients and their communities. They can do this through a range of actions from championing a change in their own organization to teaming up with schools, coalitions, and professional organizations to create broader policy changes.

In this 2-part article, we share advice and resources for physicians and other health care professionals who may be interested in health advocacy. First, we interview our co-author, physician advocate, Dr. Kyle Ragins, to share his insights and practical tips about bringing clinical voices to policy change. Then, in the second section, “Making a Difference: Local Opportunities for Health Advocacy,” we share a variety of resources and opportunities for clinicians who would like to get involved locally or on a larger scale.

 

Making Your Voice Heard: Insights from Physician Advocate, Kyle Ragins, MD, MBA

Photograph of Kyle Ragins, MD, MBA Dr. Kyle Ragins works in the Emergency Departments (ED) at Olive View-UCLA Medical Center and Ronald Reagan UCLA Medical Center and has more than a decade of experience providing care, conducting research, and advocating for underserved populations. He is on the Board of Directors of Doctors for America, a non-profit organization that organizes and trains doctors and medical students in all 50 states to be effective health advocates.

 

Why did you get involved in advocacy work?

I recognized that through advocacy work my ability to help patients could expand beyond the doors of the ED. I wanted to advocate for solutions to the systems issues I saw negatively impacting my patients’ health.

Every day, I see patients in the ED with health issues that cannot be solved in the exam room. Frequently, patients delay seeking care because they are afraid they cannot afford it or have difficulty accessing specialty care. Many don’t have access to the supports that they need to be healthy, such as stable housing, healthy food, safe communities, employment, and transportation. These issues are difficult to address in the clinical environment but are often even more important than any test I can order or medication I can give.

For instance, when I started my training, people with pre-existing conditions often didn’t have access to health insurance. Today, thanks to physicians and the many others who spoke out in support of the Affordable Care Act, we have laws that have greatly improved access to health insurance. Our perspective as clinicians is unique because we understand both the statistics (that millions more are now insured) and the human impact that policy changes like this have on our own patients. Recently, I diagnosed a man in his 30s with leukemia in the ED. He was able to sign up for insurance and get a bone marrow transplant that saved his life. Seeing this human impact inspires me to pursue advocacy work.

 

Why are clinicians uniquely positioned to be effective health advocates?

Polling consistently shows that physicians are one of the most trusted professions, and when it comes to health care, the public trusts them more than any other group. As physicians or other clinicians, we need to be good stewards of this trust and help decision-makers make informed choices and the public understand the issues, so they can make informed choices regarding political candidates and support health-promoting public policy.

Clinicians also have the unique privilege of seeing how policy plays out in the exam room. While most of us are not policy experts, we can tell our patients’ stories and describe how policies impact real lives. This provides an invaluable perspective that most policymakers won’t have if we don’t speak out.

The combination of public trust and firsthand knowledge means that adding a clinician in a white coat to any advocacy coalition provides a unique credibility. Even a relatively small number of physicians or other clinicians engaged in an issue can have an outsized advocacy impact. In fact, because physicians’ perspectives on health-related issues are so valued, some legislative staff record physician calls separately when assessing support for proposed policies.

 

What are examples of public health issues that clinicians have impacted through advocacy work?

Vaccine Exemptions

Physician advocacy efforts helped pass California Senate Bill 277, which tightened up allowable exemptions to school immunization requirements. I share this example because it’s had a tangible impact - childcare and school immunization coverage levels have increased in Los Angeles County - and because it illustrates the range of tactics clinician-advocates can consider using. Physicians signed letters of support, wrote op-ed letters, and worked with their professional associations to support the bill. At legislative hearings, they provided expert testimony and public comment. And notably, the bill’s legislative co-author is a pediatrician, Senator Richard Pan. So, from writing a letter of support to writing the bill itself, physicians were instrumental in this policy change.

Substance Use Disorder Counselors in Emergency Departments

Physicians and other clinicians can also advocate for meaningful change within their own organization. Thanks, in part, to clinician advocacy efforts, we recently placed dedicated substance use disorder (SUD) counselors in our ED at Olive View-UCLA. This has greatly improved our ability to address the needs of patients with SUDs in the ED setting.

 

How can clinicians integrate advocacy into their day-to-day jobs?

If you have an employer or work for an organization, it’s important to understand what actions are acceptable. Ask:

  • Whether you can speak on behalf of your organization and to what degree you can associate your advocacy work with your employer. Most employers will not bar you from speaking as an individual on an issue, but you should clarify the degree to which you can associate yourself with your employer.
  • What types of advocacy actions are acceptable. Often, even employers who are friendly towards clinician advocacy become sensitive when there is media coverage, whether you are publishing an op-ed or doing an interview on the local news. Identifying what type of activity your employer is comfortable with is as important as determining how much you can associate yourself with your employer.

 

What advocacy activities do you recommend?

There are many options, which I think of as a ladder of engagement. Consider the following ideas.

 


Person on ladder

ADVOCACY OPPORTUNITIES FOR CLINICIANS

  • Sign a petition supporting or opposing a proposed policy.
  • Post information on your social media accounts or tag legislators online.
  • Call elected officials. Policymakers value clinician insights and even a handful of calls from clinicians can get their attention on an issue.
  • Meet with elected officials.
  • Organize physicians and other clinicians to send letters or make phone calls to elected officials.
  • Participate in a media event. Organize your own press conference or go to one organized by someone else.
  • Be active in your professional organization’s advocacy work and submit policy resolutions.
  • Contribute to a story bank. These collections of stories (e.g., www.ShotbyShot.org) make the case for why an issue is important and if your story’s compelling, you may become a frequent media contact.
  • Write an op-ed. This can be a powerful way to act unilaterally and it’s fairly easy for a physician who cares about an issue to get published in a local newspaper.
  • Support a public health or community coalition. If you don’t have time to join, just being the white coat at a hearing or event can be impactful. 
  • Run for Office.

 

How can clinicians encourage others to support their cause?

Build support by organizing others around your issue. Use the power of the personal “ask” (preferably in person) to come to an event, donate to the cause, or help with an effort. Get to know people personally so you can frame your ask based on their values. Personal asks that draw on relationships are vastly more effective than blasting out a request to a large group.

If you want people to stay involved, recognize their contributions, share results, and help them see the impact of their work (e.g., “Thanks to your efforts, we placed over 100 phone calls!”). Often, people feel that they had an impact when they had a chance to meet with a high-level decision-maker or when the action got media attention.

 

What is your most important advice for clinicians who want to get involved in advocacy work?

Have the courage to advocate for something that you care about. As clinicians, we want to assess all possible risks, benefits, and likely outcomes. We may think that we are not expert enough, don’t know if we’ll make a difference, and are afraid of what people will think. Do not be afraid to speak from the heart about an issue that impacts your patients.

Focus on something that you encounter daily and want changed. You’ll have the passion to work on that issue and compelling stories to tell. Start with a change in your own practice and learn from that experience. You may make mistakes or have less impact than planned or may find that your activity was even more effective than expected.

Finally, remember that policymakers don’t expect you to be a policy or legal expert – they expect you to be a medical expert. Bring your perspective, expertise, and credibility as a clinician to help them understand how they can support patients and healthier communities.

 

_____________________________________________________

Making a Difference: Local Opportunities for Health Advocacy

There are many opportunities for clinicians to advocate for positive policy changes. In our policy work, we have found that people tend to associate health policy more narrowly with legislation that addresses health access, financing, or delivery systems, such as the Affordable Care Act. While laws like these have had a profound impact and have benefitted from clinician advocacy, there are many policy actions that clinicians can support to improve patient and community health. For instance, they can advocate for:

  • Organizational changes, such as strong employee vaccination policies or energy efficiency upgrades to mitigate climate change
  • Local ordinances that limit tobacco sales or use of tobacco products in communal areas
  • City planning or zoning policies that address pedestrian safety or green space
  • School policies that promote physical activity, such as joint-use agreements that allow the community to use school grounds for recreational purposes outside of school-hours
  • Funding for public health and community health initiatives
  • Taxes on unhealthy products, such as tobacco or sugar sweetened beverages
  • Laws that address the underlying factors that influence health, such as funding for federal nutrition assistance programs, environmental protections, or affordable housing programs.

Clinicians who would like to get involved in these or other activities can do so independently (e.g., write letters of support, provide public comment) and/or collaborate with professional, community, and public health partners. The table below summarizes a variety of local and national advocacy opportunities. Potential advocacy partners are also briefly described here.

Professional Associations

Many professional medical and nursing organizations are engaged in health advocacy efforts that address issues such as health care system design, access to care, immunizations, substance use disorders, nutrition, food insecurity, and firearms safety. Some also offer advocacy training. Contact your professional association to learn about their policy priorities. See the table below for local resources.

Issue-specific Organizations

Organizations such as the American Cancer Society, American Heart Association, and American Lung Association, actively promote health policy at the local, state, and national levels. Contact local chapters of these and other organizations to learn how to support efforts that address your priorities.

Public Health

The Los Angeles County Department of Public Health (LAC DPH), under the direction of the Los Angeles County Board of Supervisors, supports efforts to advance policies that promote community health and reduce health inequities, such as those briefly described below.

  • Specific Health-related Coalitions: Asthma, immunization, substance use, and tobacco use coalitions, to name a few, bring diverse partners together to advocate for policies and laws to improve personal and community health. Many welcome clinicians’ perspectives and influence.

  • Tobacco Prevention and Control Policies: Numerous local jurisdictions are adopting strong tobacco control policies related to smoke-free multi-unit housing and outdoor areas and tobacco retail sales. There is also policy work on flavored tobacco products and electronic nicotine delivery systems (e-cigarettes), which are used by teenagers at “epidemic” levels according to the Acting U.S. Food and Drug Administration Commissioner. Beverly Hills, Culver City, Hermosa Beach, and Redondo Beach are examples of jurisdictions that have recently considered stronger tobacco control policies. Clinicians can support these efforts by partnering with the Coalition for a Tobacco Free Los Angeles, writing or signing position letters, or testifying at city council meetings.

  • Sexually Transmitted Infection (STI) Prevention Funding: There have been sharp increases in the rates of STIs in the U.S. and in California. Currently, California has the second highest rate of primary and secondary syphilis and the third highest rate of congenital syphilis in the nation. When adjusted for inflation, STI funding has declined and is not adequate to address the growing disease burden. Advocates have proposed increases in state and federal funding for comprehensive STI prevention programs, which clinicians can urge their elected officials to support (e.g., submit a letter of support, write an op-ed, call or visit an elected official, or propose a policy resolution for your medical association).

  • Community Prevention Funding: Clinicians can voice support for sustainable funding for the Prevention and Public Health Fund (Prevention Fund), a section of the Affordable Care Act intended to provide ongoing, dedicated resources for public health activities in the U.S. It supports, among other things, comprehensive immunization services, chronic disease initiatives such as diabetes prevention, and public health laboratory infrastructure. Clinicians can also support the establishment of a wellness trust in California, which would create an ongoing stream of funding for community prevention efforts (See https://www.ca-allianceforpreventionfunding.org/ for additional information).

If you’re interested in these areas or other community health advocacy opportunities, please see the table below and contact LAC DPH Policy & Legislative Affairs at govaffairs@ph.lacounty.gov or 213-288-7871.

 

Summary of Selected Advocacy Opportunities
Professional Associations
Policy Focus Many professional medical and nursing organizations advocate for policy changes related to health insurance, access to care, health care delivery, health practices, community health, and various environmental and socioeconomic factors that can influence health.
Advocacy Opportunities Contact your professional association to learn about advocacy opportunities, which may include writing or signing on to position statements, testifying at hearings, media or social media opportunities, and policy resolutions.
Contact
Annual Health Policy Challenge - Los Angeles County Medical Association (LACMA)
Policy Focus LACMA’s Young Physicians Committee hosts an annual health policy challenge encouraging physicians-in-training to tackle social determinants of health affecting patients in LA County.
Each year, a topic is selected and participants form groups to address a variety of issues including: pediatric obesity, reducing sugar sweetened beverage consumption, increasing physical activity, homelessness and health care, and improving LA’s air quality. The topic for the 2019/2020 challenge is immigrant health. The winning team receives a cash prize and an opportunity to advocate for their policy proposal with local and state policymakers.
Advocacy Opportunities

Medical Students: Join a health policy team and submit a proposal for the challenge.

Physicians: Mentor a team of medical students working on a proposal, judge proposals, donate to support the health policy challenge, and get involved in LACMA.

Contact Contact Lisa Le, LACMA Vice President for Operations & Strategic Initiatives
www.losangelesmedicine.org     lisa@lacmanet.org     213-226-0304
Coalition for a Tobacco Free Los Angeles - LAC DPH Tobacco Control and Prevention Program
Policy Focus The Coalition promotes the adoption of local tobacco control policies and supports statewide policies, including policies related to smoke-free multi-unit housing and outdoor areas, tobacco sales, and restrictions on flavored tobacco products and electronic nicotine delivery.
Advocacy Opportunities Write a letter, author an op-ed, testify at a city council meeting to express your concerns, and/or participate in the Coalition for a Tobacco Free Los Angeles.
Contact LAC DPH Tobacco Control and Prevention Program
www.publichealth.lacounty.gov/tob     tobacco1@ph.lacounty.gov   213-351-7890
Violence Prevention - LAC DPH Injury and Violence Prevention Program
Policy Focus DPH partners with community residents, County departments, and stakeholders to prevent multiple forms of violence through coordination, communication, policy, and system change that is trauma informed and responsive to the community.
Advocacy Opportunities Write a letter; author an op-ed; speak at local community meetings; implement routine screening procedures focused on gun safety; expand access to culturally competent mental health supports; participate in educational programs to teach students, parents and community members about gun safety and violence prevention; and support state and federal funding initiatives for research on the causes and effects of violence.
Contact LAC DPH Injury and Violence Prevention Program
http://publichealth.lacounty.gov/ivpp/        ivpp@ph.lacounty.gov      213-351-1901
Vision Zero Coalition:  Ending Traffic Fatalities in Unincorporated Communities - LAC DPH PLACE Program (Policies for Livable, Active Communities and Environments)
Policy Focus

Vision Zero Los Angeles County’s goal is to reduce traffic fatalities to zero in unincorporated Los Angeles County communities by 2035 through policies, programs, and built environment interventions.

See the accompanying article, “Preventing Traffic Deaths, the Critical Role of Clinicians” in this issue.

Advocacy Opportunities Write a letter; author an op-ed; testify at local commission, city council, or Board of Supervisors meetings; join Southern California Families for Safe Streets; and/or speak at local community meetings to share your concerns about traffic safety.
Contact Alexis Lantz, MA
www.publichealth.lacounty.gov/place/PLACE_Projects.htm   
alatnz@ph.lacounty.gov    213-351-3129
Health Impacts of Climate Change- LAC DPH Climate Change and Sustainability Program
Policy Focus Partners promote organizational and policy changes that can slow climate change buy reducing greenhouse gas emissions and build resilience to the health impacts of climate change.
Advocacy Opportunities Share your views with your medical association, write a letter, author an op-ed, speak at local community meetings and conferences about how climate impacts health, join an organization that works on climate change from a health perspective, work with your health care facility to reduce its greenhouse gas emissions, and/or get involved in implementing LA County's Sustainability Plan.
Contact LA County DPH Climate Change and Sustainability Program www.publichealth.lacounty.gov/eh/climatechange    erhoades@ph.lacounty.gov     
626-430-5537
Public Health Funding and Infrastructure - LAC DPH Policy & Legislative Affairs
Policy Focus LA County DPH and partners support critical public health infrastructure and activities through the continued funding of the Prevention and Public Health Fund, the establishment of a statewide wellness trust fund, and increased funding for infectious disease and STI control and prevention.
Advocacy Opportunities Share your views with your medical association, write a letter, author an op-ed, or participate in a regional convening efforts through the California Alliance for Prevention Funding
Contact LAC DPH Policy & Legislative Affairs 
govaffairs@ph.lacounty.gov   213-288-7871

 

 

Conclusion

Physicians and other clinicians play a critical role in influencing and leading policy changes to improve community health. There are myriad opportunities to engage in health advocacy and give voice to what you see within the exam room. To have an impact, you don’t need to invest significant time or be a legal expert. Simply bring your perspective, expertise, and passion for improving your patients’ and your community’s health.  

 

  Continuing Medical Education
 
 

Companion Webinar with free CME:
How to Be an Effective Healthcare Advocate

To learn more about effective public health advocacy strategies view Dr. Ragin’s on-demand CME webinar.

 

Resources

The Legislative Process and Proposed Legislation

Selected LAC DPH-Led Public Health Partnerships

 

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Author Information:

Kyle Ragins, MD, MBA
Doctors for America

Joshua Bobrowsky, JD, MPH
Director of Policy and Legislative Affairs

Julia Heinzerling, MPH
Special Assistant to the Chief Medical Officer

County of Los Angeles
Department of Public Health

govaffairs@ph.lacounty.gov


Rx for Prevention, 2019
July;9(2).


Published: July 11, 2019

 

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