Models of Advocacy: Theory and Practice

Semester: Year

This course explores the multiple roles health advocates assume as they create productive change on behalf of patients/consumers, families, and communities. Advocacy is practiced both by improving the way health care is delivered within existing systems and by restructuring or (re)inventing areas of the system. Throughout the year, students will be exposed to leaders who practice in diverse arenas within this interdisciplinary field, including clinical settings, community-based organizations, advocacy organizations, the media, interest groups, governmental organizations, and policy settings. They will learn to analyze organizations and communities in order to understand hierarchies and decision-making within them, and be exposed to frameworks for conceptualizing and promoting the right to health. The course will also explore strategies to give health advocates and consumers more power in making decisions, defining issues, designing programs, and developing policies. The experiences of patients/consumers/individuals, and how systems respond to these experiences, will remain a central focus as students explore concepts, models, and practices of health advocacy. As we progress through the year, students will also be challenged to begin finding their own voices as professional health advocates.

Community Health Advocacy

This two-credit “laboratory” course introduces students to the process of community health analysis. Students will complete a Community Health Profile to gain an in-depth understanding of a community in which they are interested and participate in field visits to community health centers in New York City established to meet the primary health care needs of disadvantaged, vulnerable populations. Students will develop assessment and planning skills in order to problem-solve more effectively, to improve health conditions for populations and neighborhoods, and to utilize information and research for health advocacy projects. They will study advocacy organizations and how health advocates, community-based organizations, and allied health professionals collaborate to improve health in communities. Students are required to design an advocacy project in that community and are encouraged to implement it while still students. They are also encouraged to share their profile with community leaders who have, in some past instances, used the document to make major community improvements.

Economics of Health

This course will examine the major issues facing the American health care system from an economic perspective. A wide range of topics will be covered, from the racial and economic disparities of health and health care, to the financing of the medical care delivery system. Students will learn how the tools and analytic approaches used by health economists can enhance understanding of major public health issues such as AIDS, drug abuse, and mental health, as well as key health care financing issues such as drug pricing, the rising cost of health care, and our fragmented insurance system.

Essential Advocacy Skills

This building block course is offered in various formats including workshops, course modules, guest presentations, group projects, and departmental needs. The course focuses on strategies and tools of advocacy, supplementing work in other seminars and in the field. In one section of the course, Intentional Communication, students learn to apply advocacy knowledge to advocacy work, developing strategic communications skills that allow the advocacy to choose communication techniques that fit a particular situation. This section will look at the intentionality of professional advocacy communication and build a skill set that enables advocates to reach successful outcomes. The other section, Fieldwork Seminar, focuses on the practicum/fieldwork requirement, where students have direct, hands-on work experience. This section will identify core skills necessary for fieldwork, including researching opportunities, developing appropriate goals for internships, maximizing experiental opportunities for networking and career development.

Ethics and Advocacy

This course explores a range of ethical dilemmas confronting clinicians, patients, families, and administrators arising in acute care, ambulatory-care settings, long-term care facilities, and other institutions providing health care. Included is an examination of issues such as informed consent, competency/capacity to make decisions, refusal of treatment, withholding and withdrawal of life-sustaining treatment, physician-assisted suicide and euthanasia, confidentiality, maternal-fetal conflicts and treatment, physician-patient relationships, research ethics, and implications of new genetic advances and technology. The goal is to integrate a didactic approach to the issues with the student’s own fieldwork placements and provide students with an ethical framework within which to consider dilemmas that may arise in the course of patient advocacy. In-depth discussion focuses on fundamental ethical principles of autonomy, beneficence/non-malfeasance, and justice, as well as specific legal concepts. Students are provided with a range of perspectives necessary to assess and resolve dilemmas that arise in clinical practice.

Evaluation and Assessment

This course will focus on the many uses of program evaluation for health advocates in assessing the need for and the effectiveness of advocacy, in conducting evaluations of health programs and in using evaluation results to seek changes in health organizations. Students will discuss and study the importance of evaluation, the major theoretical orientations to evaluation research and the practical, ethical, and methodological problems involved in applying research methods in health-related settings. Major topics include how to develop and measure program goals and objectives, data collection techniques, types of samples used in evaluation, and statistical and data analysis techniques. Students implement their own program evaluations and analyze data, utilizing both qualitative and quantitative techniques.

Health Care Policy

This course will examine the formulation, implementation, and evaluation of health care policy. It will focus on the interaction of the health care system with the federal, state, and local political systems. Individual pieces of health policy will be used to study the evolution of health policy and the impact of health policy on health care in the United States.

Health Law

This course covers basic health law issues and how to determine which problems should be addressed through legal means. Topics include locating legal information, corporate law as applied to health care institutions, regulation of health services, patients’ rights and related patient-care problems, legal and ethical problems of terminally ill and psychiatric patients, medical malpractice, health care reform, new reproductive technologies, fraud and abuse, health insurance legal issues, and antitrust law in health care.

History of Health Care in the United States

From colonial times, access to health care has been less a history of access and inclusion and more one of exclusion and organizing to guarantee its access to the increasingly diverse population of a growing country. In this conference-based course we will explore the varied understandings of health and medical care from colonial times to the late 20th century. Topics to be considered will include the role ethnic, racial, gender, and religious identity played in access to and provision of health services, the migration of health care from home and community — midwifery, homeopathy — to institutions — nursing, hospitals — and the social conditions that fueled that migration, the struggle for ascendancy among the different fields of medical education, and the creation of the field of public health, its role in defining and controlling outbreaks of disease and its impact on addressing inequities in access to health care services. Course participants will prepare a major research paper investigating an aspect of the history of health care of special interest to them. The conference paper will be developed through regular meetings with the instructor and in conjunction with other course participants.

Illness Narratives: Understanding the Experience of Illness

The experience of illness is both intimately personal and reflective of larger social, political, and cultural realities. In order to relate effectively and work productively with a patient, a health care advocate must be able not only to empathize, but also to interpret and understand illness narratives. In addition, advocating for patients in the modern health care system requires a real knowledge of how physicians and other health care professionals conceptualize and explain disease. This course will introduce students to published narratives of illness as well as narrative theory regarding such pathography. Students will, in addition, write their own illness narratives during the course session — exploring issues such as selfhood, perspective, memory, family, and caregiving. Finally, students will elicit, transcribe, and interpret the oral narrative of an individual with a chronic illness.

Physiology and Disease

This course provides first-time physiology students with an introductory survey of the major areas of human physiology. The focus will be the major systems of the human body. In addition to the normal physiology of the system, representative disease states will be studied to highlight what can go wrong. Special topics will include medical terminology and medical record abbreviations. Students will be introduced to diagnostic techniques such as laboratory testing and diagnostic imaging. The course includes student presentations as well as a midterm examination. (A basic human biology course is strongly recommended before taking this course for students who have not studied human biology or anatomy and physiology at a college level or beyond.)