Public Health Advocacy

by

Regina A. Galer-Unti

• LAST REVIEWED: 27 October 2022
• LAST MODIFIED: 20 September 2012
• DOI: 10.1093/obo/9780199756797-0028

Introduction

The term “public health advocacy” refers to educating, organizing, and mobilizing for systems change in population health. Current and future threats to the health of the community are identified and public health advocates work to inform, create, and influence legislation and change the environment in order to create circumstances in which optimal health is possible. Public health advocacy occurs through media, legislative, and grassroots efforts. Although individual health advocacy for patient and client can be practiced, it should be stressed that public health advocacy, like the core discipline of public health, is undertaken to enhance the health of communities through improved health policies and programs. This article provides a collection of resources (books, journal articles, websites, etc.) selected to provide insight into public health advocacy as fundamental to the discipline of public health. In addition, sources that demonstrate the successful use of advocacy in influencing systems change are provided.

Introductory Works

Mullan 2000 explains that social justice and population health are core to the discipline of public health. Advocacy is an important component of the efforts to create healthful environments; ensure access to care; and campaign to eliminate all health, social, and economic inequalities. Kingdon 2002 is a widely accepted explanation of how agenda setting and politics work in the legislative process. Oliver 2006 provides information about healthful policy within the context of agenda setting and policymaking. Together, these works assist in understanding where advocates can have impact in the political process. In McDonough 2000, a former legislator turned academic explains the theory and actuality of the health policy process. Public health advocates use knowledge of the policy procedure and examples of success to shape future policy approaches. Brownson, et al. 2006 discusses success and thoughts for future advocacy campaigns involving chronic diseases. For some chronic diseases, advocacy organizations are formed to dedicate time and energy to policies that promote disease eradication or the attenuation of symptoms. Andrews and Edwards 2004 describes how these organizations successfully become involved in the policymaking and appropriations (i.e., monetary allotment) process. Chapman and Wakefield 2001 recalls thirty years of tobacco control advocacy victories and the strategies for this work. Finally, education and advocacy for nutritional health resulted in sweeping policy change in Finland. Puska and Ståhl 2010 discusses the Finnish Health in All Policies initiative, under which all policies must be reviewed for potential health consequences.

• Andrews, Kenneth T., and Bob Edwards. 2004. Advocacy organizations in the U.S. political process. Annual Review of Sociology 30:479–506.

  DOI: 10.1146/annurev.soc.30.012703.110542

  Although not specifically dedicated to public health advocacy, this review of scholarship is useful in its discussion of advocacy organizations (e.g., nonprofits) and their involvement at various stages of the policymaking process. Could be used in further research on public health advocacy organizations. Available online for purchase or by subscription.

• Brownson, Ross C., Debra Haire-Joshu, and Douglas A. Luke. 2006. Shaping the context of health: A review of environmental and policy approaches in the prevention of chronic diseases. Annual Review of Public Health 27:341–370.

  DOI: 10.1146/annurev.publhealth.27.021405.102137

  Examples of opportunities for public health advocacy to mitigate chronic disease are abundant in this work. Authors organize evidence from interventions across three domains—physical environment/access, economic environment, and communication environment—and suggest that change efforts should begin with environmental and policy approaches. Available online for purchase or by subscription.

• Chapman, S., and M. Wakefield. 2001. Tobacco control advocacy in Australia: Reflections on 30 years of progress. Health Education and Behavior 28:274–289.

  DOI: 10.1177/109019810102800303

  Strong example of how public health advocates secured public and political support for effective policy change. Authors discuss how framing theory and media advocacy were used to gain legislative and policy changes in Australia. Good analysis of strategies for successful advocacy work. Available online for purchase or by subscription.

• Kingdon, John W. 2002. Agendas, alternatives, and public policies. 2d ed. White Plains, NY: Longman.

  Political scientist Kingdon describes his multiple-streams (problem, policy, and political) model of the agenda-setting and policy process. Kingdon posits that all streams must converge in order for policy change to occur. Public health advocates can use this framework to understand the political process and construct advocacy campaigns.

• McDonough, John E. 2000. Experiencing politics: A legislator’s stories of government and health care. Berkeley: Univ. of California Press.

  The author, a former legislator and current academic, explains health policy in both theory and practice. Infused in this book are invaluable lessons for legislative, grassroots, and media advocacy.

• Mullan, F. 2000. Don Quixote, Machiavelli, and Robin Hood: Public health practice, past and present. American Journal of Public Health 90:702–706.

  DOI: 10.2105/AJPH.90.5.702

  Describes three types of public health officials as idealist (Don Quixote), political strategist (Machiavelli), and resource redistributor (Robin Hood). Describes historical roots of politics in public health and the need for those who work in public health to be strong advocates for the health of the public.

• Oliver, Thomas R. 2006. The politics of public health policy. Annual Review of Public Health 27:195–233.

  DOI: 10.1146/annurev.publhealth.25.101802.123126

  Explains influences on policymaking and agenda setting in the political process. Guides reader in understanding touchpoints where public health advocates may have the most influence. Discusses how policy entrepreneurs can advocate for health policy reform. Available online for purchase or by subscription.

• Puska, Pekka, and Timo Ståhl. 2010. Health in All Policies—the Finnish initiative: Background, principles, and current issues. Annual Review of Public Health 31:315–328.

  DOI: 10.1146/annurev.publhealth.012809.103658

  Advocacy (e.g., Finnish Heart Association) and public health work led to dietary policy changes and, ultimately, the adoption of Health in All Policies by Finland. All public policies, including sectors unrelated to health, must consider health-relevant consequences. Future efforts for public health advocacy must encourage social change to follow political change. Available online for purchase or by subscription.