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Advocacy for Pediatric Environmental Health © 2014 Children’s Environmental Health Network Advocacy for Pediatric Environmental Health © 2014 Children’s Environmental Health Network

Author This presentation was developed by: Carol Stroebel Children’s Environmental Health Network “Putting it Author This presentation was developed by: Carol Stroebel Children’s Environmental Health Network “Putting it into Practice: Pediatric Environmental Health Training Resource” made possible by support from the W. K. Kellogg Foundation Image in slide #1 courtesy of Alex E. Proimos/Flickr, used under Creative Commons Attribution-Non. Commercial 4. 0 International License: http: //creativecommons. org/licenses/by-nc/4. 0/legalcode

National non-partisan science-based non-profit organization created to protect the developing child from environmental hazards National non-partisan science-based non-profit organization created to protect the developing child from environmental hazards and promote a healthy environment. Activities include: • Promote sound policies • Educate

Learning Objectives • Understand the power and responsibility you have as a health professional Learning Objectives • Understand the power and responsibility you have as a health professional to influence beliefs, behaviors and policy • Define and provide examples of advocacy • Identify steps that are critical to effective advocacy

“Politics is a crucial part of pediatrics. How else are we going to get “Politics is a crucial part of pediatrics. How else are we going to get better schools, health care for our children, and housing for their families, if not by political activity? ” — Dr. Benjamin Spock

 • Health care professionals have the responsibility to advocate for policies that improve • Health care professionals have the responsibility to advocate for policies that improve health and prevent health problems. • Expertise and professional judgment give us credibility regarding health issues in the community. • We are often welcome members of advocacy campaigns

Advocate, Advocacy advocateadvckt, n, 1: one who pleads another’s cause 2: one who argues Advocate, Advocacy advocateadvckt, n, 1: one who pleads another’s cause 2: one who argues or pleads for a cause or proposal — advocacy ad-vc-kc-s’ Examples of advocacy: • attending a hospital meeting to propose expansion of a busy clinic • encouraging a patient to stop smoking • writing to an elected official Examples of advocates: You

Children’s health is at risk from Toxicant X in your community! Response Options: A. Children’s health is at risk from Toxicant X in your community! Response Options: A. Educate caregivers on minimizing their children’s exposure to the toxicant. B. Seek changes that would reduce or ban the presence of the toxicant in the community C. Other ideas?

Primary Prevention Environmental health issues are often strong examples of primary prevention Primary Prevention Environmental health issues are often strong examples of primary prevention

Individual Advocacy Some examples: • Local health fairs • Address issues via social media Individual Advocacy Some examples: • Local health fairs • Address issues via social media platforms • Produce public service announcements (PSAs) • Articles in community newsletters and newspapers, blogs, Websites • Articles or other messages in hospital/clinic newsletters or other regular mailings • Health messages on Websites, on local radio and TV spots sponsored by hospitals, universities • Materials/videos in waiting rooms to educate patients and families • Presentations to parent groups

Group or lnstitutional Advocacy Examples of such venues: • Hospital administration purchasing or management Group or lnstitutional Advocacy Examples of such venues: • Hospital administration purchasing or management departments • School board • Parent-Teacher organization • Child care facility • Local, state or Federal transportation agency • Legislators (state or Federal) • State or Federal regulatory agencies • Advisors to an institution, such as on an EPA Science Advisory Panel or similar state or local body

Group Advocacy Key steps: • Create an environmental health committee -- community, school district, Group Advocacy Key steps: • Create an environmental health committee -- community, school district, county-wide. Members should reflect a wide range of interest and expertise • The passage of legislation and the shifting of policies requires organized group action. • Join forces with state medical and nursing organizations, environmental groups, and other concerned citizens

Seven Steps To Effective Advocacy i. What is my goal? ii. What scientific information Seven Steps To Effective Advocacy i. What is my goal? ii. What scientific information do I need? iii. What other groups or individuals are involved in this policy issue? iv. Who are the relevant decision-makers? v. Who are my potential partners? vi. How do I develop and implement a strategy? vii. How do I evaluate my effectiveness and plan future efforts?

i. What is my goal? • Not as obvious as it may sound • i. What is my goal? • Not as obvious as it may sound • Time frame: – short-term, medium range, and long-term. • Type: education, primary or secondary prevention, treatment modality • General or specific – “make our community safer for children” or “halt House Bill 1234, which will weaken our state’s environmental regulations”

Examples General goals: Decrease childhood lead poisoning in community Stem increase in asthma among Examples General goals: Decrease childhood lead poisoning in community Stem increase in asthma among youth Decrease pesticide exposure in schools Decrease childhood lead poisoning in community Decrease pesticide exposure in schools Decrease presence of pesticide X in tap water Decrease exposure to pesticide X in tap water Specific goals:

Examples General goals: Decrease childhood lead poisoning in community Stem increase in asthma among Examples General goals: Decrease childhood lead poisoning in community Stem increase in asthma among youth Decrease pesticide exposure in schools Specific goals: Test blood lead levels of all children

Group or lnstitutional Advocacy Goals (1) Some examples of goals of group advocacy efforts: Group or lnstitutional Advocacy Goals (1) Some examples of goals of group advocacy efforts: • Hospital purchasing policy to purchase local or organic foods, or recycled products • Hospital cafeteria prohibits use of plastic in microwave • School district or child care policy discouraging pesticide use and requiring advance notice of such use to parents and staff

Group or lnstitutional Advocacy Goals (2) Some examples of goals of group advocacy efforts: Group or lnstitutional Advocacy Goals (2) Some examples of goals of group advocacy efforts: • Local, state or Federal transportation agency agrees to increase funds for walkability and transit projects (local, state or Federal) • State or Federal law prohibiting toxicant X from children’s toys and products • State or Federal regulatory guidance taking children’s unique exposures and vulnerabilities into account

Setting your goal • Be clear - best if not too general • Develop Setting your goal • Be clear - best if not too general • Develop it through consensus • You may need to revisit it during the process

ii. What Scientific Information Do I Need? (1) • Find supporting information from credible ii. What Scientific Information Do I Need? (1) • Find supporting information from credible sources. • Become familiar with it. Communicate the information effectively. Develop a 30 -second to 1 minute ‘elevator speech. ’ Practice it. Why is it important to children’s health?

ii. What Scientific Information Do I Need? (2) • Generate summaries of key scientific ii. What Scientific Information Do I Need? (2) • Generate summaries of key scientific studies, written in lay terms and explaining the connection to the issue of concern. • Providing the studies themselves is less useful. • Focus on what is known about health impacts and the scope of the problem. • Avoid highly technical terms. • Include information specific to the jurisdiction of a community- or state-based effort when appropriate.

Example: The study said: “Overall postneonatal mortality rates were 3. 1 among infants with Example: The study said: “Overall postneonatal mortality rates were 3. 1 among infants with low PM 10 exposures, 3. 5 among infants with medium PM 10 exposures, and 3. 7 among highly exposed infants. ” The advocates translated that to: “The study suggests that particulate air pollution has a significant adverse impact on infants older than one month” The study supports the existing “wide variety of valid studies which underscore the connection between air pollutants and harm to children’s health. ”

iii. What other groups or individuals are involved in this policy issue? Do you iii. What other groups or individuals are involved in this policy issue? Do you know the policy landscape? Ø Current relevant debates Ø Current actors in environmental health policy related to the issue • National environmental organizations • Professional associations • Targeted organizations (e. g. , American Lung Association, National Asthma and Allergy Foundation) • State and local chapters/affiliates • Community-based organizations

Potential Partners: • Research potential organizations • Develop questions you might ask these organizations Potential Partners: • Research potential organizations • Develop questions you might ask these organizations about their involvement and position on the issue you have selected • Approach them and build relationships with them

Steps for identifying ‘front groups’ • Follow the money • Identify an organization’s source Steps for identifying ‘front groups’ • Follow the money • Identify an organization’s source of funds • Who serves on their boards/committees? What’s their history/background? What have they done in the public sector, promoting the public interest? • Who have they partnered with? • Different people have different definitions of a ‘front group’

iv. Who are the relevant decision-makers? Government Institutions Federal iv. Who are the relevant decision-makers? Government Institutions Federal

iv. Who are the relevant decision-makers? Government Institutions State • Public Health agency • iv. Who are the relevant decision-makers? Government Institutions State • Public Health agency • Counterpart to U. S. EPA • Housing • Transportation • Agriculture • State legislators

iv. Who are the relevant decision-makers? Private entities • Local business, medical center, the iv. Who are the relevant decision-makers? Private entities • Local business, medical center, the corporation operating a facility in your community • Usually do not have legal requirements on openness about making decisions, sharing information, or listening to individuals or the community. • Understanding the organization’s structure and key decision-makers is important first step

iv. Who are the relevant decision-makers? Community Organizations • Usually non-profit, low-budget groups with iv. Who are the relevant decision-makers? Community Organizations • Usually non-profit, low-budget groups with full agendas, few or no staff, few resources, and great reliance on volunteers. • Have great potential to influence. Research the mission and structure of such groups. • Do they have a board? Who is on it? • Membership? Staff? • Do they provide services? • Do they advocate or lobby? • Do they have a specific geographic focus?

v. Who are my potential partners? • • A broad-based coalition is your single v. Who are my potential partners? • • A broad-based coalition is your single most effective step. Allies may include: Elected officials Professional organizations PTAs and other groups with an interest in children Groups of concerned and vocal parents Business leaders Faith communities Unions

Finding potential partners • Identifying allies involves hard work, creativity, and persuasion. • Look Finding potential partners • Identifying allies involves hard work, creativity, and persuasion. • Look beyond the ‘usual suspects’ • Advocates are judged by the company they keep. Before signing onto a coalition letter, assess and confirm your comfort level with their reputation, credibility, and the statements made in the letter.

vi. How do I develop and implement a strategy? • You’ve defined your goal vi. How do I develop and implement a strategy? • You’ve defined your goal • You’re familiar with the policy landscape and the people and process leading to change • The next step is to design a strategy that utilizes resources, partners, and tools that are most suitable to the goal.

Examples of resources and tools Informational materials • Relevant research findings • Anecdotes and Examples of resources and tools Informational materials • Relevant research findings • Anecdotes and personal experiences • Examples from other communities, jurisdictions

Examples of resources and tools Endorsements • from organizations • from individuals, including petitions Examples of resources and tools Endorsements • from organizations • from individuals, including petitions • in the form of coalition letters, coalition advertisements, etc.

Examples of resources and tools Media efforts • Websites, Blogs • E-mails, social media Examples of resources and tools Media efforts • Websites, Blogs • E-mails, social media • Letters to the editor • Op-ed columns • News stories • Editorials resulting from visits with editorial writers • Public Service Announcements • Appearances on TV, radio, news, and public affairs shows • News conferences, News releases

Examples of resources and tools Direct contact with those whose knowledge, attitudes, and behavior Examples of resources and tools Direct contact with those whose knowledge, attitudes, and behavior you seek to change • Speeches to parents and other community groups • Rallies and other events to increase public awareness • Letters, e-mails and phone calls • Office visits with an official or staff • Asking questions at a town meeting • Attending a hearing • Testifying at a hearing

Account for opponents as well as allies Your strategies should take into account the Account for opponents as well as allies Your strategies should take into account the answers to the following questions: • “Who will oppose us, and why? ” • “Who benefits from the status quo? ” • “What are the possible barriers to success? ”

Three parts of success: Popular support Three parts of success: Popular support

Three parts of success: Popular support “Expert” support Three parts of success: Popular support “Expert” support

Three parts of success: Popular support “Expert” support Political Leadership Three parts of success: Popular support “Expert” support Political Leadership

Other strategic considerations • Timing is key. Be proactive, not reactive • Strategies must Other strategic considerations • Timing is key. Be proactive, not reactive • Strategies must be flexible • Not every act of advocacy involves a full -blown effort

vii. How do I evaluate my effectiveness and plan future efforts? Successful? Follow-up activities: vii. How do I evaluate my effectiveness and plan future efforts? Successful? Follow-up activities: • Thank partners and allies • Follow up on implementation • Assure that the victory isn’t reversed in the future; and • What next?

vii. How do I evaluate my effectiveness and plan future efforts? Not successful? Follow-up vii. How do I evaluate my effectiveness and plan future efforts? Not successful? Follow-up activities: • Again, thank partners and allies • Identify how the effort could have been improved • Rethink arguments, allies, timing and targets; and • Decide if and how to make another attempt.

Lead used in gasoline declined from 1976 through 1980 110 100 90 Lead used Lead used in gasoline declined from 1976 through 1980 110 100 90 Lead used in gasoline Gasoline lead 80 70 (thousands of tons) 60 50 40 30 1975 1976 1977 1978 Year 1979 1980 1981

NHANES II blood lead measurements found a major decline in blood lead levels 110 NHANES II blood lead measurements found a major decline in blood lead levels 110 17 100 90 Lead used in gasoline 16 15 80 14 Gasoline lead 70 (thousands of tons) 12 60 11 50 Observed blood lead 10 40 30 1975 13 9 1976 1977 1978 Year 1979 1980 1981 Blood lead levels ( g/d. L)

Next steps? • Find a mentor • Get involved in professional organizations • Review Next steps? • Find a mentor • Get involved in professional organizations • Review the resources available

Resources • Children’s Environmental Health Network www. cehn. org • American Public Health Association Resources • Children’s Environmental Health Network www. cehn. org • American Public Health Association www. apha. org • American Academy of Pediatrics www. aap. org • Alliance of Nurses for Healthy Environments (ANHE) http: //envirn. org/ • Doubt is their product, 2008 book or June 2005 Scientific American article • Alliance for Justice www. afj. org/ – Bolder Advocacy initiative (http: //bolderadvocacy. org/)

Contact Information Nsedu Obot Witherspoon, MPH Executive Director Children’s Environmental Health Network Email: nobot@cehn. Contact Information Nsedu Obot Witherspoon, MPH Executive Director Children’s Environmental Health Network Email: [email protected] org Phone: 202 -543 -4033 www. cehn. org