Transcript Health Services Research with Adolescents

Successful Physician Advocacy
Jonathan P. Winickoff, MD, MPH
Associate Professor in Pediatrics
Harvard Medical School
April 26, 2013
…dedicated to eliminating children’s
exposure to secondhand smoke and tobacco
AND
…ensuring that all clinicians ask the right
questions about tobacco and secondhand
smoke exposure
Objectives
• Understand one general approach to use at
any advocacy level
• Understand importance of local practice
and community level for building state and
national change
• Hear from you about harnessing your
special role as a clinician
Scientific
Knowledge
Social
Strategies
Political
Will
Comparative Causes of Annual
Preventable Deaths in the United
States
430
450
400
(thousands)
350
300
250
200
150
112
81
100
50
0
41
30
Suicide
Alcohol
Motor
Vehicle
19
Homicide
Induced
14
Drug
Obesity
Smoking
Sources: (AIDS) HIV/AIDS Surveillance Report 1998; (Alcohol) McGinnis MJ, Foege WH. Review: Actual Causes of Death in the United States. JAMA 1993; 270:2207-12;
(Motor vehicle) National Highway Transportation Safety Administration, 1998; (Homicide, Suicide) NCHS, vital statistics, 1997;
(Drug Induced) NCHS, vital statistics, 1996; (Smoking) SAMMEC, 1995
Scientific Knowledge:
Critical Known Data
•
•
•
•
•
Stop sale of tobacco in pharmacies
Make cars smokefree
Make multi-unit housing smokefree
Link parents to quitlines at the child visit
Raise tobacco purchase age to 21
Scientific Knowledge:
Critical Known Data
• The clinician can authoritatively deliver the
critical known data to the appropriate audience to
make change
• People trust pediatricians
• When so much in this world involves money—
Pediatricians have nothing to gain except better
health for children and families
Why Local Level First?
• You understand it best
• You have the greatest chance of having
influence
• You can work out the kinks in your plan
• You can speak about your experiences and
develop anecdotes to use at all other levels
Tobacco 21
• 80-90% of adult smokers started before the
age of 18—high school is where smoking
starts
• Lester Hartman
Bonus Material: Tips and Tricks
Anecdotes
• Anecdotes can be a powerful way to make
your point
• Work them in with the scientific knowledge
During the smokefree public
housing debate in Maine, this
anecdote about a patient with CF
was used. Maine is first state with
universal smokefree public
housing!
Bonus Material: Tips and Tricks
Press and Media
• Press and media can be your friend
• Thirdhand smoke appeared on the Today
Show and suddenly people are aware of a
tobacco control issue in a new way
Bonus Material: Tips and Tricks
Do Something
•
•
•
•
•
•
•
•
•
Write effective letter or email
Phone call
Persuade others to contact representatives
Get out the vote
Contributions to candidates
Meet your representative
Testify at a public hearing
Protest/march
Run for office
Bonus Material: Tips and Tricks
How you say it matters
•
•
•
•
Get your story straight
Never, ever make up an answer
Work hard/be nice (don’t be righteous)
Learn how to negotiate (don’t view
people with polarized lenses)
• Always say thanks
Bonus Material:
Final Thoughts
• Dream the Impossible, but work in the
realm of the Possible
• Sometimes losing is better than winning
• Never negotiate with the tobacco
industry
• Work with the pros for legislative goals
• Assume someone has tried what you are
trying and can teach you something
Scientific
Knowledge
Social
Strategies
Political
Will