Promoting Health: Advocacy Guide for Health Professionals

The World Health Communication Associates (WHCA) Action Guide on Health Advocacy introduces a new action framework for strengthening policy advocacy. Health advocacy is defined as: “Blending science, ethics and politics, advocacy is self-initiated, evidence-based, strategic action that health professionals can take to help transform systems and improve the environments and policies which shape their patients’ behaviours and choices, and ultimately their health." The guide's primary aim is to be a "how-to" manual. It has been produced in two sections, one explaining health advocacy and the steps to take action and the other presenting the importance of health literacy and how it is measured, along with case studies to show how it can be strengthened through educational systems, media market places, home and community settings, workplace settings, and policy-making arenas.

The advocacy guide, published jointly with the International Council of Nurses, states in the Introduction that health professionals have ideas about improving healthcare. "Health advocacy is an individual and collective approach that health professionals can use to turn these ideas into generalised realities and to create positive health and social change. Section 1 provides an ethical rationale for action and identifies key global health trends driving the need and opportunities for strengthened health professional advocacy. Section 2 identifies ten "action steps" which you can adapt to your own issues and contexts. In Section 3, specific advocacy skills and processes are described in more detail. These approaches can and have been used by health professionals in a wide variety of settings to enhance their own personal development, stand up for and with their patients, strengthen their professions, and facilitate policy change at institutional, community, regional, national and international levels."

The document deals with policy change strategies, and it qualifies the political systems where advocacy is possible: "'Advocacy' assumes that people have rights and that these rights are enforceable; for example, the right to voice opinions openly and to organise, as well as the right to adequate health care, pollution-free environments, employment and housing. Advocacy often focuses on ensuring that these rights are exercised, respected and addressed. The approaches detailed in Section 3 are potentially effective only in political environments where:

• policy-makers can be influenced by public opinion; and/or
  
• governments can and do take action to protect the rights of their citizens; and/or
  
• there is an open and free media through which people can express themselves/find a voice (Sen 1990)."

The document reviews a set of global trends in health which include telecommunications advances - "The internet, mobile phones and other telecommunication advances allow for instant local-global linkages, and cost-elective information transfer and intelligence gathering." The second section lists and details the following 10-step advocacy framework:

1. "Taking action - overcoming obstacles to action;
   
2. Selecting your issue - identifying and drawing attention to an issue;
   
3. Understanding your political context - identifying the key people you need to influence;
   
4. Building your evidence base - doing your homework on the issue and mapping the potential roles of relevant players;
   
5. Engaging others - winning the support of key individuals/organisations;
   
6. Developing strategic plans - collectively identifying goals and objectives and best ways to achieve them;
   
7. Communicating messages and implementing plans - delivering your messages and counteracting the efforts of opposing interest groups;
   
8. Seizing opportunities - timing interventions and actions for maximum impact;
   
9. Being accountable - monitoring and evaluating process and impact; and
   
10. Taking a developmental approach - building sustainable capacity throughout the process."
    

Advocacy tips are inserted where applicable. These tips describe a media audit checklist:

1. "Is your issue being covered by the print and broadcast media?
   
2. If not, are other issues receiving attention that could be linked to your issue?
   
3. What are the main themes, arguments, images, metaphors presented on various sides of the issue?
   
4. Who is reporting on your issue or stories related to it?
   
5. Who are appearing as spokespeople on your issue? Who are appearing as opponents to your issue? 6
6. Who is writing op-ed pieces or letters to the editor on your issue?
   
7. Are any solutions presented to the problem?
   
8. Who is named or implied as having responsibility for solving the problem? Is your target named in the coverage?
   
9. What stories, facts, or perspectives could help improve the case for your side?
   
10. What’s missing from the news coverage of your issue? (Apfel 2003)"
    

Step 7 details communicating messages and implementing plans. "Communications is at the heart of advocacy implementation. Policy decisions are rarely made on the basis of facts alone. To a large degree the outcome of policy debates reflects the values that inform them and the frames that define them....In developing messages, advocacy communication draws on advertising and social marketing principles. The key to developing successful messages is knowing the audience thoroughly and then tailoring simple, concise messages to their interests. Information about target audience interests and needs comes from formative research." Tip 8 includes five point on developing message content (page 28); tip 9 describes an appropriate spokesperson (page 28); and page 29 describes dealing with controversies, using notes of encouragement, and using scientific and advocacy communication approaches differently. Advocacy campaign evaluation is the subject of tip 11, which has questions on costs, measuring success in shifting debates, and implementation of follow-up strategies, among other points (page 33).

The final section, Tools and Process, gives information on framing, formative research, working with media, media interviews, networking, social marketing, media advocacy, lobbying, and internet-based advocacy. It includes processes and content suggestions for the tools along with notes of caution. For example, under internet-based advocacy, "Campaigns to influence decisions-makers that are only internet-based can be dismissed as artificial, easily manipulated, unrepresentative and a manifestation of political inertia. 'Click' participation and 'voting by cellphone' are among the most extraordinary 'democratic' developments of recent years, but they are open to abuse and should not be relied upon as the sole means of promoting a campaign."