Physicians as Community Health Leaders
This module was developed to connect physicians with tools to assist them in working in their communities to promote policies that prevent the social, health and economic consequences of unhealthy weight and obesity.
Objectives
- Build physician capacity to engage in community-based leadership
- Address barriers to physician involvement in community-based leadership
- Provide strategies and resources to facilitate physician engagement
Introduction and Overview
What is community health leadership?
- Coordinated effort to defend, promote or protect something (a cause, a public health issue such as obesity prevention, a belief) or someone that you care about by influencing the public policy debate
- Success comes with an understanding of the process and finding an issue about which you feel passionate.
The initial focus is on obesity
Community leadership for obesity prevention includes:
- Looking at the wellness needs of the entire population
- Working with community organizations and other partners
- Understanding that the community has a role to play in the health and wellness of its residents so that healthy choices are the easiest to make
To reduceand combat obesity throughout the United States, the Surgeon General has outlined six grassroots initiatives (see resources):
- Improving our Communities
- Healthy Choices and Healthy Home Environments
- Creating Healthy Child Care Settings
- Creating Healthy Schools
- Creating Healthy Work Sites
- Mobilizing Medical Communities
Physicians as community health leaders work to: Reform public policy, create awareness and/or educate the community about risks of obesity and related diseases; work towards interim improvements and systemic solutions.
Physicians can:
- Provide credibility, influence and the ability to speak for their patients (who might be voiceless children, adults and families).
- Personalize an issue by drawing on years of experience working with patients.
- Powerful voice -- often a physician can lend his/her voice to an existing advocacy group.
Keys to successful community advocacy
- Understand the Process
- Patience and Persistence
- Communicate and cultivate relationships.
- Set interim goals and don’t expect immediate results.
- Review your specific role (i.e., you might be a spokesperson, help recruit other physicians and medical professionals to the coalition or host an event, among several activities).
- Determine your time commitment and what level of support you will need from the coalition. For example, if you are a spokesperson, you may want help drafting talking points or a letter to the editor.
- Discuss how you can promote the coalition in your practice, including posting signage or a "welcome letter" from the coalition in your waiting area or displaying coalition resources on obesity prevention (nutritional guidelines, local recreational programs, support groups, etc.)
Myths and Barriers to Engagement
- "I just can't fit anything else into my schedule."
Physicians may not have – or may not be able to carve out – time for advocacy.
Solution: Even one hour can make a difference: present at a local event or meet with an elected official - "I don’t have communication or advocacy skills and I don't have time to learn them."
Physicians may not know what skills they need or may not have those skills. - "Advocacy or speaking out is best left to a professional advocate."
Unlike clear guidelines of evidence-based clinical care, advocacy may be less defined and less concrete; physicians may not understand the problem at hand (and therefore be reluctant to participate); they may not understand what advocacy does – and does not – involve. - "Where and when does community leadership advocacy begin and what's the end game?"
Community advocacy is a process and typically includes a broader plan with specific short- and long-term goals; most community leadership is coordinated through a variety of groups. Tapping into one of those groups and adding your voice will strengthen those efforts. - "My voice won't be heard."
Physicians may be reluctant to use their professional position "outside of the doctor's office." - "I need to see the results to know that I’m using my time wisely." While it does take time to see changes in public policy starting small has its reward. The first step could be the establishment of a school wellness councilor change in vending machines at your hospital.
Get Started: Strategies and Tools
Define the problem and outline your goals
- Define the problem and support it with facts, anecdotes and "real life" examples first.
- Outline the problem broadly and then focus on your particular concern (it might be the increase in the number of students in your community who are overweight; the increase in the rate of diabetes in your community or the lack of recreational facilities available).
- What issues are currently coming up that address or worsen the problem, e.g., a proposed ordinance to build a walking trail, a proposal to cut physical activity classes, a proposed change in vending machine options in schools, a zoning issue around fast food establishments near schools.
Identify the community-specific problem
Think about your community. What specific changes or trends have you observed related to obesity prevention? For example:
- What impact does childhood obesity have on your patients?
- Has childhood diabetes increased during the last three years? If yes, by how much?
- How would you describe the health of the student population? What percent are overweight? Has that number increased or decreased in the last three years?
- How would you describe school meals? Has there been an increase in high fat, high sugar, high calorie meals? Does the school system allow soda/candy vending machines on school property?
- What types of recreational facilities – parks, pools, tennis courts -- are available – and who uses them? Are there bike lanes on roads throughout your community?
Identify your allies and target audience
- What issues does the audience care about and how can you connect your issues to theirs?
- How can you tailor your interaction/outreach to engage support?
- Would your particular ethnic background help you speak more confidently to a group with a similar ethnic background?
- Have you taken the time to listen?
- Will a particular group provide unconditional support?
- Will they support your position if they know more about it? Or is there little likelihood that the particular individual or group will accept your position?
Audiences may include:
- Elected officials (likely decision-makers)
- Community, faith-based, business and civic leaders (likely people who can influence others)
- Like-minded coalitions
- Parents (including PTAs, PTOs)
- Students
- Teachers
- Other physicians, medical professionals
- Health care facilities
- School leadership
- Homeowners (i.e., people near a proposed facility)
Potential (local community) goals
- Improve the nutritional quality of meals served at school and child care facilities.
- Remove vending machines from public schools.
- Enhance existing recreational facilities with more child-centered activities or build new facilities.
Achieving these goals might require:
- Improving the nutrition quality of school and child care meals may require an action by the local school board and the city agency responsible for child care facilities.
- Removing vending machines from public schools (through city, county or state involvement).
- Enhancing existing recreational facilities may require city or county involvement.
Create your message
Effective messages are:
- Memorable
- Persuasive
- Genuine
- Repeated (and repeated and repeated.....)
- Personal anecdotes
- Less is more
Put Your Skills to Work - The 12 Actions to be a Leader
- Be a resource. Start at your office.
- Be a champion. Lead by example: do you have a healthy lifestyle?
- Reach out to your network – offline or online. Become involved with your state medical association or specialty society.
- Plan and host an event or speak at a regularly scheduled community meeting.
- Meet with an elected official or another key decision-maker.
- Talk with a reporter. Build a relationship.
- Attend a community meeting.
- Leverage your involvement. Which professional groups are involved in similar efforts?
- Identify online resources. Sign up to receive issue alerts.
- Contribute. Contribute your time or other resources.
- Speak Up. Write a letter to the editor of your community or city newspaper.
- Make Your Case. Provide testimony at a town hall or local community meeting.
What's Your Plan?
What actions will you pursue in your community? Think about:
- Actions you can take in your office with your patients
- Actions you can take in your community
- Your first step will be
