March 23, 2017

Advocacy in Medicine

Advocacy in Medicine: A Necessity in the Post-factual World

Too often in academia, we spend significant amounts of time reading about, discussing, and listening to lectures on the foremost challenges impacting our world today. And while this process is educational and informative, there remains one lingering question – So, what are we going to do about it?

More importantly – what can we, as individuals, do about it?

Let me tell you about my path to action and why advocacy is important in medicine and public health today.

It was a Thursday morning in the middle of August. I was sitting in my Public Health Policy class at the Bloomberg School of Public Health. Our guest lecturer was Sir George Alleyne, Director Emeritus of the Non-communicable Disease (NCD) Alliance and former director of the Pan American Health Organization (PAHO). He stood before the class of 250 students and began a large-group discussion on the burden of non-communicable diseases (NCDs) globally. The next hour was different than the majority of our lectures, no PowerPoint slides to be found.

While listening to my classmates describe the variety of factors contributing to the growing burden of NCDs, I heard them share cross-cultural stories. NCDs impact people from all walks of life, regardless of their heritage, gender, or educational level. We discussed how cardiovascular disease is the #1 cause of morbidity and mortality globally, how the vast majority of deaths caused by NCDs are preventable, how social determinants of health affect health outcomes, and how low- and middle-income countries are disproportionately affected.

NCDs are “silent killers” and account for 38 million deaths annually. They are often less visually and emotionally relatable compared to a patient with Ebola or a newborn with Zika. This may account for the relatively minimal attention that NCDs receive in the media, and more importantly, in global funding. To me, this is unacceptable and irresponsible.

After class, a small group of students approached our lecturer to continue the conversation.

I remained in my seat, feeling unsatisfied. This lecture, like many before, was undoubtedly compelling, but it was not action-oriented. The challenge of NCDs was too important of an issue for me to walk away. Fortunately, I was not alone.

After speaking with Sir George, one of my classmates and I were inspired to start a chapter of the Young Professionals Chronic Disease Network in Baltimore (YP-CDN Baltimore). Our goal was to organize the student body and local professionals to advocate for the health of marginalized populations whose lives were negatively impacted by NCDs and whose voices were not being heard.

With overwhelming support from colleagues and friends, we have spread the word and actively engaged over 100 graduate students in medicine, nursing, law, and business. We picked an important advocacy issue – the rising cost of prescription drugs – and joined a local, diverse grassroots coalition led by the Maryland Citizens’ Health Initiative (MCHI) to advocate for the Prescription Drug Affordability Initiative, a bill that will be introduced before the Maryland State General Assembly on January 11, 2017. Through this effort, we aim to start bringing transparency to cost of the prescription drugs and to facilitate discussions about affordability.

This story is just one in the grand scheme of advocacy. Furthermore, I strongly believe that all health care professionals and students are in a unique position to recognize the suffering and inequity their patients face and to act on it accordingly.

You undoubtedly have, or will in the future, come across patient stories and circumstances that capture your attention.

This may include the 45-year-old construction worker who cannot afford his insulin, the 22-year-old college student struggling with opioid use disorder and looking for medical help, or the 60-year-old grandmother with heart disease who is unable to afford healthy food. There are countless stories, and often, similar themes emerge over time.

Despite this, the underlying structural and policy issues impacting our patients frequently go unnoticed for some time. This is not surprising, considering the increasing pressure we face with less time per patient, more time devoted to documentation, and lower reimbursement rates. It is tough. But…

We can do better. And frankly, we must do better.

Regardless of your thoughts on the recent presidential election, one thing remains constant – physicians are respected members of society. People listen when we speak. We have a powerful platform that can benefit our patients and society at large. This is a strength we should take advantage of!

I understand that some of us may not want to engage with lawmakers, government officials, or local health leaders. We may not care to do so. We may not have the time to do so. Nevertheless, it is important to recognize that these individuals are often the ones who make decisions on behalf of all of us.

In the policy world – not having an opinion about a particular issue publicly is interpreted as support for the status quo.

Therefore, if lawmakers and government officials are poorly informed about the challenges our patients face, then they are less likely to act favorably in that regard. Moreover, they may act in a way that compromises the situation even further.

This is precisely why your voice is powerful.

One of the most compelling things you can do is tell a story. This includes stories about your patients and their tribulations, stories from your experience in delivering health care, and stories you have heard from colleagues. Stories are a goldmine and they capture the attention of legislators, helping them to connect with important issues afflicting those they represent.

I believe the first step for us, as health care providers, is to start talking about the issues and organizing ourselves through local and statewide organizations. That puts us on the path to bringing about change. Often, working locally is the most rewarding. Of course, there is much more to it than that. I cannot overstate the importance of building a grassroots coalition and partnering with local organizations on a core issues. This lends greater credibility and social power, and it is one of the reasons why the Maryland Citizens’ Health Initiative has been a successful coalition over the last two decades.

And success is achievable. Don’t take my word for it, just look around.

For example, Project Access of Durham County (PADC), an independent nonprofit that provides free specialty care to uninsured Durham residents living below 200% of the federal poverty line, was formed in 2006 due to the strong advocacy efforts of four local organizations. The Partnership for a Healthy Durham, Durham CAN (Congregations, Associations, and Neighborhoods), Latino Community Credit Union, and Durham Health Partners recognized the need to improve access to health care for low-income uninsured Durham County residents. Together, they engaged key stakeholders, searched for an effective solution, and founded PADC. This remarkable local program was the result of hard work from a diverse group of organizations, and the current board of directors includes professionals trained in business, law, medicine, nursing, and social work.

Together, we too can channel our voice, and the voices of our patients, to achieve meaningful change and ultimately improve the health of our population. Join the movement by talking with your colleagues about key local issues and reaching out to your local professional society.

Hussain Lalani is a medical student (MS3+) at Duke School of Medicine and a current MPH student at Johns Hopkins Bloomberg School of Public Health. Portions of this piece were previously published in a blog post for Young Professionals Chronic Disease Network, entitled “Breaking the Mold and Taking Action,” written by Mr. Lalani (Available at: