Reducing poverty, eliminating hunger, expanding access to health care: These goals are some of a public health leader’s top priorities. Public health leaders strive to protect and promote healthy communities through many means — and they cannot do so without advocacy. Advocacy refers to the many ways that individual people and groups contribute to the creation of new laws, practices, and policies.
Public health advocacy requires many skills beyond public health expertise, including knowing how to do the following:
- Develop and implement advocacy programs
- Empower communities to advocate for their own health needs
- Navigate public health advocacy challenges and limitations
How to Advocate in Public Health
Advocacy starts with understanding a problem and rallying others to help address it. In a nutshell, here are the broad steps involved in advocacy, including public health advocacy:
- Identifying an issue
- Collecting data and stories about the issue
- Researching current policies that affect the issue
- Analyzing the issue from multiple stakeholders’ perspectives
- Communicating the nature and scope of the issue
- Building a coalition to address the issue
- Generating a policy plan to address the issue
- Pushing for policy change
- Passing a new policy
Advocacy in Action: Understand a Problem
When engaging in public health advocacy, leaders start by analyzing a complex situation — such as opioid overdoses, homelessness, vaccine hesitancy, or environmental pollution — then dive into the data and communal experiences that can illuminate the scope and nature of the problem at hand.
Often, this involves learning about the policies that already attempt to address this issue — and any existing policies that exacerbate the issue.
Consider the example of opioid overdoses, a public health tragedy that is often preventable. Some current public health policies help save lives by making rapid treatment for opioid overdoses more widely accessible, such as city and state policies that encourage police and fire departments to carry naloxone (a lifesaving medication that reverses overdoses) when responding to emergency situations.
Other public health laws can be a hindrance. For example, many states still require individuals to have a prescription to access naloxone, which leads to preventable overdose deaths when emergency professionals do not arrive on the scene soon enough.
Many public health leaders argue that states should eliminate the state laws that require prescriptions for naloxone — especially since the Centers for Disease Control and Prevention (CDC) describes naloxone as “easy to use and small to carry” and notes that “there are two forms of naloxone that anyone can use without medical training,” including an injectable medication and a nasal spray.
By succeeding in getting naloxone prescription laws overturned, advocates could pave the way for more individuals to acquire naloxone (especially the easy-to-use nasal spray form) over the counter and administer it in the event of an overdose.
Advocacy in Action: Form a Coalition
Once a public health advocate understands an issue, they must assemble a network of people who are willing to take action. That is, they need allies.
A coalition is an alliance of different individuals and groups that join forces to advance a specific change. Coalitions are crucial for conducting advocacy work because public policy creation takes resources that individuals and smaller organizations may not have alone.
Coalitions can be made of different stakeholders — people with different interests, incentives, and attachments to different aspects of an issue or its consequences. For example, in combating the opioid epidemic, public health leaders may form coalitions with individuals and organizations in health care, social work, law enforcement, community mental health, and harm reduction services as well as public health.
Coalition members rarely agree on everything, so gaining consensus is a largely impractical goal. Instead, advocates working in coalition with other advocates must often collaborate and find compromise when defining a specific policy path. Effective coalitions rely on listening, finding common ground, and being willing to continue pushing for policy change over long periods of time.
Advocacy in Action: Set Strategic Goals
Diverse coalitions need to set strategic policy goals and create a plan to meet those goals. For example, public health leaders trying to address the opioid epidemic are well aware of how public misconceptions about opioid drug use pose a major barrier to passing public policies to protect people experiencing overdoses. To address this, public health leaders could (and have) pushed to educate the public about overdoses as a public health issue rather than a criminal issue, setting goals to raise awareness.
Advocacy strategies often have four components:
- Identify a target audience.
- Create a realistic plan.
- Craft key messages to persuade the target audience.
- Develop a communication road map to deliver key messages.
Successful public health advocacy also requires tracking and monitoring progress on the way to achieving policy objectives. This involves evaluating successes and failures, overcoming setbacks, and responding to changing conditions to seize new opportunities as they arise.
Public Health Advocacy Examples
To better understand it in action, consider the following public health advocacy examples:
Examples of Public Health Advocacy in Law
Public health advocacy often involves influencing legislators to get them to change public policy. Leaders from various public health movements have used advocacy to promote public health research, change minds, and ultimately pass policies that make our nation safer and healthier.
Although seat belts were introduced as potentially lifesaving tools in the 1930s, many Americans continued to die preventable deaths due to injuries sustained in motor vehicle crashes that could have been avoided by wearing a seat belt. Seat belt use rose from 11 percent in 1981 to 90 percent in 2021, according to the U.S. Department of Transportation.
Advocacy was responsible for this surge in seat belt use. Public health leaders advocated:
- Educating the public about safety risks associated with not wearing a seat belt
- Passing state laws mandating the use of seat belts
Smoking tobacco was the leading cause of preventable death in the U.S. in 2022, according to the CDC. Given that the tobacco industry spends billions of dollars each year on marketing, and an estimated 1,600 youth try nicotine for the first time each day, tobacco-related health problems and mortality continue to be top public health issues.
To address these issues, public health leaders promote policies and programs such as the following:
- Studying cigarette smoking habits and the factors that contribute to smoking use, including the use of electronic cigarettes and smokeless tobacco
- Promoting preventive measures to combat tobacco marketing and stop tobacco use before it begins
- Creating smoking cessation programs based on empirical research
Examples of Public Health Advocacy in Health Care
Public health advocacy leaders note that health outcomes are often the result of environmental, economic, social, and political factors that go far beyond individuals’ choices to eat healthfully, exercise, and get routine check-ups.
Addressing Heart Health Inequities
Heart disease remains the leading cause of death for all adults in the U.S., with one person dying every 34 seconds from a heart-related disease in 2022, per the CDC. Adults from the Latino and Black communities experience even higher rates of heart disease than their white counterparts, according to findings from the Racial and Ethnic Approaches to Community Health (REACH) program. Meanwhile, according to the CDC, less than 3 percent of all state public health budgets go toward chronic disease programs, like those addressing heart disease.
Public health leaders are taking multiple actions to prevent and control chronic diseases and protect heart health:
- Creating racially competent public health communications kits to educate the public about heart disease risks
- Calling for increased funding for public health programs that address heart disease
- Reducing health inequities through specific policies, such as those promoted by Million Hearts, a federal initiative led by the CDC and the Centers for Medicare and Medicaid Services (CMS) and WISEWOMAN (Well-Integrated Screening and Evaluation for Women Across the Nation) created to provide outreach to marginalized groups
Addressing Black Maternal Mortality
Black mothers in the U.S. are around three times more likely to die in childbirth than white mothers, even when adjusting for factors such as access to prenatal care, according to the American Public Health Association.
In response, public health leaders at the CDC are creating impact reports and recommendations for groups to address systemic racism and other social factors that influence maternal health:
- Calling on medical systems to address unconscious bias in health care
- Evaluating and improving prenatal and postpartum care delivery
- Promoting economic equality, transportation access, and stable housing
Leadership in Public Health
Public health leaders have important decisions to make about how to advocate for the health policies and practices needed in their communities. Two common public health approaches to advocacy involve leading from the top down as experts and leading from the bottom up as instigators who empower communities to become their own public health advocates. Effective leadership in public health means knowing when and how to adopt each advocacy approach to get results.
Public health leaders sometimes need to leverage their expertise. For example, an expert on public health interventions related to breastfeeding will have years of experience and evidence to draw upon when considering which best practices to begin with when crafting a new breastfeeding policy proposal.
When public health leaders act as experts, they ground their work in research. Some public health leaders are experts in conducting relevant research.
Experts attempt to identify the best ways to improve the lives of different populations and communities. But, sometimes, public health leaders need to empower communities to cultivate grassroots efforts to change public health policy for the better.
Enhancing Collective and Community Impact
Rather than adopt an expert-led policy agenda, sometimes public health leaders will get better results by encouraging and supporting community-led initiatives. People from vulnerable groups, such as people experiencing homelessness and people from immigrant and refugee communities, have traditionally been excluded from collaborative advocacy projects.
Public health leaders can create and secure funding for localized projects to bring communities together to discuss and act on the issues affecting them. Working alongside community health advocates, for example, community members may reveal they have needs for resources that public health leaders were unaware of.
Why Is Leadership Important in Public Health?
Public health problems tend to be systemic and complex — which is why leadership is important. Public health issues may require multipronged solutions and years of ongoing advocacy to address.
Forming Coalitions Is Challenging
To advance public health policies, public health leaders need to create coalitions. But coalitions are, by nature, made up of different people and organizations that may disagree on key issues. Public health leaders are crucial for forming alliances between and across disparate groups to achieve policy goals that could not be reached otherwise.
Changing Public Opinion Takes Time
Public policy changes do not happen overnight. Change typically requires sustained effort over months, years, or decades.
The scientific process on which public health policies and practices are built takes time: designing experiments, securing funding, carrying out research, publishing findings, and communicating those findings to a broad audience of nonexperts is time- and resource-consuming. This does not even begin to cover the advocacy work of generating best practices and building coalitions to support specific policy changes.
Public health needs leaders that will shepherd policy proposals from idea to action — all while overcoming challenges, addressing setbacks, and changing strategies as needed. Because changing public opinion (and changing law) takes so long, the public health advocacy field needs leaders who are willing to devote their efforts long term.
Achieving Health Equity Is Complex
Healthcare disparities present challenging issues within society. To make lasting changes, public health needs forward-thinking leaders who understand health equity.
Public health equity is not simply equal treatment for everyone. Equity means that different groups may need different interventions or support due in part to persisting structural injustices, such as racism and sexism.
Public health policy must take into account social determinants of health (SDOH). The SDOH framework stipulates that environmental, social, and political factors influence health outcomes. The nonmedical factors that can influence individuals’ health include:
- Financial security
- Home, environment, and neighborhood safety
- Governmental policies
- Social prejudices
- Adverse childhood experiences (ACES)
- Access to healthy food
The social determinants of health have a major effect on the likelihood of needing healthcare services, according to the World Health Organization. Marginalized individuals, families, and communities often experience worse health outcomes due to these larger social forces.
Public health leaders understand that organizations must consider the SDOH or risk failing to achieve health equity.
Be an Advocate for Your Community With a Career in Public Health
Public health advocacy is challenging yet deeply rewarding work. It involves marshaling multiple stakeholders, creating new alliances, crafting strategic messages to diverse audiences, and researching the policies and practices that will actually make our communities safer and healthier. Does public health advocacy call you?
Ambitious public health professionals who want to be advocates working for healthier communities should consider an advanced education, such as Tulane University’s Online Doctor of Public Health (DrPH) in Leadership, Advocacy, and Equity. Pursuing a DrPH program can help potential and existing leaders gain the expertise and hands-on training they will need to pursue a career path that promotes public health and equity.
Learn more about how to become a public health leader.
Guide to a Career in Public Health Research
Why Racism Is a Public Health Issue
Advocacy for Public Health Policy Change: An Urgent Imperative, “Health Equity Depends on Advocating for Public Health Policies”
American Heart Association, “A Public Health Action Plan to Prevent Heart Disease and Stroke”
American Journal of Public Health, “Racial and Ethnic Disparities in Maternal Mortality in the United States Using Enhanced Vital Records, 2016-2017”
American Journal of Public Health, “Toward a New Strategic Public Health Science for Policy, Practice, Impact, and Health Equity”
American Public Health Association, Advocacy for Public Health
American Public Health Association, Health Equity
American Public Health Association, Health Reform
American Public Health Association, Speak for Health
Centers for Disease Control and Prevention, Heart Disease Communications Kit
Centers for Disease Control and Prevention, Working Together to Reduce Black Maternal Mortality
Centers for Disease Control and Prevention, Fast Facts and Fact Sheets, Smoking and Cigarettes
Centers for Disease Control and Prevention, WISEWOMAN
Change Lab Solutions, “Public Health Advocacy: The Basics”
Health Affairs, “Public Health Advocacy Must Be Taught”
Million Hearts, About Million Hearts® 2027
The Network for Public Health Law, Q&A: Strengthening Public Health Advocacy
Oxford University Press, “Public Health Advocacy” in The New Public Health Law