Developing a Comprehensive Curriculum for Public Health Advocacy

Previous articles in this journal have demonstrated the gap in public health school curricula regarding advocacy. Radius, Galer-Unti, and Tappe (2009) found that most public health schools have some advocacy training and that faculty at those schools believe that advocacy training is important, but those same faculty lack advocacy-related professional preparation or experience and vary widely in their confidence in their competence to teach it. Jernigan (2010) found that although public health schools may provide some advocacy training, of the 10 leading schools of public health, only 1 had courses covering the full “trifecta” of such training: policy advocacy, media advocacy, and community organizing.

The question that remains is how to fill this gap in advocacy training for public health students. Approximately 9,000 students graduate from public health schools every year in the United States (Association of Schools of Public Health, 2010). Developing faculty who can reach this large cohort of students with advocacy training on each campus is not likely to happen quickly, given the findings of Radius et al. (2009) regarding faculty preparation and experience. Clearly, scale matters: How can we take advocacy training to scale in public health, without waiting for the development of faculty at each school who could deliver such training?

The content of these courses is a second significant challenge. Public health advocacy is both undertheorized and underevaluated. Although there are nascent theories of how to construct public health advocacy campaigns to counter unhealthy products and industry practices, for example, these theories are largely descriptive and untested (Freudenberg, Bradley, & Serrano, 2009; Jahiel, 2008). We in public health pride ourselves on being “evidence based,” but our evidence for which kind of advocacy strategies to use in which setting is largely lacking or based on case studies that may or may not have transferable lessons. Which theories, and which skills, should be taught? To begin to approach this challenge, the public health field is going to have to draw on the expertise and experience built up over the past century in political and media advocacy in a wide range of fields beyond public health.

A third challenge lies in making the curriculum interactive and engaging, with the opportunity to measure learning. Much of advocacy is learned best by doing or secondhand through case studies. But where are those case studies to come from, and how will we bring them to life for students?

An on-demand, web-based curriculum could help us meet these challenges. In this article we propose the content for such a curriculum, which could be delivered online or in other ways. This content outline has been developed through extensive consultation with successful advocates in a wide range of fields, some of whom are serving on a pro bono basis as advisors to our efforts to build out a curriculum. In preparation for developing the outline, we reviewed other existing online trainings that touch on these topics, as well as available resources for in-person training. This curriculum represents an attempt to move beyond what is currently available. Oriented toward public health students but also toward the larger body of public health professionals, the curriculum is currently titled “Change University.” Through 100 hours of interactive online training, the curriculum would provide a thorough introduction to the current state of knowledge about advocacy in each of five areas: campaigning and organizing, campaign communications, policy making, fund-raising, and new media. The course would be divided into sections reflecting these areas of focus, then further fleshed out into specific skill areas. Students could access their training from anywhere in the world. Currently available technologies could permit professors or supervisors to review the results of students’ work if they wish to, through an integrated learning management system or other tracking system. Perhaps most important, because of the flexibility possible with online learning modules, the course language, case studies, and quizzes could be tailored to the specific needs and concerns of different public health worker populations.

Starting with the campaigning and organizing section of the curriculum, the content would immediately take learners into the nuts and bolts of advocating for change. An entire module would take the learner through the steps of moving from a problem to an issue, something that is amenable to change through a policy process, whether that process be public through governmental channels, or private, as in corporate, neighborhood, or other less official “policies” that can play defining roles in social and behavioral conditions putting a given population at risk.

Next, the curriculum would guide students through the process of identifying their desired solution to the problem and the decision maker(s) who can make the solution possible. From there, the course would take the learners through strategic planning for their campaign as a whole and give them the skills to build the power base—grassroots and beyond—needed to give clout to their policy solutions.

There is art and skill involved in the process of persuading decision makers to back a particular policy. Even a power base is no guarantee of success unless that base is skillfully deployed to pressure for change. That’s why the strategizing taught by the curriculum would cover topics such as the recruitment and development of leaders, as well as specific pressure strategies such as market-based campaigns such as boycotts and shareholder actions. Also included will be discussion of strategies for engaging existing sites of social power (“grasstops organizing”) in campaigns for policy change. A 1-hour module on grasstops organizing has already been developed, and an excerpt may be “test-driven” at www.change-university.com, though we should emphasize that this is a “beta” version and future trainings may employ a different format.

The curriculum would delve deeply into key skills under the larger umbrella of campaigning and organizing, from the relatively simple—how to run meetings for maximum results—to the comparatively complex, that is, how advocates can sustain momentum from one victory to the next. Still other modules would tackle the ins and outs of building coalitions with organizations and institutions, how and why to elect supportive candidates, how to use the electoral process itself as a means of moving an issue forward (DeMarco & Schneider, 2000), how to research decision makers and their inner circles, and how to expose pressure groups with interests antithetical to those of public health.

Because so much of changing social and behavioral conditions hinges on government, the curriculum would include substantial instruction in policy making and lobbying. Topics would include how government and policy processes work at the local, state, and federal levels. Critical to this knowledge would be how the regulatory process, party leadership, committees, and caucuses function. Another module would teach learners to go beyond how things are “supposed” to work and gauge the actual political environment for their desired policy solutions. Because the legal stakes are high, the curriculum would contain detailed instruction on who can lobby, and how to comply with ethics and lobbying rules.

With this groundwork in place, the course would then turn to legislative action planning: that is, where and when to apply political pressure to encourage policy makers to implement a desired solution. This section of the course would describe in detail the many considerations that go into creating and carrying out a sound advocacy plan. Specific modules within it would focus on running an effective meeting with policy makers, organizing them to take up the cause, how to track legislation, cultivating relationships with legislative staff, and how best to plan and carry out a trip to Capitol Hill or the statehouse. To prepare learners to take on corporate targets, the curriculum would map out the unique features of applying pressure to the private sector. Last, the course would provide the research tools that undergird this entire process of planning and execution.

In this media-dominated age, no advocacy curriculum would be complete without a substantial discussion of strategic campaign communications. Learners would gain skills in campaign communications planning, developing effective messages, and identifying the right messengers. Other modules would cover finding the right balance between “persuasion” and “pressure” communications, tapping the power of earned versus paid media, working with reporters and editorial boards, and running press conferences and other high-visibility media events. Because radio and television each offer their own unique opportunities and pitfalls, students would learn how to work well with the producers in each medium. Still another module would focus on a skill often central to public health advocacy: preparing testimony for legislative hearings. Rounding out the communications skills set would be how to run a media audit to gauge the effectiveness of a particular campaign.

New media are surging even as some traditional media outlets fade in importance. Although there is debate over the significance of these changes for democratic action (Curran, Fenton, & Freedman, 2012), what is clear is that the media landscape is changing, and advocates need to understand the implications of those changes for advocacy. Going online can offer ways to build a member and donor base, and the course would present cutting-edge strategies for attracting each. Learners would be given the tools to craft persuasive e-mail and text messages and to tap the power of platforms such as Facebook, Twitter, and the blogosphere. Other coursework would prepare students for online advocacy with resources designed for the purpose, for example, constituent relations management tools and software packages. Finally, the curriculum would help learners understand the principles of reciprocity that are key to successful new media strategies, whether in the blogosphere, by tweeting, or elsewhere.

Few of the skills mentioned above can be brought to bear without money. The coursework would therefore immerse learners in the details of fund-raising planning and execution. This would first and foremost mean instruction in understanding and evaluating assets and supporters, as well as how to move these supporters up the ladder of involvement. Wooing new backers, whether individuals, foundations, corporations, or government agencies, would be mapped out in separate modules. Special fund-raising projects—bequests and legacy gifts, events, direct mail and phone fund-raising, and capital campaigns—would all be covered. Other skills taught in this section would include connecting fund-raising with organizing and communications, how to write annual reports, and where to find fund-raising research tools.

The curriculum described above would go a long way toward closing the advocacy skills gap in public health. Each section of the course would include video case studies, where learners could hear directly from practitioners about their experiences as advocates. Other aspects of digital media would also contribute to the learning experience, including the use of social media networks to enable advocates to connect with others who work on similar issues or face similar tactical challenges, as well as discussion forums where advocates anywhere could pose questions and get answers, thereby multiplying the thinking that goes into solving problems.

The course would build on the unique features available via the Internet to equip public health professionals with the knowledge of how to organize, strategize, and influence policy on an unprecedented scale. The course would overcome the three barriers mentioned at the beginning of this article: scale, content, and interactivity. The scale barrier would be overcome by making critically needed skills available to learners anytime, to anyone with an Internet connection. The content barrier would be conquered by employing the leading figures in each area of expertise to write the needed materials. The interactivity barrier would be broken by the very nature of online learning, which can deploy quizzes and other learner engagement devices, as well as integrated learning management systems to measure results.

We envision making the training available through schools of public health such as the Johns Hopkins Bloomberg School, where faculty are working closely with the developers of Change University on the design of the curriculum. The full 100 hours of content and interactive coursework could be available for academic credit through such schools, as well as to the general public (without the option of academic credit but with the ability to gain a certificate of completion) for free or for a nominal fee.

We are surrounded today by public health crises ranging from alcohol problems to obesity to the ongoing challenges of health care reform. Critical to success on these multiple fronts will be our ability to train legions of health professionals to advocate for change. As a field, we possess the data, the evaluations, and the frontline experience of what is most likely to work in improving the health of the public. We can bring about policies that work, if we can bring to scale the kinds of training and skills development that would be accessible in the comprehensive, on-demand, web-based advocacy curriculum envisioned here.