Power, politics and persuasion : the critical friend in public health advocacy

  • Michael Moore

Student thesis: By Publication


The aim of the thesis is to share knowledge on how the public health advocate can either plan and/or evaluate public health advocacy strategies in a logical and sequential manner.
The research question my publications have addressed include:
1. How can public health advocacy be improved?
2. Will a reflective approach prior to and over the development of years of publications enhance understanding and improve practice?
3. Do the publications indicate the utility of a framework for public health advocacy actions?
The purpose of this “Critical Overview”, therefore, is to illustrate how a series of publications in peer review journals have provided a framework for developing structured efforts to provide a logical method for guidance for implementing public health advocacy action through:
(1) Planning
(2) Developing and implementing
(3) Evaluating.
The advocacy action I address in this context, is about the use of advocacy tools to influence community and government policy rather than a specific advocacy such as supporting an individual who is seeking assistance for better access to particular health services. My research has demonstrated that the key elements of advocacy to influence higher level policy change includes establishing a sound understanding and vision, and having influence through traditional and social media, building relationships and engaging with policy makers at the community, bureaucratic and political levels.
A sequential framework
A key element in the introduction of new knowledge is presenting a largely sequential framework and reflecting on the efficacy of such a framework as per PUBLICATION 2 (that will be dealt with in more details later). Those existing frameworks, as identified in the literature review, do not attempt to provide a sequential guide to planning advocacy action in health. Rather, the approach is to provide ideas or indicators of the sorts of things that have worked from time to time in advocacy action. Despite efforts to apply a more structured approach myself, I regularly found that planning campaigns involved looking at previous campaigns or copying ideas from others. Whilst this had some efficacy, it seemed to me that putting forward a carefully considered, academically sound and more structured approach for consideration by others would provide a tool that would genuinely allow for the transition from research into practice.
Justification for the research – research into practice
There is a personal and reflective element to this research proposal. As a public health leader listening at conferences and in my role as President of the World Federation of Public Health Associations it had come to my attention that an ad hoc approach to advocacy has been the hallmark of many efforts to bring about change within the public health sphere. Some advocacy efforts have been successful (Daube 2013, Chapman 2015). Many have not achieved what ought to have been possible.
As practice and reflection have been a key element in developing the sequential framework for advocacy action, it is the later publications in this dissertation that provide specific examples of the application of the framework or, more regularly, as part of the implementation of advocacy action.
Ironically, the literature review highlighted at one point the failings of my organisation, in implementing a logical and methodical process to bring about change with regard to a National Food Plan. An evaluation of the process by Carey and others (Carey et al 2015), as discussed later in the literature review, highlighted the failure of the PHAA to undertake some of the specific steps I had personally identified. The reflective process in the writing of this thesis highlighted for me the importance for practitioners to not only identify all of the steps of the Kotter Plus – a 10 Step Plan but also to apply them as part of planning and work.
There is a growing interest in improving the effectiveness of advocacy amongst NGOs. There is also a growing interest amongst academics in ‘research translation’. It is my view that the need for a wider understanding of more effective approaches to public health advocacy will assist others to reflect on this demanding, complex and multi-faceted issue and consider better methods for carrying out public health advocacy.
The phrase critical friend which I have invoked as key for encouraging a better understanding of public health advocacy, has been chosen for its dual meaning. My initial intention is to encourage people to understand the importance of maintaining an appropriate engagement, where possible, with those in power. Politicians are used to being criticised. The main role of the official opposition is to double-check, look critically and hold the government to account. A minister invariably faces a person from the opposition with the specific responsibility to criticise where possible – this is usually the shadow minister, but will also regularly include cross-bench politicians. Reflections on my own experience as a minister for health, along with discussions with other ministers, reinforced a willingness to accept fair criticism when delivered appropriately from NGOs and others in their field of responsibility.
However, when blind criticism is offered without acknowledging achievements or good intent, it simply destroys relationships and undermines the chances of a constructive approach.
The other meaning of ‘critical’, however, is also very important and can be a crucial component of advocacy. It is significant if the relationship built by a public health professional with those in power allows influence that is a key, or a critical part of the adoption of policy objectives. Understanding the exercise of power, understanding how politics works and being effective within the context of being persuasive depends on being a critical friend.
Date of Award2020
Original languageEnglish
SupervisorRachel Davey (Supervisor), Brenton Prosser (Supervisor), Katja Mikhailovich (Supervisor) & Shawn Somerset (Supervisor)

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