Advocacy is core business for those seeking to improve public health but as a field it is under-funded and under-developed.
Public health advocacy is vital for efforts to prioritise the public interest ahead of corporate and other vested interests, especially at a time when misinformation and false facts are proliferating, a number of speakers told the Congress.
However, as many presentations also made clear, advocacy is generally under-funded, under-developed and under-appreciated as a core competency for public health.
A highlight of the Congress was the Leavell Lecture on the role of advocacy delivered by Professor Mike Daube AO, Professor of Health Policy at Curtin University and an international leader in public health advocacy.
Professor Daube, who received the World Federation of Public Health Associations highest honour, the Hugh Leavell Award for Outstanding Global Health Leadership, defined advocacy as “the pursuit of influencing outcomes...that directly affect people’s lives”.
Professor Daube cited the American health and social advocate Michael Pertschuk’s observation that advocates are likely to succeed when someone, somewhere, has been made to feel uncomfortable.
As Pertschuk put it: “Advocates are unabashed tellers of truth to power… They may often be irritating and difficult, but they churn up our collective conscience and annoy us into action”.
He noted the imbalance in power between public health advocates and massive global industries that spend billions on advertising, public relations and lobbying. In one recent example involving the European Union, a tobacco company employed 160 lobbyists to work on just one campaign issue.
“By contrast,” Professor Daube said, “the number of core campaigners even in areas such as tobacco and alcohol is tiny; very few are full-time; and for most of us this work is over and above the day job.”
The need for more capacity in advocacy
Speakers called for greater investment in advocacy on a range of topics, including climate change and health, the social determinants of health, health inequalities, health in all policies, poverty, obesity prevention, violence against women, gambling, alcohol, activity, tobacco control, arms control, and gun control.
Mr Michael Moore, Chief Executive Officer of the Public Health Association of Australia and President of the World Federation of Public Health Associations, stressed the need for advocacy to be inclusive of communities and “those who miss out”.
“If you want to make a difference, empowering civil society is an important way to do it and advanced democracies would be recognising this,” he said.
Some speakers highlighted a need for greater involvement of people harmed by gambling to participate in advocacy, as their voices and experiences were often missing from public debate.
Ms Jane Martin, executive manager of the Obesity Policy Coalition, stressed that obesity advocates operated on an unequal playing field.
“We are a mosquito next to the political and economic power of the food/sugar industry,” she said. “We need to develop advocates in the community and more public health advocates.”
Ms Martin added that advocates needed to come from a wider range of disciplines, including economics and the law.
Exemplars of excellence in advocacy
Many examples of effective advocacy were profiled at the Congress, including an outstanding presentation by Dr Bronwyn King, a radiation oncologist and Chief Executive Officer of Tobacco Free Portfolios.
She provided an exemplary case study in advocacy, showing the combined power of using personal story, evidence and strategy to achieve significant change.
Dr King and Tobacco Free Portfolios are leading an international push for divestment from the tobacco industry that is targeting sovereign wealth funds, pension funds, insurers, banks, asset consultants and fund managers.
Powerful language in advocacy
In another outstanding presentation on effective communication, Dr Alessandro Demaio, a medical officer with the Department of Nutrition for Health and Development at the World Health Organization in Geneva, called for “much smarter” advocacy.
He contrasted the powerful impact of marketing language and imagery with the often-dense language of public health.
“They bring summer,” he said. “We bring a confidence interval.” Public health messages needed to be simple, relatable, positive and inclusive, he said.
Increasingly, Dr Demaio no longer speaks about non-communicable diseases or NCDs to the general public; rather than speaking about the problem, he talks about solutions that they love – like food, children and good health.
Dr Demaio also urged public health advocates to reframe their messages in language that spoke the truth about harmful corporate agendas.
Rather than talking about a “sugar tax”, he suggested highlighting the external costs of products such as sugary drinks. Their cost to consumers may be low, but their costs to society, in causing illness and harm, are enormous.
He also urged public health advocates to be more collaborative, strategic and “more passionate, focused and angry”.
“Often we are too polite,” he said. “Our planet is at a tipping point.”
Using the right language for the audience
Many other presentations also highlighted the importance of using effective language suited to the particular audience being addressed.
Dr Colin Tukuitonga, Director-General of the Secretariat of the Pacific Community, recommended using language that is explicit about who benefits from obesity and chronic diseases.
The term “lifestyle diseases” wrongly implied that people had a choice when many people, especially in the Pacific, were victims of trade agreements and corporate interests that profited from unhealthy food environments.
Other delegates suggested the need to talk about “local ecosystems” rather than “place based approaches”.
Professor Martin McKee, Professor of European Public Health at the London School of Hygiene and Tropical Medicine and Research Director at the European Observatory on Health Systems and Policies, also urged public health advocates to be reflexive about their own use of language.
This was especially important at a time of rising populism marked by “hatred of the ‘other’.”