Health Advocacy and Social Medicine Curriculum
Despite the expenditure of vast resources on the US health care system, there remain numerous challenges to the health of the public and to providing equitable and optimal health care. These include inequalities in access to and quality of care for vulnerable populations including the uninsured, racial and ethnic minorities, immigrants, prisoners, people with chronic mental illness, homeless persons and health policies and medical decision-making that are often guided by corporate and pharmaceutical interests rather than sound medical and scientific principals. 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 engage in advocacy to improve health care systems.
The health advocacy and social medicine curriculum (HASM) at CHA is designed to provide medical residents with knowledge of key health policy issues, social determinants of health, health challenges of specific vulnerable population and theoretical foundations of physician advocacy. It also provides training to develop skills to conduct health services and public health research and successfully engage in advocacy on behalf of patients and populations. It also provides exposure to successful physician activists to encourage and inspire careers that incorporate advocacy. Although many forms of advocacy exist, emphasis will be placed on research-based advocacy-- the collection and presentation of data in an understandable form to policy makers (institutional, local or national), government regulators, the media and the general public in order to influence health policy.
I. Increase knowledge:
- Health policy
- Health care financing /single payer system
- Current federal health policy debates
- Massachusetts health policy
- Health and human rights
- Racial/ethnic inequalities in care
- Medical care in resource-poor settings
- Foundations of physician advocacy
- Influences of the pharmaceutical industry
- Issues in public health advocacy
- War and public health impacts
- Basics of epidemiology and study design
- Key healthcare issues of the chronic mentally ill, hopeless persons, immigrants, racial and ethnic minorities
II. Increase skills in research methods and advocacy
- Conducting research for advocacy
- Leadership Public speaking
- Survey methods
- Media relations and interviews
- Health policy lobbying
- Using large secondary databases
III. Familiarize learners with different career pathways in health activism and advocacy through meeting with and hearing the personal career narratives of successful health activists and leaders.
One third of internal medicine residents each year (roughly equal proportions from each year of training) will participate in this year long experience such that every trainee will participate at some point in their training. Residents participating in the HASM curriculum will meet thoughout the year with experts in health policy, research methodology and advocacy in morning didactic sessions comprised of lectures, skill building sessions, case studies. Most sessions will take place on the CHA campus but some sessions will take place off campus when needed to meet with non-CHA experts at advocacy organizations, the Massachusetts Statehouse or other hospitals. These sessions occur during 2 2-week blocks (4 mornings per week), 1 in October and 1 in February. In addition, they occur every 6 weeks throughout the year.
HASM curriculum participants will also develop and conduct a research-based advocacy project over the course of the year. This will be a hands-on research experience in which participants will identify a health justice oriented problem in the health care system that needs to be addressed, (drawn from personal interest and experiences) and develop a methodology for collecting and collect and analyze data that bears on the problem. They will then develop and execute a strategy for using the research to advocate for a specific policy change that addresses the problem. Results of the research will also be prepared for publication or other public presentation.