Describe levels of advocacy in the care of underserved and vulnerable communities.
Illustrate ways health professionals can engage in advocacy.
Provide a menu of activities for community advocacy.
Michael lives with his family in North Richmond, California, a city with five oil refineries. His 6-year-old daughter has been to the emergency department three times in the past few months for respiratory complaints, as have many of her classmates at school. Michael’s bronchitis has been lingering for quite some time and last year he had a heart attack. The refineries are known to release high levels of air pollutants including carcinogens and chemicals that cause respiratory and neurologic problems. Michael suspects that the pollution spewing from the refineries contributes to illness in the community. Michael’s wife is pregnant and he worries about harmful effects of the pollution on his unborn son. Because North Richmond is his home and he cannot afford to live anywhere else, Michael feels frustrated and helpless.
The term “advocacy” often conjures images of rallies, marches, and protests. But at its core, advocacy is an activity on someone else’s behalf directed toward a specific goal. For the health professional, the “goal” and the “someone” are clear: a better state of health for patients.
Medical professionals’ obligation to advocate for their patients is often conceived as a fundamental professional duty. Entrusted with the details of patients’ life, their hopes, and concerns, medical providers are obligated to use this intimate knowledge to their patients’ benefit. Although doctors, nurses, and other health professionals engage in daily advocacy on behalf of their patients (for example, helping patients obtain medications or disability benefits), aspirational definitions of physician, and other health professional roles include not only the promotion of the health of individual patients but also of society as a whole.
In its Declaration of Professional Responsibility, the American Medical Association declares, “humanity is our patient.” Physicians are asked to pledge to “… respect human life and the dignity of every individual; … and to … advocate for social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being.”1 The American Nursing Association likewise defines nursing’s role as “… alleviation of suffering …, and advocacy in the care of individuals, families, communities, and populations.”2 In this chapter, we focus on these broader community and population advocacy efforts, explore the roles clinicians can play, and present practical advocacy tools.
TYPES AND LEVELS OF ADVOCACY
Clinician advocacy starts with providing care that integrates the full spectrum of a patient’s needs. Examples include helping patients navigate complex health care systems, asking pharmacies and insurance companies to cover specific medications, and referring patients to social service agencies.
Advocacy at the individual patient level is a core component of every provider’s professional obligations. However, ...