Community Health Advocacy This page intentionally left blank Community Health Advocacy Sana Loue, J.D., Ph.D., M.P.H. Case Western Reserve University Cleveland, Ohio Linda S. Lloyd, Dr.P.H. Alliance Healthcare Foundation San Diego, California and Daniel J. O'Shea San Diego County Office of AIDS Coordination San Diego, California KLUWER ACADEMIC PUBLISHERS NEW YORK,BOSTON, DORDRECHT, LONDON, MOSCOW eBookISBN: 0-306-47824-2 Print ISBN: 0-306-47390-9 ©2002 Kluwer Academic Publishers NewYork, Boston, Dordrecht, London, Moscow Print ©2003 Kluwer Academic/Plenum Publishers New York All rights reserved No part of this eBook maybe reproducedor transmitted inanyform or byanymeans,electronic, mechanical, recording, or otherwise, without written consent from the Publisher Created in the United States of America Visit Kluwer Online at: http://kluweronline.com and Kluwer's eBookstore at: http://ebooks.kluweronline.com Preface Health professionals are often confronted with situations that demand change including, for instance, a community's or population's inability to access adequate health care, or the need for a disease-specific preven- tion program where one does not exist, or a lack of understanding on the part of legislators as to the economic and noneconomic impacts of a partic- ular disease or condition. In each such instance, advocacy may be required to move beyond the status quo. The form that the advocacy efforts take, however, may necessarily depend upon the specific issue at hand and the context in which the situation has arisen. This text provides a foundation for the initiation of advocacy efforts and for the evaluation of their success. Chapters 1 and 2 provide a frame- work for advocacy efforts through an exploration of what it means to be, and to work with, a community, and how the needs of a particular community may be assessed. It is critical to remember that, oftentimes, multiple strategies must be utilized simultaneously in order for advocacy efforts to succeed; accord- ingly, six chapters focus on specific strategies that can be utilized in an advocacy effort. Chapter 3, which addresses grassroots advocacy efforts, provides an overview of various theoretical models and numerous real- life examples of how grassroots efforts are organized. Chapter 4 continues to address community-wide advocacy issues through an exploration of the formation and development of coalitions. Chapters 5,6, and 7 explore advocacy efforts in the more structured realms of legislatures, adminis- trative agencies, and courts, while Chapter 8 focuses on media advocacy. Chapters 9 and 10 challenge the health professional engaging in advocacy efforts to establish a mechanism by which to judge the success of those efforts in terms of their outcomes and in terms of their solutions to the moral dilemmas that have been posed during the process. Each chapter v vi PREFACE concludes with one or more case studies, with discussion questions, and with a list of references. We have drawn these chapters from our collective experience as re- searchers, health professionals,health advocates, and health program fun- ders and from the many questions that have been posed to us in these capacities. This text is intended to provide both practical and theoreti- cal guidance to health professionals and students who advocate for the protection, enhancement, and restoration of community health. Acknowledgments The authors gratefully acknowledge the helpful review and critique of earlier versions of this manuscript by Dr. Siran Koroukian, Dr. Ruth Lyn Riedel, and Nancy Mendez. Gary W. Edmunds and Nancy Mendez of Case Western Reserve University and Katherine Silver of Alliance Healthcare Foundation deserve praise and thanks for their time and diligence in lo- cating needed materials.Mariclaire Cloutier of Kluwer Academic/Plenum Publishers deserves praise, as always, for her insightfulness and support. vii This page intentionally left blank Contents Chapter One Defining Community 1 Sociology 3 Psychology 6 Anthropology 7 Communitarian Philosophy 7 PublicHealth 9 Defining Community in Practice 10 Syringe Exchange in San Diego County, 1998–2001 10 Discussion Questions 13 References 14 Chapter Two Assessing Community Needs and Framing Issues 17 Definitions 17 What Is “Need”? 19 Conducting a Needs Assessment 19 Framing the Issue 29 Case Study 30 Discussion Questions 34 References 35 Chapter Three Organizing Community: Grassroots Activism 37 Basic Concepts and Definitions 37 Theoretical Models of Community Organizing 40 Community Mobilization 43 Strategies for Community Organizing and Mobilization 44 The Cycle of Organizing and Mobilization 48 ix