Abstract
Emerging professionals and new Certified Health Education Specialists often lack academic training in and actual experience in National Commission for Health Education Credentialing Area of Responsibility VII: Communicate, Promote, and Advocate for Health, Health Education/Promotion, and the Profession. For undergraduate and graduate students who have an opportunity to complete an internship or practicum experience, gaining experience in Competencies 7.2: Engage in advocacy for health and health education/promotion and 7.3: Influence policy and/or systems change to promote health and health education can have a profound impact on their career development and their ability to advocate for policies that promote health and health equity. Compelling evidence suggests that interventions that address social determinants of health such as poverty and education and those that change the context through improved policy or healthier environments have the greatest impact on public health, making it vital for emerging public health professionals to gain experience in policy advocacy and systems change. In this commentary, students and faculty from two large universities in the U.S.–Mexico border region reflect on the value of policy advocacy in academic internship/fieldwork experiences. Based on their experiences, they highly recommend that students seek out internship opportunities where they can participate in policy advocacy, and they encourage university faculty and practicum preceptors to provide more opportunities for policy advocacy in both classroom and fieldwork settings.
Keywords
Although policy advocacy experience is increasingly desired in the public health education profession, emerging professionals and new Certified Health Education Specialists often lack academic training in and actual experience in National Commission for Health Education Credentialing (NCHEC) Area of Responsibility VII: Communicate, Promote, and Advocate for Health, Health Education/Promotion, and the Profession (see http://www.nchec.org/assets/2251/hespa_sub-competencies_color_coded_3.pdf). For undergraduate and graduate students who have an opportunity to complete an internship or practicum experience, gaining experience in Competencies 7.2: Engage in advocacy for health and health education/promotion and 7.3: Influence policy and/or systems change to promote health and health education (NCHEC, 2016) can have a profound impact on their career development and their ability to advocate for policies that promote health and health equity. Compelling evidence suggests that interventions that address social determinants of health such as poverty and education and those that change the context through improved policy or healthier environments have the greatest impact on public health (Frieden, 2010), making it vital for emerging public health professionals to gain experience in policy advocacy and systems change.
In this commentary, students and faculty from two large universities in the U.S.–Mexico border region reflect on the value of policy advocacy in academic internship/fieldwork experiences.
Sue Forster-Cox, Phd, Mph, Mches: New Mexico State University
As the Field Experience Coordinator in the Department of Public Health Sciences, I work with all graduate and undergraduate public health students to help them identify a field experience site that complements their personal and professional goals and interests. Our students are earning their degrees both on campus and online; potential sites depend on where the students live or seek to complete their experience. Each year I work with 60 to 80 students, securing sites and working with them as they plan their goals and objectives for their field experience. Students tend to want to focus on infectious or chronic disease prevention or management, or may have a specific health topic in mind (e.g., obesity, HIV/AIDS, maternal and child health, substance use prevention). However, as our understanding of the role of policy advocacy in our profession has evolved, so has our awareness of the importance of preparing students to be effective policy advocates, regardless of their area of interest and expertise. Within the past few years I have had more students with an interest in or background in public health policy. As more students seek sites and experiences involving policy advocacy, I have become more aware of the diverse people and groups in our region who are addressing different public health issues through policy development, implementation, and evaluation. I share this information through the courses I teach, engaging students in projects and discussions that highlight the role of public health policy, often using local community examples. Students realize who is on the policy forefront and how they may become involved, thus building our cadre of public health professionals with a passion for health policy.
Dylan Pell, Ba: New Mexico State University
After working for years in a flawed child welfare system, I returned to school seeking better strategies to improve public health outcomes. As a dual MPH/MSW student I completed my field experience with local community organizers and later with a governmental health services agency. In both instances, my work revolved around criminal justice reform with a focus on improving outcomes for children and persons with mental illness. These experiences increased my capacity for shaping policy and working within systems of institutional power.
As a student learning about policy change, I was challenged in many unexpected ways. My duties ranged from registering new voters outside of Walmart to speaking at a public policy conference with an audience of more than a thousand people. I planned and participated in a public protest of county government officials. Later, I would be preparing materials for the county manager to present to the same community. I learned how to submit public record requests and the value of speaking directly to persons affected by the health problem. More important, I learned how powerful relationships are in shaping and improving public policy.
Through my advocacy experience, I have learned that while improving policy is very hard, it is also very possible! The realization that my participation in civil discourse can and will result in change was transformative. It was empowering to end a personal conversation with a judge or city councilwoman and see them act publically as a result of my thoughts and work. As a student, I brought what I learned back to the classroom. My application of the strategies gained from the field has contributed to changes in policy in at least three different areas of my college over the past 3 months. I continue to participate in policy discussions as a community member, and I expect to work on policy in whatever career follows graduation.
Daniela Marquez, BS: YMCA of El Paso and The University of Texas at El Paso
Prior to my undergraduate practicum in the fall of 2014, I had very little experience in public health policy. My practicum experience was through the YMCA as part of a regional initiative that aims to reduce underage drinking and alcohol related harm. I had the opportunity to research and advocate for evidence-based public health policies in our communities. The practicum led to my employment with the YMCA, where I now work full-time as a Project Manager while completing my MPH degree. As an intern, I contributed to issue briefs on alcohol policy, learned community mapping using Geographic Information Systems, and gained experience in policy advocacy, media advocacy and legislative advocacy (7.3.8; 7.3.9; 7.3.10: NCHEC, 2016). I’ve been able to share our work with colleagues at regional and international conferences including American Public Health Association, Alcohol Policy 17, and Society for Public Health Education (SOPHE). Every day I learn more about the impact that strong policies have in our communities and the importance of having more public health voices heard in the policy arena. Because of my practicum experience I developed a strong commitment to serve as a mentor to others in the profession (7.4.9: NCHEC, 2016). I have helped develop our small public health policy internship program, through which we provide a mentored practicum experience for public health students interested in creating healthier environments and improving policy to reduce alcohol and tobacco use. I’m grateful to work with the community creating a better City for our future generations, and for the opportunity to work with our emerging health professionals. As someone who has benefited from a strong practicum experience, I am committed to supporting similar opportunities for other students and to working with my colleagues to increase the availability of funded internships. This helps students who are underrepresented in our field by making academic internships more accessible to more people.
Evelyn Garcia, BS: YMCA of El Paso and The University of Texas at El Paso
I have had multiple internship experiences as an emerging public health professional. I have interned in several settings, including a university wellness center, a federal health agency, and a large community nonprofit organization. With the wellness center, most of my work focus was on education at the individual level, so I had little exposure to policy or systems change work. In contrast, my internship with the Center for Minority Veterans at the U.S. Department of Veterans Affairs in Washington, D.C., focused on social justice and the role of policy in improving health. Currently, as a public policy intern with a regional initiative focused on reducing underage drinking and associated harms, I work primarily within Area of Responsibility VII, using strategies that advance advocacy goals (7.2.5: NCHEC, 2016). I have also been involved in regional tobacco control efforts, advocating for local policies that reduce secondhand smoke exposure and improve existing clean indoor air ordinances. Like many other emerging professionals in my region, through my internships I developed relationships with other advocates and became involved in community networks and coalitions that promote policy and environmental change strategies to improve individual and community health. My career decisions have been shaped by my internship experiences such that I know I want to focus on the policy side of public health, making the healthy choice the easy choice. As a SOPHE member, I have also become active in our regional SOPHE Chapter, serving as a Graduate Student Representative. Through my mentors and other SOPHE members, I’ve heard about the Health Education Advocacy Summit and the advocacy resources available online (Health Education Advocate, 2016) and plan on attending the 2017 Summit to gain more experience on Capitol Hill. I also plan to become a Certified Health Education Specialist, and feel better prepared for the credentialing exam because of my policy advocacy experience.
Brenna Bandstra, BS: YMCA of El Paso and The University of Texas at El Paso
My practicum experience as an undergraduate in Health Promotion began on a stormy highway on the border of Oklahoma and Texas. While navigating the traffic returning to my last semester in college, I received a call from a peer who found an internship opportunity that would focus on creating healthier environments and improving local policy to reduce underage and binge drinking. After hearing more about the internship, I knew that it aligned well with my career goals. My career path was paved by my brother, who lost his life during a mental health crisis. Through my brother’s experience, I realized that there is a huge gap in mental health promotion and treatment and support for people with mental illness. Improving law enforcement, health care, and school policies would help address this gap.
My academic preparation did not include much focus on public policy, and I saw my practicum experience as an opportunity to gain much-needed experience in policy advocacy. In my first meeting with my preceptors, I shared my interest in public policy in general and mental health policy in particular. Although my practicum projects focused on alcohol and tobacco policy, my preceptors encouraged me to participate in regional mental health advocacy efforts, which helped me understand the broad relevance and usefulness of the advocacy skills I was learning. Through participation in several local policy campaigns and through research on health disparities and the consequences of inaction, I learned that policy and systems change have the greatest capacity to improve health outcomes. My experience instilled in me a tireless work ethic, a strong dose of optimism, and a passion for fighting for health equity in my community. It also motivated me to pursue graduate school, where I plan to focus on public policy.
Sophia Ornelas, BS: YMCA of El Paso and The University of Texas at El Paso
Prior to my health promotion practicum, I hadn’t been involved in policy advocacy, and was eager to gain experience in Area of Responsibility VII. For my project, I developed community outreach material about a new local ordinance and sought feedback on the materials. I became more familiar with other communication and media strategies, including press releases, issue briefs, and infographics. In another aspect of my practicum, I surveyed community members to assess support for a smokefree policy at the county level. Although the City of El Paso has a comprehensive clean indoor air ordinance and has been “out front” with policies to protect people from secondhand smoke exposure and provide affordable and accessible cessation services (Garcia, Hernandez, & Mata, 2015), the County lacked secondhand smoke exposure protection in many places. Encouraged by what I learned in my practicum, I engaged in legislative advocacy by speaking out in support of a smokefree policy, which will reduce exposure to secondhand smoke among county employees and the general public (Paso del Norte Health Foundation, 2016). My experience helped me get a job with our local health department!
Communicate, Promote, and Advocate for Health, Health Education/Promotion, and the Profession: Your turn!
Some of the students who contributed to this article sought out a practicum/internship experience with a policy focus while others landed accidentally into the policy realm. Based on their experiences, they highly recommend to other students that they seek out experiences where they can participate in policy advocacy, and they encourage university faculty and practicum preceptors to provide more opportunities for policy advocacy in both classroom and fieldwork settings. If you aren’t currently in an internship or practicum setting, here are some other ways to gain experience in policy advocacy:
Join a local community coalition or health council and get involved in local advocacy efforts
Attend a city council or county commission meeting and speak up on issue that is important to you
Volunteer with local advocacy organizations
Seek out faculty and community mentors who are engaged in policy advocacy and consider a thesis, capstone, or community service project that evaluates policy change and impact
Visit your local or state representative—they often have constituent committees that provide input on community issues and legislative priorities.
Finally, there are many opportunities to participate in student and professional organizations at local, state, and national levels. American Public Health Association (http://www.apha.org/), National Association of County and City Health Officials (http://www.naccho.org), and SOPHE (http://my.sophe.org/) all provide policy advocacy resources and ways to gain experience across the career span. Get connected, get involved, and get experience!