Successful Physician Advocacy Successful Physician Advocacy

J. Gary Wheeler, MD, MPSJ. Gary Wheeler, MD, MPS

Little Rock, ArkansasLittle Rock, Arkansas

Objectives Objectives Understand the different spheres of

advocacy at the practice, community, and state levels.

Identify at least two qualities physicians bring to strengthening advocacy campaigns and partnerships

Identify tools for advocacy, especially stories

David Bourne, MDDavid Bourne, MD

I’m going to helpI’m going to help

• Public not private health

Individual Individual behaviorbehaviorTrigger: Paper in Pediatrics re: magazines and tobacco promotion

Action: Removing all magazines from your waiting room areas which promote tobacco use (e.g. Sports Illustrated)

Advocacy: CommunityAdvocacy: Community

• Trigger: observation of increased numbers of patients in your practice using tobacco

• Action: Join the school district health committee to improve the curriculum about tobacco use and second hand smoke

Advocacy: stateAdvocacy: state

• Trigger: death of non-smoking restaurant worker who is a parent of a child in your practice from Lung Cancer (squamous cell carcinoma)

• Phone your representative on the state legislature in support of a smoke free workplace regulation. Participate as a “science” expert on SHS for the legislative committee

Justifications for AdvocacyJustifications for Advocacy

• Professional tradition– …it is not enough, however, to work at the individual

bedside in the hospital.. In the near or dim future, the pediatrician is to sit in and control school boards, health departments, and legislatures. He is the legitimate advisor to the judge and the jury, and a seat for the physician in the councils of the republic is what the people have a right to demand.

– Abraham Jacobi, 1904

Reasons not to advocateReasons not to advocate

• Don’t know how to do• No time• Can’t sell prevention• I’m not that kind of person• Won’t make a difference• My medical school will fire me

– Galer-Unti, RA.Health Prom Pract 2004:280

11:40: surfing web for best nicotine replacement therapy (NRT) prices.11:43: Discover following link after description of a nicotine replacement patch: “Additional Information CLICK HERE for Quit Assist website from Philip Morris USA”11:44: To self: “Did PM [Philip Morris] actually pay for that? If so it’ll never get removed—what the heck, it’s easy to click Contact Us and point out the incongruence”.11:45: Message sent: “The last place people who are trying to quit smoking need to be clicking for assistance is a tobacco company website. There are multiple online assistance programs, (I listed some). Please consider replacing or at least eliminating the link to Philip Morris”.13:31: (Same day!) Message received:“Having read your message, I instructed the sales department to change all of the listings to reflect a link to www.becomeanex.com as I personally felt that this website was extremely well designed and geared to helping the smoker quit without linking them to any preferential, alternate websites. Please feel free to re-examine our website. I think it will help ensure our personal motto of “Be Well” not just in theory, but in practice. Thank you for your concern and we appreciate your input”. 13:33: Revisit site—every smoking cessation product on the site has new link.

Need for Advocacy??Need for Advocacy??The tobacco industry spends more than $12.8 billion per year advertising and marketing its lethal products

More than 5 million children alive today will die prematurelyfrom smoking-related illnesses

Nearly every adult who smokes (almost 90 percent) took hisor her first puff at or before the age of 18

Increasing tobacco taxes is an effective way toprevent and reduce smoking, especially among kids

•More than 5 million children alive today will die prematurely from smoking-related illnesses? •Nearly every adult who smokes (almost 90 percent) took his or her first puff at or before the age of 18? •Or, that increasing tobacco taxes is an effective way to prevent and reduce smoking, especially among kids?

Advocacy: the political processAdvocacy: the political processChristopher KushChristopher Kush

• Write effective letter

• Send effective e-mail

• Phone call

• Persuade others to contact representatives

Advocacy: the political processAdvocacy: the political processChristopher KushChristopher Kush

• Get out the vote

• Contributions to candidates

Advocacy: the political processAdvocacy: the political processChristopher KushChristopher Kush

• Press clippings file

• Write a letter to the editor

• Write an op-ed

• Meet the editors

• TV interview

Advocacy: the political processAdvocacy: the political processChristopher KushChristopher Kush

• Meet your representative

• Testify at a public hearing

• Protest/march/activity

• Run for office

Health Advocacy ToolboxHealth Advocacy Toolboxhttp://www.cthealthpolicy.org/toolbox/http://www.cthealthpolicy.org/toolbox/

• Always be polite

• Always say thank you

• Get your story straight

• Never, ever make up an answer

• Trust your champion

• Patience

• You are not the only fish in the pond

Advocacy successAdvocacy success

• Preparation

• Persistence

• Opportunity

A CEO, a parent group, a A CEO, a parent group, a chancellor, and a COPH dean chancellor, and a COPH dean

• ACH and a conversation about the “hut”

• Chancellor-Michigan Smoke free hospitals

• COPH data• Public Health Rep. 2007 Nov-Dec;122(6):744-52.• Impact of a smoke-free hospital campus policy

on employee and consumer behavior.• Wheeler JG, Pulley L, Felix HC, Bursac Z, Siddiqui

NJ, Stewart MK, Mays GP, Gauss CH.

Arkansas Hosp AssociationArkansas Hosp Association

• The ledge• The value of data• Act 134 of 2005• Published

– Making Hospital Grounds Smoke-Free: A Case Study of Arkansas Act 134 of 2005 :Journal of Public Health Management and Practice: March/April 2009 - Volume 15 - Issue 2 - p E9-E15 doi: 10.1097/01.PHH.0000346020.12641.92

• Felix, Holly C. PhD; Wheeler, J. Gary MD; Pulley, LeaVonne PhD; Stewart, M. Kathryn MD; Bursac, Zoran PhD; Mays, Glen P. PhD; Mackey, Diane S. JD

The Big Stage-the ledgeThe Big Stage-the ledge

• Infighting/Outfighting-nuances of the bill

• The coalition/lobbyists/nationals

• Role of data- passive smoke and MIs-Helena, Montana and Colorado

• Try, try and try again-ACT 8 of 2006

Be prepared

• Act 13 of 2006

Some lessons learned Some lessons learned

Dream the Impossible, but work in the realm of the Possible

Sometimes losing is better than winning

Never negotiate with the tobacco industry

Work with the pros for legislative goals

Assume someone has tried what you are trying and can teach you something

More lessonsMore lessons

• Work hard/be nice (don’t be righteous)

• Learn how to negotiate (don’t view people with polarized lenses)

• Money is the root of most behavior

• Always say thanks

Role of the PhysicianRole of the Physician

• Expert• Make the theoretical palpable• Own the data• Be the face but rely on the pros for strategy until

you are a pro• Link to a coalition or non-profit• Stay informed (ANR, CTFK, Richmond Center)• Manage your time