Passion and Persistence: Connecting Public Health, Population Health, and Advocacy

1. Passion and Persistence Public health, population health and advocacy: how it all connects

2. Presentation at Knowing Our Communities Halifax, May 8, 2013 Sharon MacIntosh, Public Health Services, Capital Health, (sharon.macintosh@cdha.nshealth.ca) and Phyllis Price, Public Health Services, South Shore Health, (pprice@ssdha.nshealth.ca)

3. Connections • Public health is about the blending of science, community activism, social values and politics to advance the interests of the public’s health. (Dorfman et al, 2009) • Population health aims to improve the health of individuals by creating healthier societies(Marmot, M. 2004) • Advocacy can be “the pursuit of influencing outcomes – including public policy and resource allocation decisions within political, economic, and social systems and institutions – that directly affect people’s lives.” (World Health Organization,http://www.who.int/tobacco/research/advocacy/en/) • Advocacy is a core competency of public health. (Public Health Agency of Canada, 2009) • An effective advocate has been described as someone with the ability to “use available evidence and knowledge about an issue to push for improved public health over the long term.” (Ashbridge, M. 2004)

4. Today’s Goal • to deliver a practical, participatory session that provides people with a fundamental understanding of how to engage in advocacy for healthy public policy.

5. Today’s Process • Review key elements of advocacy • Share some lessons learned in advocacy campaigns in Nova Scotia • Respond to burning questions about advocating with multiple levels of government (and provide an opportunity for follow-up) • Provide useful handouts and reference lists

6. What is advocacy? • a process of influencing outcomes, such as healthy public policy adoption (World Health Organization) • a way to change both the health policy rules and the resource allocation decisions of government and private institutions (Dorfman et al, 2009) • a catch-all word for the set of skills used to create a shift in public opinion and mobilize the necessary resources to support an issue, policy or constituency(Wallacket al, 1993: 27-28)

7. The Advocacy Process: Key Elements

8. 1) Deciding to Take Action • Ask yourself • What are your public health objectives? • What do you want to change or preserve? • Can a “win-win situation be first developed with decision makers? • Look for and be prepared to act on windows of opportunity. • Be sure you want the change and are willing to be in for the long haul.

9. 2. Framing the Policy Question: Get the Facts and Do the Analysis • Focus on accurate information and in-depth understanding . • Have a clear purpose. Frame the issue in terms of health . • Document your position. • Write a clear, concise, compelling case with credible facts. • Share your case with internal and trusted external stakeholders for feedback. • Assess readiness - decide how to proceed. • Identify political opportunities.

10. 3. Building your Power Base: Organizing and Coalition Building • Build credible partnerships and coalitions • Strengthen efforts through maximum participation • Identify allies and credible organizations that have traction • Include people “inside the system” • Find credible, engaging champions • Ensure your coalition includes everyone it should • Determine best person to “lead” the group • Speak with many voices but with consistent messages • Ensure everyone has support and materials needed

11. 4. Making a Plan: Goals and Strategies • Be clear about you want to achieve. • Take advantage of outside expertise and resources. • Develop your policy objectives. • Generate a list of policy options. • Pick policy options. • Identify and understand key players, decision makers, influencers. Determine “Who can give you what you want?” • Learn about your opponents. Develop a plan to counter opponent’s efforts.

12. Making a Plan (2) • Try to avoid controversy.   • If necessary, divide your advocacy voices into “moderates” and “vanguards.” • Maintain your credibility. • Keep your eye on the prize. • Become familiar with and use governmental /departmental procedures. • Bring issues to the local level. • Use multiple strategies.

13. 5. Building Support: Communicating your Message • Be scrupulously honest. • Choose appropriate channels and vehicles. • Focus on top 2 or 3 points of message. • Speak with many voices but with same goal and key messages. • Implement and assess communication activities over time.

14. 6. Implementing Your Plan: Monitoring and Flexibility • Maintain solidarity. • First rule: “be there.” • Debrief after the meeting or events. • Monitor progress and share what is happening with the team. • Create a small leadership team. • Be passionate and persistent. • Don’t give up.

15. 7. Evaluation • Measure regularly and objectively what has been accomplished and what more needs to be done. • Your reasons for evaluation determine the technique. • Answer 3 questions before starting: • What do we want to do? • How are we going to do it? • How do we measure success?

16. 8. Acknowledging Key Players: Thank Them • Celebrate little successes to maintain commitment. • Give credit to politicians. • Plan an event to recognize everyone. • Leave adversaries with a graceful exit.

17. Advocacy challenges • Expectation of quick results. • Achieving great things with small budgets. • Not leaving room for complacency. • Staying the course. • Creating and maintaining a high profile. • Avoiding exhaustion. • Maintaining strong partnerships. • Staying politically neutral / being truly non-partisan.

18. Final Thoughts • Recipe for success: creativity, hard work, perseverance • Keep to your basic principles • Personal principles • Work principles • Campaign principles • Sustaining principles

19. a) Basic personal principles • Factual accuracy • Total honesty • Non confrontational tone (keep inflammatory rhetoric in check) • Respect confidences

20. b) Basic work principles • Work within a coalition • Define the problem • Have a plan with defined interim goals and final goals • Include community building • Be flexible about strategies • Don’t humiliate opponent (Build allies, not enemies)

21. c) Basic campaign principles • Frame the issue—tell a story • Stay on the offensive • Raise the stakes • Stay on mission — don’t get sidetracked • No party politics

22. d) Basic sustaining principles • Maintain perspective • Have 3 to 5 key advisors • Have a life • Never think it’s over • Never quit

23. Let’s keep talking • Small group work: • Based on the process and the lessons learned and your own experiences, what are the most useful lessons you've learned that you'd like to share with the group? • What's the thing you most need to know before you leave today? • Other questions or comments? Join Google Group: Nova Scotia Advocacy Discussion • https://groups.google.com/d/forum/nova-scotia-advocacy-discussion

24. “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.” Margaret Mead