The Cambridge Hospital/Harvard Medical School

 

Contact:
Danny McCormick, M.D., M.P.H.
Email: danny_mccormick@hms.harvard.edu

Course last offered: Fall 2007

Page last updated:
January 28, 2010


Health Advocacy and Activism Elective
October 22-November 16, 2007
Cambridge Health Alliance/Harvard Medical School
Course Director: Danny McCormick, M.D., M.P.H.
Course Coordinators: Michael Hochman, M.D. and Mathew Watson, M.D., M.P.H.

Introduction

Despite the expenditure of vast resources on the U.S. health care system, access to medical care, particularly high quality care, is not available for large numbers of Americans, particularly for groups such as the homeless, immigrants, the incarcerated, racial and ethnic minorities, the uninsured and the poor.  Threats to the public’s health such as the toxic effects of tobacco, environmental pollution, inaccessibility of nutritious foods, violence, including war, remain substantial and take their largest toll on the most disadvantaged in society.  Global health threats such as AIDS, tuberculosis and armed conflict are rising rapidly but are not substantively addressed primarily because of commercial and political, rather than medical barriers. Physicians are often in a position identify social, political and health care system level forces that adversely affect the care of patients and can be highly effective as advocates in shaping health policy, health care delivery and the health of the public.  Yet most physicians are inadequately trained to take advantage of their unique position to promote change.

This elective is designed to provide physicians with knowledge and skills that will begin to enable them to become effective health activists. It will provide an introduction to major current health care policy issues, teach specific skill sets needed to conduct basic research and advocacy campaigns for specific proposals and provide real-world examples of research-based activism to encourage and inspire activist careers. Although participants will be exposed to multiple forms of advocacy, emphasis will be placed on research-based advocacy and activism-- the collection and presentation of relatively simple data in a format that is understandable to policy makers (institutional, local or national), government regulators, the media and the general public in order to change existing health problems and policy.

To address these learning goal, this month-long intensive course will be organized in to: 1. a series of group didactic and discussion sessions on key health policy issues and research and advocacy skills led by experts in these respective areas; and 2. a project to develop a proposal for an individual research-based activist change project by each participant that will reflect his/her own interests and abilities. At the end of the elective, it is expected that each participant will have a detailed, realistic proposal to change an existing health problem or policy and it is hoped that these proposals will be carried out.

Elective Objectives

The specific learning objectives for the elective are to:
 
1. Increase participant knowledge of:
• Foundations of political activism—what is the basis for physicians becoming activists?
• Health care financing and the proposal for a single payer health care financing system
• Current federal health policy issues and debates
• Massachusetts health and health policy issues
• Global health issues such as HIV and AIDS
• Health and human rights
• Racial/ethnic inequalities in care
• Health needs and care of the homeless
• Health and legal issues for political
• Basics of study design and biostatistics
• Data and intellectual resources

2. Increase participant skills in:
• Leadership for health care change
• Public speaking
• Media relations
• Giving interviews
• Health care lobbying
• Organizing and strategizing for political change in health
• Conducting survey-based research
• Grant writing
• Using large databases for research
• Conducting a campaign for a health care change proposal

3. Familiarize participants with different career pathways in health activism and advocacy through meeting with and hearing the personal career narratives of successful health activists and leaders.

Elective Structure and Format

This elective is a 1 month, full-time intensive experience that will take up most time not spent in clinic or in scheduled conferences. Four mornings (9:00am-12:00pm) per week (weekdays except Wednesday) will be spent in group sessions that will address the learning objectives described above.  Sessions will be comprised of didactic lectures and group discussions led by experts in these respective areas. In addition to their roles as clinicians and scientists, the speakers stress the importance of addressing the underlying social, political, and economic factors influencing health. Speakers will talk about their motivations for becoming health advocates, as well as cover advocacy skills such as strategy development and media relations. Sessions each week will also be devoted to “work shopping” each participant’s research project with experienced research mentors and all participants.  For most sessions, relevant readings will be provided in this binder.  We encourage participants to actively engage in the discussions in these sessions.  All participants and instructors should seek to learn from and teach all other participants and instructors. Most sessions will take place at the Cambridge Health Alliance campus but several will occur off campus at the speaker’s organization offices; locations are listed on the detailed schedule below. It is expected that all participants will attend all of these sessions—with absences only under very extenuating circumstances.

Another central activity of the elective is the developing a research-based health activist project that aims to change a health care issue or policy. This will be a hands-on longitudinal research experience in which participants will: 1. identify a health problem drawn from personal interest and develop a proposal for collecting and organizing data that bears on the problems and a strategy for using the research to advocate for a specific policy change that addresses the problem. Participants will have almost every afternoon and Wednesday mornings available to work on this research/advocacy project. Considerable group time will be spent working through proposals to brainstorm and provide constructive feedback.  These efforts will culminate in a brief write-up of and presentation the project by each participant. Please see section on research change project below for details.

Readings

In this binder we have provided relevant readings for most sessions as well as a collection of general readings that will be useful for health activists. 

Elective Participation

Because we invite outside speakers who are not compensated it is important to respect their commitment to our education therefore we expect that all participants will attend all of these sessions—with absences only under very extenuating circumstances.  If you cannot attend a session please discuss this with Michael, Mathew or Danny prior to the session.

Elective Evaluations

Instructors will provide feedback about the research-based activist project to participants throughout the course of the month. In addition they will complete written evaluations of each resident and medical student, based on participation and effort in completing the research-based activist project. In addition, each participant will be asked to complete a formal evaluation of the elective on the last day.

Participants will also be asked to complete a pre and post-elective survey regarding knowledge and attitudes about health activism.

Research-Based Health Activism Elective Detailed Schedule

Monday, October 22
Location: Learning Center C/D 

9:00-10:00: Danny McCormick, M.D.: Elective Introduction

10:00-11:00: Danny McCormick, M.D., M.P.H./Mike Hochman, M.D.: Selecting a Change Project

11:00-12:00: Rob Marlin, M.D. “Care of Victims of Political Violence”

Tuesday, October 23
Location: Learning Center C/D

9:00-10:00: Danny McCormick, M.D., M.P.H.: Review of Epidemiology and Biostatistics for the Activist-Researcher

10:00-11:00:  Danny McCormick, M.D., M.P.H.: Fundamentals of Study Design

11:00-12:00: Simon Ahtaridis, M.D., Attending Physician, Cambridge Health Alliance: Opportunities for Health Activist Leadership

Thursday, October 25
Location:  Learning Center C/D

9:00-10:00: Karen Weintraub, Health Editor, Boston Globe: Getting Media Interested in Health Stories

10:00-11:00: Mike Hochman, M.D.: Editorial Writing

11:00-12:00: Danny McCormick, M.D., M.P.H.: Data Sources for Activist Research  

Friday, October 26
Location:  Learning Center C/D

9:00-11:30: David Himmelstein, M.D., Steffie Woolhandler, M.D., M.P.H., Danny McCormick, M.D., M.P.H.: Research Project Workshop
!!Must have 2 research project ideas!!

Monday, October 29
Location:  Learning Center C/D

9:00-10:00:  Jim O’Connell, M.D., President of Boston Health Care for the Homeless Program: Health Care for Boston’s Homeless

10:00-11:00: Danny McCormick, M.D., MPH: Health Policy and Congress

10:45-11:30: David Bowen, Ph.D., Staff Director for Health, U.S. Senate Committee on Health Education Labor and Pensions and principal health policy advisor to Senator. Ted Kennedy: Legislative Update on Health and How Physicians Can Influence Health Care Through the Legislative Process

Tuesday, October 30
Location:  Learning Center C/D

9:00-10:30: David Himmelstein, M.D.: Single Payer National Health Insurance

10:30-12:00: Danny McCormick, M.D., M.P.H.: Federal Health Care Apparatus & Current Federal and State Health Policy Issues
 
Wednesday, October 31
9:15-11:00: Cambridge Hospital General Medicine Research Group Meeting
Location: Macht Auditorium

11:00-12:00: Robert Greifinger, M.D. – Prison Health Care Reform
Location: Private Dining Room

12:20-1:20: Danny McCormick, M.D., M.P.H.: Research Project Workshop
Location: Macht 143

Thursday, November 1

9:00-11:00: Danny McCormick, M.D., M.P.H.: Research Project Workshop
!!Must have a methodology!!
Learning Center C/D

11:00-12:00: Susannah Sirkin, Deputy Director of Physicians for Human Rights USA: Health and Human Rights Activism
Location: PHR Offices, Bow Street Cambridge

Friday, November 2
Location: Washington, DC

12:00pm- 5:00pm: PNHP Leadership Training Course Annual Meeting

7:00- :  Dinner

Saturday, November 3
Location: Washington, DC: Washington Marriott 1221 22nd Street NW

9:00am-5:00 pm: PNHP Annual Meeting

7 pm--  : Dinner

Monday, November 5
Location: Hauser Center for Nonprofit Organizations, JFK School of Government,
79 JFK St. Bennett #237, Cambridge, MA 02138, phone: (617) 384-9637

9:00-11:00: Marshal Ganz, MPA, Ph.D.- Lecturer in Public Policy, John F. Kennedy School of Government, Harvard University: Organizing: People, Power and Change

Tuesday November 6
Location: Longwood Medical Area (see below)

9:00-10:15: Jerry Avorn, M.D., Chief, Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’ Hospital: Pharmacology, Politics and Prescribing
Location: One Brigham Circle, a large brick building at the intersection of Huntington Avenue, Tremont St., and Francis St.

10:30-12:00: Joia Mukherjee, M.D., Medical Director, Partners in Health: Providing Care in Resource Poor Countries

Location: Partners In Health, 641 Huntington Ave, 1st Floor
Boston, Massachusetts 02115

Wednesday November 7
Location: Macht Auditorium

8:00-9:00: Marcia Angell, M.D., former editor of the New England Journal of Medicine. Medical Grand Rounds: The Drug Industry.

9:15-10:30: Marcia Angell, M.D.—informal discussion with activism elective participants

Thursday November 8
Location:  Learning Center C/D

9:00-12:00: Edward Downes, Ph.D., Associate Professor, BU school of Communications: Media Relations and Interviewing Skills
Friday, November 9

9:00-10:00: John McDonough
Health Care For All: Massachusetts Health Care Reform

Location: Health Care For All, 30 Winter Street, 10th floor, Boston, MA, 02108

1:00-3:00: Research Project Workshop with Danny McCormick, M.D., M.P.H., David Himmelstein, M.D., Steffie Woolhandler, M.D., M.P.H.
!!must have advocacy plan!!
@ Learning Center A

Monday, November 12

Free-time for project work

Tuesday, November 13
Location:  Learning Center C/D

9:00-10:00: Andy Wilper, M.D., Harvard General Medicine Fellow: General Internal Medicine Fellowships
Location:  Learning Center C/D

10:00-11:00: John Wolfe and John Kerzinski
CHA Office of Sponsored Research: Getting Grants to Do Your Work
Location:  Learning Center C/D

11:00-12:00: Robert J Lifton, M.D., Professor of Psychiatry, CCNY and visiting Professor of Psychiatry, Harvard Medicical School and Cambridge Health Alliance: Physicians and Torture
Location: Macht Auditorium

Wednesday, November 14

9:00-10:00: Alex Green MGH
Disparities Solution Center:
Health Care Racial Disparities: Where Do We Stand in 2007
Location: 50 Staniford Street, Boston MA. 9th Floor

10:00-12:00: 
Final Project Workshop:
Final Questions
Private Dining Room

Thursday, November 15
Location: Macht Auditorium

9:00-12:00:
Final Presentations

Friday, November 16
Location: Learning Center C/D

9:00-11:25:
Final Presentations

Research-based health activist change project

The goal of the change project is allow participants to go through each stage of the process of using research-based activism to change an existing health care problem or policy in a hands-on way and by the end of the elective, to have a clear road map for completing the project. Each participant will select a health issue or health policy that needs changing and that he/she is interested in changing. The issue could focus on a population (e.g., prisoners, Haitians in Cambridge, the chronically mentally ill), or an issue (e. g., access to care, influence of the pharmaceutical industry on prescribing) and can be local or national in scope.  Consideration should then be given to the availability of data sources that can be used to address the issue. It will require a lot of thinking to identify an issue that is important and for which data could be collected.  Much of the first week should be devoted to this task.

Once the project topic is selected, participants must consider exactly what data elements should be collected and how they will be analyzed and presented for maximal impact—what tables or graphs would you construct, for example.  Then, a clear statement of the meaning (interpretation) of the data should be developed and the argument for why the data support the need for a change in current practice or policy.  Finally, consideration should be given to how the data will be used to change current practice or policy.  This will entail creating a specific proposal for a change and then identifying potential allies and barriers to implementing the proposed change and the target audience for your work (those who can effect the change).  Participants will then need to develop a plan to advance the proposed change or bring it to fruition.

A concrete example might be identifying a problem with inadequate access to hepatitis C screening and treatment among prisoners. You might want to examine Massachusetts Department of Corrections data on how many prisoners with Hepatitis C are receiving treatment and what kinds of treatment they are receiving.  How many had biopsies?  When discharged, how many have follow up care?  You might propose a new state law that mandates Hepatitis C testing for all prisoners and referral to a hepatologist. Your target audience might be the Governor and State legislators.  Your campaign might consist of forming alliances with prison rights activist groups and the Gastroenterology section of the Massachusetts medical association and lobbying for passage of the new law. Please see tab with extensive list of examples of prior projects.

Because this project is a central part of the course, we have developed a timeline for completing the different stages of the project and all participants should meet the milestones outlined below:

Week 1 (Friday October 26th):
Present 2 solid ideas for potential research project

Week 2 (Thursday, November 1):
Present finalized research project topic
Background for project
Potential data sources

Week 3 (Friday, November 9)
Present and describe data sources
Present plan for data analysis and organization
Present plan for accessing other resources/allies
Present ideas on how to use the data to advocate for change

Week 4 (Wednesday, November 14)
Resolve remaining issue prior to final presentation 

The final 2 classes will be devoted to final presentations of projects.  Each participant will present their project to the class (and invited Department of Medicine Members) in detail for 10 minutes and then have an opportunity to answer questions from the audience.

Mentorship

There will be dedicated time each week for participants to discuss the research-bas change projects with elective faculty, however, participants are encouraged to seek out mentorship outside the elective if desired.  It may be helpful to identify an expert in the area of the change project selected to provide advice, knowledge of pertinent resources or ongoing mentorship of the project.  Potential mentors include course faculty, other Cambridge Heath Alliance faculty or Harvard Medical School Faculty at other campuses.  This is not required but can be helpful.

Readings

There are 2 books which would be very worthwhile to get for the elective and beyond.

1. Epidemeology in Medicine by Chales Henekins and Julie Buring. 1987. Publishers: Little, Brow and Company.

2. Organizing for Social Change. Midwest Academy Manual for Activists.  3rd Edition. By Kim Bobo, Jackie Kendall and Steve Max. 2001. Publisher: Seven Locks Press.

There is one other book that is a compilation of short autobiographies of successful physician activist that is interesting and inspirational but net essential to get:

The Doctor-Activist: Physicians Fighting for Social Change by Ellen Bassuk. 1996. Publishers: Plenum Press.