Working with Community CoalitionsWorking with Community Coalitions

J. Gary Wheeler, MD, MPSJ. Gary Wheeler, MD, MPS

Little Rock, ArkansasLittle Rock, Arkansas

Goals and Objectives Goals and Objectives • Goal:

– Appreciate the complex structure of community behavioral change and the role of community advocacy

• Objective:– Describe how physicians can collaborate with

community coalitions to influence tobacco prevention and control policy

How things happenHow things happen

• By choice

• By fiat/force

• By incentives

• Uncontrolled events

ChoiceChoice

Washing clothes

Fiat/forceFiat/force

SpeedLimits

IncentivesIncentives

Tax Code

Social Change: Ecologic ModelSocial Change: Ecologic Model

MD RN

Models of policy changeModels of policy change

• Outside initiative model– NGOs (policy entrepreneurs)– Bring pressure on policy makers

• Mobilization model– Government leaders who define terms– Seek broad support

• Inside Access Model– Those with easy access to policy makers– Slip in specific laws under the radar

Advantages/DisadvantagesAdvantages/Disadvantages

• Inside Access Model– Efficient for technical issues; undemocratic,

unsustainable

• Outside Access Model– Populist; cost and effort are huge

• Mobilization Model– Model of government; popularity/leadership of

the governmental leader

The overlooked factor: The overlooked factor: communitycommunity

So, polls really are important

Benefits and Challenges of Coalitions

• Benefits– Strength in numbers– … relationships– ….diversity– ….resources

• Challenges– Autonomy– Different Goals– Efficiency

Steps to Coalition Success

• 1.Clarify/reaffirm vision & mission • 2.Create ownership of coalition • 3.Solidify coalition infrastructure & processes• 4.Recruit & retain active, diverse membership• 5.Develop transformational leaders • 6.Market your coalition• 7.Focus on action & advocacy• 8.Evaluate your coalition

Why do coalitions need physicians?

• Most people trust their health care professionals• Established, credible members of communities

with significant influence• We represent strong political allies (AMA, AAP,

etc)• We are the final word on the health science of a

public debate• We have personal contact with patients and can

tell their stories

Why physicians?

• We are often the only advocates for patients

• We may have more freedom to speak compared to others

Effective interactions

• Attendance

• Contribute (resources)

• Help connect

• Schmooze

• Accept role as an equal partner

• Eye on the prize

Engage other physicians

• Professionals• Create a “deeper story” by consolidating data

from the clinical/patient perspective and community perspective

• Have a defined role for their participation. Have a realistic “ask” of them that builds off of their skills and talents.

• Be respectful of time constraints. Health care professionals are often juggling clinical care, academic work, after-hours call, administrative responsibilities, and family time.

Most important lessonsMost important lessons

• Remember to say thanks