Health advocacy

Abstract

ABSTRACT: In the medical profession, activities related to ensuring access to care, navigating the system, mobilizing resources, address-ing health inequities, influencing health policy and creating system change are known as health advocacy. Foundationalconcepts in health advocacy include social determinants of health and health inequities. The social determinants of health(i.e. the conditions in which people live and work) account for a significant proportion of an individual’s and a population’shealth outcomes. Health inequities are disparities in health between populations, perpetuated by economic, social, and polit-ical forces. Although it is clear that efforts to improve the health of an individual or population must consider “upstream”factors, how this is operationalized in medicine and medical education is controversial. There is a lack of clarity around howhealth advocacy is delineated, how physicians’ scope of responsibility is defined and how teaching and assessment is con-ceptualized and enacted. Numerous curricular interventions have been described in the literature; however, regardless ofthe success of isolated interventions, understanding health advocacy instruction, assessment and evaluation will require abroader examination of processes, practices and values throughout medicine and medical education. To support the instruc-tion, assessment and evaluation of health advocacy, a novel framework for health advocacy is introduced. This frameworkwas developed for several purposes: defining and delineating different types and approaches to advocacy, generating a“roadmap” of possible advocacy activities, establishing shared language and meaning to support communication and collab-oration across disciplines and providing a tool for the assessment of learners and for the evaluation of teaching and pro-grams. Current approaches to teaching and assessment of health advocacy are outlined, as well as suggestions for futuredirections and considerations.