Foreword: Child Advocacy in Action xv
Tina L. Cheng
Advocacy within Healthcare
Child Advocacy in Action: If Not You, Who? If Not now, When? 1
David M. Keller
The notion that the physician has a responsibility to both the patient in their care and the community in which they reside has been a source of inspiration and tension within the profession for centuries. The profession of Pediatrics has uniquely incorporated advocacy into its training programs and will likely continue to incorporate advocacy into its professional standards for the foreseeable future. In this article, we review the history of advocacy within the profession, outline the skills needs for successful child health advocacy and offer examples of how advocacy combined with pediatric practice has improved the lives of children.
Advocacy in Pediatric Academia: Charting a Path Forward 11
Abby L. Nerlinger, Debra L. Best, and Anita N. Shah
Pediatricians are effective advocates to improve the health and well-being of children, yet there are limited avenues by which to pursue academic promotion based on these activities. Drawing on an expanded definition of scholarship, pediatric advocates can use the portfolio format to highlight the quantity, quality, and impact of advocacy activities. True congruence with research and education will only be achieved through recognition and value by institutions and organizations.
Making Advocacy Part of Your Job: Working for Children in Any Practice Setting 25
Lee Savio Beers, Melinda A. Williams-Willingham, and Lisa J. Chamberlain
Effective child health advocacy is an essential strategy to improve child health, and can improve access to equitable care. It can also be professionally rewarding and improve career satisfaction. However, while advocacy has been a part of pediatrics since its origins as a specialty, many barriers to engaging in health advocacy exist which can be challenging to navigate. There are a wide range of organizational practice settings, which are each accompanied by unique strengths and limitations. No matter the practice setting, pediatricians can be effective advocates for child health through leveraging organizational, professional, and community resources and partnerships.
Advocacy in the Community
Community Engagement: How to Form Authentic Partnerships for Lasting Change 35
Sara M. Bode
Pediatricians play a critical role in promoting child health through community engagement, yet the skills required to be effective leaders and advocates alongside the community are often not the focus of traditional medical training. The American Academy of Pediatrics Community Pediatrics Training Initiative provides faculty and resident training, curricula, and collaboratives to teach the core skills needed for upstream interventions that can affect the entire population of a community. Core skills include community assessment and competence, composed of data, observational, and experiential components. The work of community action begins to effect system-level change for sustainable, impactful improvements in child health.
Community Advocacy in Pediatric Practice: Perspectives from the Field 43
Karen Camero and Joyce R. Javier
Pediatrics is a specialty that is grounded in advocacy, possibly more than any other field of medicine. Infants, children, and adolescents depend on others to cover their basic needs including food, shelter, and education and rely on proxy voices to speak out on their behalf. In this article, we describe the importance of community advocacy in pediatrics, best practices for training pediatricians in community advocacy, and case studies to highlight trainee experiences and demonstrate how community advocacy and community-based participatory research can be incorporated in the career of a pediatrician.
Advocacy on the State Level
Making Maternal Child Health a Population Health Priority in Maryland 53
Tina L. Cheng
This case study illustrates state legislative advocacy in action in Maryland. Success in strengthening maternal and child health is described using the Academic Pediatric Association’s 4-step approach to advocacy: (1) Identify the Issue and Target Audience; (2) Craft the Message; (3) Develop Relationships and Coalitions, and (4) Communicate the Message. Starting with state legislation and formation of a Maryland Maternal Child Health Task Force led to maternal child health named as 1 of 3 state population health priorities. This guided subsequent programmatic investment and attention. Further dissemination of task force recommendations has led to additional supportive legislation.
Firearm Injury Prevention Advocacy: Lessons Learned and Future Directions 67
Deanna Behrens, Maya Haasz, James Dodington, and Lois K. Lee
Injuries and deaths due to firearms in children and young adults is a public health crisis in the United States. Pediatric clinicians are powerful advocates to reduce harm due to firearms. By forming coalitions with legislators on a bipartisan basis, working with government relations teams in the hospitals, and partnering with community allies and stakeholders, pediatric clinicians can work to enact legislation and influence policies at the individual, state, and national levels. This can include advocacy for strengthening Child Access Prevention Laws and firearm safer storage campaigns.
Advocacy on the Federal Level
Inclusion of Children in Clinical Research: The Role of Advocacy and a Personal Journey 83
Scott C. Denne, James Baumberger, and Lynn Olson
Many groups have historically been excluded from clinical research. It has required vigorous, long-term advocacy efforts for better inclusion of women and children across racial and ethnic groups. To understand who is included in clinical research, data are required. A personal journey of advocacy requiring the National Institutes of Health to report inclusion in clinical studies by age was ultimately accomplished by federal legislation.
Child Health Advocacy: The Journey to Antiracism 91
Joseph L. Wright and Tiffani J. Johnson
The last several years have seen accelerated activity and discourse directed at antiracism. Specifically following the 2020 murder of George Floyd, institutions across the country engaged in a range of introspective exercises and transparent reckonings examining their practices, policies, and history insofar as equity and racism is concerned. The authors of this article, both active protagonists in this domain, have been, and continue to be, part of ongoing national efforts and have learned much about the strategies and tactics necessary to initiate, engage, and sustain traction on the path to antiracism.
Advocacy for Unaccompanied Migrant Children in US Detention 103
Paul H. Wise
During 2021, nearly 150,000 unaccompanied children (UCs) were apprehended at the US–Mexican border. Most are leaving Guatemala, Honduras, and El Salvador, motivated by poverty, climate change, and violence. UCs are most often apprehended by the Border Patrol and then transferred to the Office of Refugee Resettlement (ORR), the Department of Health and Human Services. ORR is responsible for ensuring that the child is released to a parent or sponsor in the United States capable of providing an adequate home. Advocacy must not only address a complex system of legal and custodial care but also confront a troubled political environment.
Global Child Advocacy
Advocacy for Global Tobacco Control and Child Health 117
Felicia Scott-Wellington, Elissa A. Resnick, and Jonathan D. Klein
Tobacco and secondhand smoke remain leading threats to public health. Evidence since the 1950s has shown that the tobacco industry has acted in bad faith to deceive the public about the health effects of smoking. They have specifically targeted vulnerable populations including children and adolescents with various—and often misleading—marketing efforts and promotions. The increased popularity and weak regulation of electronic cigarettes have created a new generation of smokers who mistakenly believe they are “safer” from harm. Continued research, advocacy, and government action are needed to protect public health. Public health advocates must know the evidence, build coalitions, and prepare for industry countermeasures. Persistence is key, but public health efforts have successfully decreased tobacco-related deaths.
The Pediatrician’s Role in Protecting Children from Environmental Hazards 135
Leonardo Trasande and Christopher D. Kassotis
Children suffer disproportionately from disease and disability due to environmental hazards, for reasons rooted in their biology. The contribution is substantial and increasingly recognized, particularly due to ever-increasing awareness of endocrine disruption. Regulatory actions can be traced directly to reductions in toxic exposures, with tangible benefits to society. Deep flaws remain in the policy framework in industrialized countries, failing to offer sufficient protection, but are even more limited in industrializing nations where the majority of chemical production and use will occur by 2030. Evidence-based steps for reducing chemical exposures associated with adverse health outcomes exist and should be incorporated into anticipatory guidance.
Advocacy to Action
Translating Research into Child Health Policy: Aligning Incentives and Building a New Discourse 151
Christian D. Pulcini, Jean L. Raphael, and Keila N. Lopez
Research has led to major achievements in public policy and child health. Despite the gains, the need for research to inform policy remains paramount against a backdrop of inadequate public health investments, health inequities, and public skepticism toward science. However, the translation of research into child health policy has often been slow due to misalignments in incentives between researchers and policy makers and a paucity of conceptual models to inform translation. This article outlines barriers to translation, provides examples of discordance between evidence and policy, summarizes models to inform translation, and offers strategies to improve translation of research to policy.
Effective Communication for Child Advocacy: Getting the Message out Beyond Clinic Walls 165
Perri Klass, Nia Heard-Garris, and Dipesh Navsaria
Clinicians who want to communicate child advocacy messages, stories, and arguments can draw on their clinical and scientific experience, but effective communication to wider––and nonmedical––audiences requires careful thought. We discuss choosing and honing the message, developing writing and speaking skills that fit both the exigencies of the chosen medium and format, including op-eds, essays, social media, public testimony, and speeches. We provide guidance on proposing articles, working with editors, shaping language and diction for a general audience, and drawing on clinical experiences while respecting confidentiality. all with the goal of effective communication, spoken and written, in the service of children and child advocacy
Going Farther by Going Together: Collaboration as a Tool in Advocacy 181
With greater understanding of the impact of social determinants on child health, advocacy has become essential to promoting children’s health, particularly at the population level. Successful advocacy requires coalition building. Steps on how to create a productive coalition, including the selection of partner organizations, understanding how these groups enhance your activities, and strict definition of assigned roles is reviewed. Examples of successful coalitions are reviewed. A list of potential partners, who focus on various aspects of child health, is provided.
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