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John Hopkins University School of Public Health


Susan DeFrancesco, JD, MPH 
Assistant Scientist, Department of Health Policy and Management
Hampton House, Room 502
Baltimore, Maryland 21205
phone: (410) 502-8671

Course last offered: Winter 2002

Page last updated: October 29, 2008

Issues in Health Advocacy 301.645 (3 units)

3rd quarter, January 22 to March 14, 2002
Tuesdays and Thursdays, 9:00am to 10:20am
W2015 SPH


Faculty: Susan DeFrancesco, JD, MPH
Assistant Scientist, Department of Health Policy and Management
Office: Hampton House, Room 502
Phone: 410-502-8671

Shelley Hearne, Dr. P.H.
Executive Director, Trust for America’s Health
Office: 617 Water Street – Suite 317, Baltimore, MD 21202
Phone: 410-837-7350

Course Learning Objectives:

  • to understand the role of advocacy in public health 
  • to begin to develop the analytical skills of a successful public health advocate
  • to become aware of, examine, and learn to apply strategies and tools used by public health advocates

Course Format: Accomplished public health advocates who work in a variety of settings on various health topics will lecture and introduce students to a broad range of perspectives and advocacy experiences. Class discussion and exercises, group work, and mock health advocacy exercises will serve to integrate and illuminate lecture topics.

Student Requirements: Students are strongly urged to attend class and come prepared to listen, think, and participate in discussions. The grade for the course will be based on class attendance and participation (20%), three writing assignments (20% each), and participation in a mock legislative hearing (20%). Instructions for the assignments will be given in class; due dates are included in the syllabus.

Additional Opportunities: Students who would like to work with an advocacy organization for additional credit or as part of the course (class assignments would be modified to compensate for the time spent working for the organization) please see Ms. DeFrancesco ASAP. Dr. Dan Morhaim, a member of the Maryland House of Delegates, is willing to provide an "internship" experience for interested students; other placements are possible.

Lecture Topics

January 22 Introductions. Overview of course content and requirements. Class exercise on "What is Advocacy?"

Learning Objective: To ascertain a working definition of public health advocacy, and to differentiate it from public campaigns aimed at changing unhealthy or unsafe behaviors

January 24 An introduction to public health advocacy and related issues.
Susan DeFrancesco, JD, MPH

Learning Objective: To begin to gain an appreciation for the components of a public health advocacy effort and the barriers and aids to success.

Required Readings:
"The Advocacy Connection," Chapter 2 in Media Advocacy and Public Health: Power for Prevention, L. Wallack, L. Dorfman, D. Jernigan and M. Themba. Sage Publications, 1993.

First Assignment distributed - due Feb. 12

January 29 Media Advocacy
Lynn Cook, MHS, CHES

Learning Objectives: To learn what media advocacy is and understand its use as a tool for public health advocacy; to learn how to frame a media story.

Required Reading:
Media Advocacy: A Strategy for Advancing Policy and Promoting Health. L. Wallack and L. Dorfman. Health Education Quarterly. Vol. 23(3):293-317. August 1996.

January 31 Class exercise in media advocacy.

Required Readings:
"Young Boy Pulled Trigger, Killing Mother, Police Say. Bob Robertson. Pittsburgh Post- Gazette. July 23, 1994, p. B6.

"Childproof Guns" (Letter to the Editor). Susan DeFrancesco. Pittsburgh Post-Gazette. August 12, 1994.

"Parents Face a Dilemma: Custody vs. Care." William Branigin and Victoria Benning. The Washington Post. February 18, 2000, p. AO1.

"Activists: Ads tempt teens to smoke" by Phuong Ly, Charlotte Observer, 12-21-98

"Ads urge teens not to start smoking" by The Associated Press, Winston-Salem Journal, 12-22-98

"Drug Companies in South Africa Capitulate Under Barrage of Public Pressure," webplaced on Medecins Sans Frontieres website, April 19, 2001.

February 5 Building Coalitions and Using Voter Education to Implement Public Health Goals
Glenn Schneider, Deputy Director, MD Citizens Health Initiative

Learning Objectives: To further understand the components of a public health advocacy campaign, including the importance of coalition building and the use of the media; to recognize the use of voter education as an advocacy tactic.

Required Readings:
Elections and Public Health. V. DeMarco and G. Schneider. American Journal of Public Health, Vol. 90, No. 10:1513-1514. October 2000.

"Developing Effective Coalitions: An Eight-Step Guide," L. Cohen, N. Baer, and P. Satterwhite. Spring 1994. Contra Costa County Health Services Department Prevention Program.

February 7 Legislation as a Tool for Health Advocacy
Shelley Hearne, Dr. P.H.

Learning Objectives: To understand the legislative, administrative, and judicial role in policymaking; to be able to assess the advocacy intervention points in the policymaking process.

Required Readings:
The Passage of Maryland’s Gun Law: Data and Advocacy for Injury Prevention. S. Teret, G. Alexander, L. Bailey. Journal of Public Health Policy. Vol. 11, No.1. Spring 1990.

Advocating for Children’s Health at the State Level: Lessons Learned. M.E. Aitken, L.A. Rowland, G. Wheeler. Arch. Pediatr. Adolesc. Med. Vol. 155. August 2001.

February 12 Advocacy in Health Care: the Maryland State Legislature
Dan Morhaim, MD Delegate, 11th District, Maryland General Assembly

Learning Objective: To understand the legislative process in Maryland and the role of the public health advocate in policy development and political debate.

Required Reading:
Browse the Maryland General Assembly website at and Dr. Morhaim’s website at

Second Assignment will be distributed -- due February 28.

February 14 Grassroots Advocacy: Community Advocates and Public Health
Betty Robinson, Director, Community Organizing, The Citizens Planning and Housing Association
Wardie Smith, Community Organizer, Maryland Chapter of the National Council of Alcoholism and Drug Dependence

Learning Objectives: To understand the role of community organizing in public health advocacy; to gain a sensitivity to the interpersonal issues involved in working with communities.

Required Reading:
An Agenda of Substance: Grassroots Efforts to Reduce Alcohol and Tobacco Problems. Chapter 2 in Making Policy, Making Change: How Communities are Taking Law into Their Own Hands, Makani N. Themba. Chardon Press, 1999.

February 19 Class exercise to integrate new knowledge.

February 21 Should Academicians Advocate?/Advocacy in the Courtroom

Learning Objective:   To gain an appreciation for the issues that frame the debate regarding the academician’s role as advocate; to gain insight into the role of the public health professional in courtroom advocacy.

Required Readings:
So What? S. Teret. Epidemiology, Vol. 4, No. 2, p.93. March 1993. Policy Recommendations in Epidemiology Research Papers. K. Rothman. Epidemiology, Vol. 4, No. 2, p.94. March 1993.

Reflections: Testifying in the Minnesota tobacco lawsuit. J. Samet. Tobacco Control. 1999:8:101-5.

February 26 Advocacy: A Vital Element in Strategic Communication in Many Countries
Phyllis T. Piotrow PhD, Professor and Director, Johns Hopkins University Center for Communication Programs

Learning Objective: To understand the Johns Hopkins Center for Communication Programs’ approach to health advocacy and the use of the paradigm in international settings.

Required Reading:
"A" Frame for Advocacy
at (read through sections from Analysis to Continuity). Website of the Johns Hopkins University Center for Communications Programs. Also, click on "Article on Advocacy" for Some Thoughts on Advocacy for Reproductive Health Programs by Phyllis Tilson Piotrow, Ph.D; also see information about the work of the the Johns Hopkins University Center for Communications Programs.

February 28 Public Health Preparedness: Analysis of the Current Political Debate
Shelley Hearne, Dr.P.H.

Learning Objective: To better understand the technical and political aspects of a current public health issue in preparation for the course's culminating exercise.

Required Readings: 
Bioterrorism: Review of Public Health Preparedness Programs.
Testimony before the Subcommittee on Oversight and Investigations, Committee on Energy and Commerce, House of Representatives, Statement of Janet Heinrich, Director, Health Care-Public Health Issues. GAO-02-149T, October 10, 2001. Available on the General Accounting Office (GAO) website – go to , click on GAO reports, Find GAO reports, and search for the report by its number.

Bioterror An Uneasy Fit for the CDC. New York Times, Nov. 11, 2001.

Other readings may be assigned.

Assignment for Culminating Class Exercise will be distributed - due March 14.

March 5 Advocating for National Policies to Protect Consumer Safety and Health
Mary Ellen Fise, JD, General Counsel, Consumer Federation of America

Learning Objective: To comprehend the variety of tactics that are used to influence federal public health policies and the challenges involved in implementing those tactics.

Required Reading:
Selected parts of the Consumer Product Safety Act.

March 7 The Law of Lobbying and Advocacy for Non-Profits
Jon Vernick, JD, MPH, Assistant Professor, Johns Hopkins School of Public Health

Learning Objective: To better understand the important role of non-profit organizations in public health advocacy and legal limitations on their lobbying efforts

Required Reading:
Lobbying and Advocacy for the Public’s Health: What are the Limits for Nonprofit Organizations? J. Vernick. American Journal of Public Health, Vol. 89, No. 9:1425-1429. September 1999.

March 12 No class - faculty will be available in our classroom for consultation regarding the culminating exercise; classroom can also be used by students to work on their preparations.

March 14 Culminating Class Exercise - Mock Congressional hearing

Please note: This class will be held in W2008 SPH.

Additional Background Reading:
(These books are on reserve in the 9th floor library and are available for purchase from the Medical Book Store).

Public Health Advocacy: Creating Community Change to Improve Health. David G. Altman et al. Palo Alto, CA: Stanford Center for Research in Disease Prevention, 1994.

News for A Change: An Advocate’s Guide to Working With the Media. L. Wallack, K. Woodruff, L. Dorfman and I. Diaz. Sage Publications, 1999.