The Case for Advocacy Curricula and Opportunities in Medical Education: Past Examples to Inform Future Instruction.

ABSTRACT: With recent advances in understanding racial, socioeconomic, and mental health issues in medicine and their relation to policy and legislation, medical professionals are increasingly involved in local and national advocacy efforts. At the frontlines of these initiatives are medical students who, in addition to completing required coursework and clinical training, devote themselves to serving patients through civic participation. The burgeoning evidence concerning health care disparities and inequity, along with greater awareness of racial and socioeconomic discrimination, have made advocacy an essential aspect of many students' medical training. Every year, thousands of medical students join national medical advocacy organizations, in addition to regional, state, and local groups. Despite the rich history of medical student involvement in advocacy, there remains much speculation and skepticism about the practice as an essential component of the medical profession. From early initiatives pushing for national health insurance after World War II to encouraging antidiscrimination policies and practices, medical students have been collectively working to create change for themselves and their patients. Through efforts such as banning smoking on airplanes, creating safe syringe programs, and protesting against police brutality, many medical students work tirelessly in advocacy despite minimal educational support or guidance about the advocacy process. Given that medical student advocacy continues to grow and has shown measurable successes in the past, the authors believe that these efforts should be rewarded and expanded upon. The authors examine historical examples of medical student advocacy to suggest ways in which advocacy can be integrated into core medical school curricula and activities. They call attention to opportunities to support students' development of knowledge and skills to facilitate legislative change, expansion of interprofessional collaborations and credit, and curricular updates to promote social and health equity.

An Organ for My Child: Public Appeals for Limited Resources.

The case of Jamie Fiske and subsequent public appeals for particular children by President Ronald Reagan represent classic cases in pediatric bioethics in which parents or others publicly appealed for a donor organ for a particular child. These raise questions about the appropriate boundaries for public appeals for a limited resource for a particular child and how the press and medical community should respond to such appeals. Public appeals by parents to advocate for their child to receive a limited resource above others promote rationing by morally irrelevant factors and shift the public focus from the national shortage of organs for transplant to the needs of a particular child. Yet these appeals are understandable and will likely continue. Recognizing this, we consider appropriate responses by the media, transplant community, hospitals, and individual clinicians.

Twenty-Five Years of Research and Advocacy on Violence Against Women: What Have We Accomplished, and Where Do We Go From Here? A Conversation.

This article is a conversation between two academic experts, Callie Rennison and Nikki Jones, who endeavor to sum up what has been accomplished in eliminating violence against women in the United States during the 25 years of the journal's existence. Domestic violence, rape, and sexual harassment are discussed. Although prevalence rates are down in domestic violence, rape and sexual harassment remain persistent problems. Looking at violence against women from an analysis of President Trump voters in the 2016 U.S. presidential election, Rennison and Jones observe the extent to which the current ideas and attitudes of women-both young and old-will need to change before violence can be eliminated. Rather than viewing events in the United States as totally negative, they see them as presenting new opportunities for greater understanding of violence against women and for new methods of prevention and perpetrator accountability.

Envisioning Future Directions: Conversations With Leaders in Domestic and Sexual Assault Advocacy, Policy, Service, and Research.

This article delves into the views of 72 leaders in domestic violence and sexual assault advocacy, policy, service, and research to determine their vision for the future direction of the field. Through discussions with experts, we identified numerous strategies necessary to best meet the needs of domestic violence and sexual assault victims. Common themes focused on the need to (a) examine the context of victims' and offenders' experiences; (b) increase cultural competence to adequately provide appropriate victim services and criminal justice responses for underserved, marginalized, and culturally specific populations; (c) increase reliance on victims' voices; (d) continue to develop partnerships at both the community and the state levels and ensure the role of local communities; (e) expand the concept of successful outcomes that can be reliably and validly assessed; (f) emphasize mixed-methods approaches to address these questions, in recognition that various methods complement each other; and (g) be open to novel or emerging approaches to intervention.

Health advocacy in nursing: contribution to the reorientation of the Brazilian healthcare model.

Inequalities are the result of the different positions held by individuals in different social spaces, and are related to the distribution of power and property. Health advocacy is a strategy to reduce such inequalities, especially those considered unfair and unnecessary, aiming to fully promote the right to health. This study aims to discuss the contribution of nursing in the field of health advocacy, which includes the right of everyone to a healthy life as one of the strategies for the reorientation of the Brazilian healthcare model.

Ethical Framework for Risk Stratification and Mitigation Programs for Children With Medical Complexity.

Those in hospitals and health care systems, when designing clinical programs for children with medical complexity, often talk about needing to develop and implement a system of risk stratification. In this article, we use the framework of an ethical evaluation of a health care program to examine what this task of risk stratification might entail by identifying specific and detailed issues that require particular attention and making a series of recommendations to help ensure that programs for children with medical complexity avoid potentially ethically problematic situations and practices.

Addressing Social Determinants of Health Through Advocacy.

The social determinants of health (SDOH) are receiving increased attention due to their influence on health disparities, health outcomes, and overall quality of life. Nurse leaders must take an active role in advocating for strategies that address these important issues. The purpose of this descriptive study was to explore nurses' knowledge, attitudes, and behaviors related to SDOH. A sample of 107 registered nurses completed the SDOH survey. Findings revealed that nurses experience personal discomfort and anticipate patient discomfort related to addressing the SDOH in their practice. They also voice a lack of skill, lack of time, and a dependency on other professionals to address these issues. The findings highlight the need for nurse leaders to advocate for nurses and those they care for through policy development, collaboration, and education. Based on the findings of this study, multiple strategies for nurse leaders serving as advocates are presented.

LGBT Older Adults and Nurse Administrators: An Opportunity for Advocacy.

One of the greatest health care challenges of the 21st century is the rapidly growing number of older adults in the United States. This aging population is also becoming increasingly diverse, and with this diversity comes an increased number of older adults who identify as lesbian, gay, bisexual, and transgender (LGBT). The needs and health outcomes of this specific subgroup of the older adult population cannot be extrapolated from the more general population of older adults. Nurses have the opportunity to lead health care providers in improving care for this vulnerable and sometimes invisible population. Leading this charge will require nurse executives who advocate, create care environments that are inclusive, and staff with nurses who can care for the specific needs of LGBT older adults. The purpose of this article is to raise awareness of the health needs of LGBT older adults and identify how nurse executives can advocate to improve care for this overlooked population.

Health advocacy in nursing: contribution to the reorientation of the Brazilian healthcare model / Defensa de la salud en enfermería: la contribución para la reorientación del modelo asistencial en Brasil / Advocacia em enfermagem: contribuição para a reorientação do modelo assistencial no Brasil

ABSTRACT Inequalities are the result of the different positions held by individuals in different social spaces, and are related to the distribution of power and property. Health advocacy is a strategy to reduce such inequalities, especially those considered unfair and unnecessary, aiming to fully promote the right to health. This study aims to discuss the contribution of nursing in the field of health advocacy, which includes the right of everyone to a healthy life as one of the strategies for the reorientation of the Brazilian healthcare model.

RESUMEN Las desigualdades son el resultado de las distintas posiciones ocupadas por los individuos en distintos espacios sociales; y son relacionadas a la repartición de poder y de propiedad. La defensa de la salud es una estrategia para la reducción de tales desigualdades, principalmente, las consideradas injustas y desnecesarias. Con el objetivo del alcance pleno del derecho a la salud, el presente estudio pretende discutir la contribución de la Enfermería en el campo de la defensa de la salud, en el cual se incluye el derecho de todos a una vida saludable, como una de las estrategias para reorientación del modelo asistencial en Brasil.

RESUMO As desigualdades são resultado das distintas posições ocupadas pelos indivíduos em diferentes espaços sociais; e são relacionadas à repartição de poder e propriedade. A advocacia em saúde é uma estratégia para a redução de tais desigualdades, principalmente as consideradas injustas e desnecessárias, com vistas ao alcance pleno do direito à saúde. O presente estudo pretende discutir a contribuição da Enfermagem no campo da advocacia em saúde, no qual se inclui o direito de todos a uma vida saudável, como uma das estratégias para reorientação do modelo assistencial no Brasil.

Setting the global health agenda: The influence of advocates and ideas on political priority for maternal and newborn survival.

This study investigates a puzzle concerning global health priorities-why do comparable issues receive differential levels of attention and resources? It considers maternal and neonatal mortality, two high-burden issues that pertain to groups at risk at birth and whose lives could be saved with effective intrapartum care. Why did maternal survival gain status as a global health priority earlier and to a greater degree than newborn survival? Higher mortality and morbidity burdens among newborns and the cost-effectiveness of interventions would seem to predict that issue's earlier and higher prioritization. Yet maternal survival emerged as a priority two decades earlier and had attracted considerably more attention and resources by the close of the Millennium Development Goals era. This study uses replicative process-tracing case studies to examine the emergence and growth of political priority for these two issues, probing reasons for unexpected variance. The study finds that maternal survival's grounding as a social justice issue spurred growth of a strong and diverse advocacy network and aligned the issue with powerful international norms (e.g. expectations to advance women's rights and the Millennium Development Goals), drawing attention and resources to the issue over three decades. Newborn survival's disadvantage stems from its long status as an issue falling under the umbrellas of maternal and child survival but not fully adopted by these networks, and with limited appeal as a public health issue advanced by a small and technically focused network; network expansion and alignment with child survival norms have improved the issue's status in the past few years.

Clinical Community Psychology: Reflections on the Decades Following Swampscott.

The Swampscott report was foundational, but in some ways reflected divisions within community psychology that have continued into the present. Community psychologists trained in the 1970s and, especially, the 1980s confronted a period where the original focus of community mental health began to have less influence in the mental health field due to a variety of public policies, and the growth of third party payments as a significant source of health care funding. Programs that engaged communities and provided a base for prevention interventions were greatly curtailed because of changes in federal legislation and limited opportunities for state and local funding, although prevention interventions found growing interest from research funders. Clinical and community psychologists who trained in this period increasingly looked to a variety of areas outside of mental health. Consequently, the field of community psychology has become more applied and less academic, with increased attention to advocacy, theory, and global perspectives. The sweep of these changes and their implications for the future of the field are discussed here.