In part I of this series, we identified health advocacy as an overwhelming topic, yet a role that is expected of healthcare professionals. In part II, we aim to provide a working definition of advocacy as well as provide examples of how advocacy may be incorporated into professional practice.
At the Advocacy Training Workshop held by the Global Health Office, Angela Day provided a wonderful introduction to health advocacy:
In their Advocacy Guide for Health Professionals, the International Council of Nurses defines advocacy as follows:
“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.”
Advocacy can be achieved at many levels, including the individual, the community, and/or the population.
Individual patients need physicians to assist them in navigating the healthcare system and accessing the appropriate health resources in a timely manner. This includes things like phone calls to specialists to speed up referrals, helping a patient find a family physician, and advocating for improved access to treatment for patients in rural areas.
Communities need physicians to identify and address local health issues and determinants of health in the community in which the physician practices. This includes things like encouraging safer and healthier environments, promoting recruitment and establishment of necessary specialists and health services, and working with community outreach programs.
Populations need physicians to identify and address health needs and determinants of health of marginalized, disadvantaged, and vulnerable populations on a local, provincial, and national scale. This includes things like promoting aboriginal and refugee health equity, supporting mental health initiatives and destigmatizing mental illness, and promoting public health. Often, this type of advocacy occurs at a political level to promote changes in policy and practice.
Following Angela’s informative introduction were presentations from Dr. Scott, Dr. van Zoost, and Dr. Hennen about what advocacy means to them and the experiences they’ve had as health advocates. Most striking was the passion each of these physicians holds for the work they do. Whether it’s encouraging the development of midwifery (Dr. Scott), starting a health promotion and foot care program for the homeless (Dr. van Zoost), or advocating for people with disabilities (Dr. Hennen), each physician personifies a burning, unequivocal devotion to their patients and their communities. And the surprising part? Few considered themselves advocates until invitations to this workshop highlighted that they were, in fact, actively engaged in advocacy. They got involved in their respective advocacy efforts because they felt it was right and because, as physicians, they were in the privileged position to do so.
Their enthusiasm for advocacy continued to be apparent in the second half of the workshop when participants broke in to small groups and, with the help of the presenters, worked through practice scenarios that stimulated discussion around social determinants of health and potential courses of advocacy. Groups identified personal, social, cultural, and environmental factors that contribute to the health (or lack thereof) of individuals, communities, and populations. Barriers to the access and availability of health services were recognized and possible solutions discussed. And through it all, the presenters facilitated the discussion in a way that made health advocacy much more than an ambiguously defined, yet nationally directed, part of medical practice. They showed health advocacy to be an inspiring and fulfilling characteristic intrinsic to the role of physician.
So maybe it’s not only about satisfying the criteria of a competency framework, but engaging with your patients and your community. Not only about reciting definitions, but understanding and acting on social conditions, situations, issues, and policies that incense the moral fibres that lead us to become doctors in the first place. Not only about fulfilling professional obligations, but promoting social justice and human rights.
If you have come here to help me, you are wasting our time. But if you have come because your liberation is bound up with mine, then let us work together. –Lilla Watson