In the Classroom: Translating Passion into Action.
“Advocacy is like a baby crying in church,” Harold Cox said to the collected students. “She knows she needs to communicate with Mom to get what she wants, and Mom is interested in helping the baby and giving her what she needs—but she also sees all of these people trying to strain their necks to look back at her.”
Identifying a need and the decision-maker who can make it happen, and targeting that decision-maker with a proven, attention-grabbing strategy—that’s advocacy, Cox told the students in the MPH core course PH718: Leadership and Management for Public Health. For one week, Cox, associate dean for public health practice and director of the Activist Lab, and Anne Fidler, assistant dean for public health practice, rotated through each MPH core course to teach an advocacy primer, a condensed version of the advocacy bootcamp regularly put on by the Activist Lab.
The class broke into smaller groups and began by choosing sides on an issue: Legalize recreational marijuana? Increase funding for HIV prevention? Require sex education in all junior high schools? Once they had their position, each group defined the problem they wanted to fix, why it mattered, and what should be done.
Next, the groups identified the decision-makers who could bring about those changes and discussed strategies to engage them. “You need to be at the table and hang out where the decisions get made,” Cox said. “You can’t just say, ‘I’m interested in this, but I’ll let someone else do it.’ You need to be at the table or it won’t happen.” The groups also discussed those who might be opposed to such change.
Cox shared a story from his time as the chief public health officer for Cambridge, where he led the process to make Cambridge a non-smoking city. He recalled identifying the one tie-breaking vote on the city council, and all of the efforts to appeal to—and pester—her. He described how advocacy across city lines undermined the argument that Cambridge bars and restaurants would lose smoking patrons to other Greater Boston cities. Still, he warned, “Rarely does anything happen all at one time.” Efforts in Cambridge began in 1975, he said, and a ban on smoking in bars and restaurants wouldn’t successfully pass until 2003.
Students next came up with potential partners in their efforts, and coalitions they could join or create to help their goal. The groups then planned out what actions they would take. For good measure, Cox played School House Rock’s “I’m Just a Bill,” reminding the students of each legislative step needed to create policy.
Finally, with all of the factors in place, the students formed their final arguments and prepared to present them as testimony for a mock government hearing. Cox shared his first time testifying before Congress: “I remember them saying, ‘Mr. Cox,’ and I said, ‘Mr. Chair,’ and then I don’t remember anything else,” he said. He read the transcript later, “and luckily I didn’t embarrass myself,” but he had learned the importance of rehearsing, of keeping testimony short, of speaking slowly, and of making the point clear.
Word choice, Cox said, is also key to creating effective messages: “Illegal versus undocumented, pro-life versus anti-choice, Obamacare versus Affordable Care Act.” Likewise, some people will respond to the idea of fairness, while others will be more moved by economic arguments. “Both of these kinds of people exist, and you need to be able to appeal to them,” he said.
Just before the mock testimony began, Cox threw the students a curveball: “There’s been an emergency, and the person in your group who was going to testify can’t make it to the hearing. Pick someone else.”
Each student who eventually testified had 90 seconds to make their case. One student argued for sex education in all junior high schools, pointing to rising rates of STIs and framing a yearlong course as an investment in a lifetime of healthy choices. Another fighting for a decrease in HIV prevention funding suggested redirecting resources to mental health and addiction programs, folding HIV prevention and care into wider efforts that could have wider benefits. One student made a creative case for why prisons could benefit from making recreational marijuana available to inmates, while another pro-marijuana group pushed a gradual agenda of legally classifying marijuana as less dangerous than other controlled substances.
Cox played the part of difficult audience member, knocking things off his desk and stepping out in the middle of one testimony to talk with someone in the hall. “You just kept going!” he said when the testimonies were finished. “That’s great. You need to be ready for anything.”
After the class, Cox explained why this advocacy primer had been added to the core MPH courses. “Our students frequently tell us that they want to be on the front lines,” he said. “We wanted an activity that would allow all of our students to get the same core information about how you make a change, and what factors and skills are needed to make that change.”
Brian Danner, one of the students who argued for sex education, said the value of gaining these skills was clear. “When we go into public health, we’re going to be the change in the world,” he said. “It starts with us, and it starts in the classroom.”
Another student, Mackenzie Hine, said she also enjoyed seeing a smart, driven, but often quiet classmate get up—in that last-minute switch—and give testimony. “So often people have this passion but they don’t know how to translate it,” she said. “It’s great to get these tools.”