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  • Advocating for Occupational and Environmental Medicine: An IOMSC Toolkit for Occupational Medicine Societies

    1 Background
    Occupational medicine (OM) societies, in all countries and regions, have unique opportunities to take forward the mission of their organization by taking part in effective advocacy. All societies, no matter what their philosophy or size, may benefit from a basic understanding of the principles of advocacy. You will also need to recognise that the scope of activity will be tailored to your resources and to particular institutional arrangements within your country. The potential benefits of advocacy are substantial. These benefits may include: 
    • increasing resources for occupational health overall, helping to build the case for an OM model, especially in areas where OM it is not well understood;
    • carrying out needed improvements in policies and practices;
    • increasing your profile among other health professionals, the public, the Government and influential groups; and
    • drawing attention to specific problems faced by the working population at the worksite and in the communities where they live. 

    The purpose of this document is to describe the basic elements of advocacy, that might be common to all OM societies, and to describe some basic approaches, techniques and activities that may be particularly effective. (Attached to this document is a series of appendices that provide more detail, in a step-by-step fashion, that may describe how you may continue to develop and fine-tune your advocacy efforts.) 

    We believe that advocacy is important, not only in achieving any particular goal or policy aim, but also that, over time, advocacy efforts can help educate the public as to the critical role that OM plays in: 
    • improving the health and well-being of workers; 
    • making sure workplaces are safe; and 
    • protecting the environment. 

    While we are aware that many of our member societies already take part in active advocacy, we also believe that there is room for substantial expansion, especially at the more local level. For example, a study by the American College of Occupational and Environmental Medicine (ACOEM) in 2012 showed that of its local (state-based) societies, only 38% had given comments to a state regulatory agency in the past year, and only 15% reported having met a government official. Yet it is precisely those important issues that are best, or perhaps even only, dealt with using advocacy programs. To help encourage more active advocacy efforts, as part of our program of activity, we keep a list of advocacy activities that member societies are encouraged to contribute to, and from which to draw.

    If you are planning advocacy activities, you should be aware that states and countries may often put limits on the amount of advocacy that can be carried out by a medical society based on their incorporation or tax status (or both). Some might note specific and important differences between what is commonly considered ‘advocacy’ and those activities that may be considered formal lobbying. Before beginning any type of advocacy campaign, it is important that you understand these limits, get legal advice as appropriate, and prepare your activities accordingly.

    2 What Is Advocacy?
    Advocacy can be defined as a broad set of activities organized ‘to influence policymakers to design, adopt, and put in place or change policies and practices’. Policymakers may be within the public or private sectors and can be on any level (for example, a state or local area, ministry of health, a national parliament, a multilateral agency or any other type of organization). Basically, advocacy is the act of identifying a problem, and constructively taking part in a series of activities designed to influence decision-makers to move toward another more appropriate policy. Advocacy will usually include important elements of:

    • campaigning – speaking publicly on an issue with a view to generating a response from a wide audience;
    • educating and informing – promoting awareness and understanding of issues from the occupational medicine viewpoint to those in a position to make a difference; and 
    • contacting those who make laws for the purpose of influencing a specific piece of legislation. 

    Generally speaking, you should see advocacy as a long-term process. Effective advocacy needs a well-planned approach. One-shot attempts to tackle issues are unlikely to be effective. You will become more successful in advocacy as you gain more experience and sophistication, recognizing along the way that any one particular effort may, or may not, achieve the immediate goals. 

    3 Models of Advocacy
    When considering developing an advocacy program, you have two approaches to consider. 
    1. The ‘build it yourself model’ where you alone choose your priority issues, create and support your own ability to directly communicate with the main constituencies, and make your case to the most influential policymakers. 
    2. The ‘alliance model’ where you invest in developing a partnership, or a coalition, of multiple and probably larger medical societies and work within that partnership or alliance to include your message in a broader framework. 

    There are advantages and disadvantages to each approach. 

    Under the "build it yourself model," some of the advantages include:
    • you have complete control over your messages and how you might choose to communicate those; 
    • you have the ability to ‘scale up’ or ‘scale down’ depending on your resources and yearly budget cycles; 
    • you have complete control of the specific issues you choose to advocate for; and
    • there is the opportunity to create your own identity and brand. 

    If you choose this approach, you might encounter legal restraints, find your efforts too costly, find it difficult to maintain continuity with your own leadership changes, and be challenged to show consistent results. 

    Some advantages of the alliance model would include: 
    • lower overall costs (as costs are being shared among many societies); 
    • access to more information as there are more organizations involved in gathering it; 
    • the opportunity to more fully inform other members of the partnership about the specialty of OEM. When a wide range of different interest groups agree and work together on a given issue, the message is often more compelling. 

    Some disadvantages might include the time and costs of investing in long-term relationships; costs may be fixed (in other words a fee to join the alliance) and not be affected by annual budget variations; and as one voice of many it may prove challenging to gain maximum attention and the focus of policymakers on the most important issues. These two basic approaches are not mutually exclusive and effective models have been developed where you can include elements of each approach, depending on your strategic assessments and resources. (See Annex 1 Choosing the most appropriate method for advocacy.)

    4 Philosophy and Framework — Getting Organized
    4a Philosophy 
    In approaching your advocacy work, you should have an overall philosophy that will characterize your efforts. You can take a critical approach or a collaborative, encouraging approach. In practice, advocacy work can combine the two to a greater or lesser extent, for example, highlighting the inadequacies of specific policies and practices, and also suggesting alternatives that would have more desirable effects. Taking a collaborative and supportive approach has, in general, been considered to be the most effective approach. 
    The way in which you deliver an advocacy message can also take different approaches. The first is through direct communication (for example, talking privately to the policymakers and practitioners) and the second through campaigning, using the mass media to attract public attention to the issue. Again, in practice, much advocacy work uses a combination of both approaches. Content, style and method of delivery will vary between and within organizations according to the targets and circumstances of the specific issue being dealt with. However, most organizations will find a model within this range that best suits the nature of the organization. For all organizations, whatever approach is preferred, professionalism and respect are crucial.

    Whichever approach you take, a key to successful advocacy is knowledge and using evidence effectively to back up your position. For OM doctors, this is a tremendous advantage as applying evidence-based medical practice is a hallmark of the specialty. Uninformed and unsupportable opinion will not bear up to cross-examination by opponents and may cause lasting damage to your credibility. 
    An issue, which inevitably influences the model of advocacy you follow, is that of funding. If you depend a lot on government funding, you will be less likely to take a critical approach using the mass media and more likely to take an encouraging, inspirational approach. In these situations, criticizing government policy is more likely to be restricted to face-to-face talks.

    4b Identifying the aim 
    When advocating for a change within an institution, such as a government department or a hospital, the aims usually fall into two categories.
    • Changing policy 
    • Changing practice

    In most cases, you would need to adopt a new policy before you change your practice. As a result, changing policy may be seen as an initial goal, with changing practice being the end point. That, in turn, can lead to a change in the situation of those who will benefit. As an organization that has helped bring about a change in policy, and so having achieved some level of credibility, you will be well positioned to get involved in the more detailed work of changing practice or drafting detailed regulations.

    4c Why and when 
    Wherever change in policy or practice needs to take place, advocacy has a role to play. Government policies at a national or local level can restrict good practice in occupational health and medicine. Advocacy has a vital role to play in proving the effects of policies and making sure appropriate policies exist to allow good occupational health and medicine to be available to all who need them. Advocacy is needed to create a policy environment, which will make practical work as effective as possible.

    Advocacy can most appropriately take place:
    • before or just after an election;
    • when something happens to bring the issue to public attention;
    • before the issue goes public;
    • before the issue gets in front of a law-making body;
    • when legislation is being changed;
    • on quiet news days;
    • when you have information and expertise relevant to the issue; and
    • when the target audience are potentially interested in the issue.

    4d Targets 
    Advocacy should target the decision-makers involved in the issue identified. It is important to remember these will be either elected or career individuals and it should be assumed that they take their responsibilities seriously. However, it is vitally important, though not always straightforward, to identify which specific people have the authority for making sure policies are put into practice appropriately and when people have the authority to change legislation or regulation. 

    It will help in developing an advocacy message that will appeal to your target audience if you learn as much as possible about these people. For example, what are their political interests and what group of people do they represent? Do they already know anything about your issue, have they already taken a public position on the issue, can you link your issue to something you know they support?

    4e Delivering the message 
    In representing the issues you want to advocate on, you must be credible. As we have said above, it is critical that arguments presented to policy-makers are based on evidence and that you provide the appropriate materials to support your points. Basic messages should, generally, be delivered by one person in your organization who will be clearly accepted as speaking on your behalf. Delivering effective advocacy messages is a particular skill that you should aim to develop and make part of your main skills, through external training programs, and so on. See Annex 4 Setting up and carrying out a face-to-face meeting.

    When possible, it is often helpful to involve the people directly affected by the advocacy issue or problem. The people affected by an issue or problem, other people representing them, or both groups together can carry out advocacy. Advocacy is often more powerful if those affected by the problem or issue are involved with, or lead, the process. For example, if you were advocating for policies that would improve the cardiac conditions of workers, it may be useful to involve a patient advocacy group that focuses on closely related health issues.

    If you plan to advocate on behalf of others you need to make sure that you represent their opinions and interests fairly. This means having a close relationship with those affected by the problem or issue, a deep understanding of the issue from their viewpoint, and permission from those affected by the problem or issue to include their positions in your own communications efforts. See a summary of the benefits and possible pitfalls below.

    Why is it helpful to involve those directly affected by the advocacy issue, from early in the planning process?
    • They will have added expert knowledge of the issue or problem.
    • They can suggest workable solutions based on direct experience of the problem.
    • They can view a problem from a different perspective.
    • They are often highly motivated, because they are directly affected by the issue.

    Pitfalls to avoid
    Involving those affected by the problem superficially or not at all can result in:
    • identifying irrelevant issues;
    • suggesting solutions which do not solve the problem, or which make the problem worse;
    • public disagreement;
    • loss of credibility for the organizations and people involved in advocacy;
    • increased stigma and exclusion of those affected by the problem or issue; and
    • a loss of power of those affected, so they end up being less in control of their own situations.

    4f Setting the framework 
    There are a number of steps to take once you have decided to carry out advocacy work. You can call these steps "setting your framework." Seven important steps are listed below:
    1. Identify the issue, for example, lack of OM doctors. Deciding which problem or aspect of a problem to tackle. Your advocacy efforts will be more effective if the problem is very clearly defined and is closely connected to your area of expertise. 
    2. Analysis, for example, on workplace health. This is essential for making informed decisions when choosing which issue or aspect of an issue to work on, identifying solutions to the problem and setting a realistic goal and aims. Good, credible information is essential to put together a persuasive argument. It is important to choose the information that you can use to best support your argument and to plan how this information will be gathered.
    3. Developing the message. Think through carefully — what do you want to say and how will you say it? Different audiences respond to different messages. For example, a politician may become motivated when they know many people in their district care about an issue. It is important to decide what type of message will best encourage your target audience to act as you want. Careful and thorough preparation of convincing arguments and a clear presentation style is needed. 
    Developing a clear and compelling message is vital to the success of your advocacy work. Your message should explain what you want to change, why, and the benefits of doing this. You will need to review and revise your messages regularly as you learn new things about your issue or your target audience. In just a few sentences your message should say why your issue is important and what you want others to do to support it. It should give the audience a clear choice of actions and explain the consequences of these. Your message should take into account the interest and knowledge of your target audience and it should be short and simple.
    4. Goal and aims. The goal is the vision for the future, and what you hope to achieve over a long period of time, 10 to 20 years perhaps. For example, this might be access to OM for all. The goal needs to be clear and to include what you are trying to achieve. Problems can be complicated and the goal often may be long term. 
    The advocacy aims are what you want to change in the shorter term. The aims must be narrowed down into things that are achievable within the project timeframe. They should be specific and measurable and clearly tackle the problem identified. A number of solutions may present themselves and the advocacy will be most effective if the solutions which are most politically, economically and socially realistic are identified.
    5. Finding allies. Building political support to act on the problem is an important stage. Actions should include building partnerships, meeting with decision-makers, building awareness and delivering effective messages for example, with industry and trade bodies. The power of advocacy is increased when more people support the aim. Even within your own organization, forming partnerships can help build agreement for action. You need to identify suitable allies, such as other groups who may share a desire to achieve the advocacy aims.
    6. Identifying resources. Advocacy needs resources. Maintaining effective advocacy over the long term means careful planning of costs. It is important to think through all the costs and resources which will be needed. These need to be budgeted for and potential funding sources identified.
    7. Creating a plan to monitor and evaluate. The timeframe needs to take into account important points in, for example, the parliamentary calendar. It is important to know if and when the advocacy aim has been achieved and to continually assess how you can improve the advocacy strategy. You should put a system in place to make sure you get feedback and evaluations of the effectiveness of the strategy. You need to be clear how people will know when the aims have been achieved.

    The main factors for effective advocacy include:
    • An effective message. A concise and persuasive statement about the advocacy goal that captures what you want to achieve and why. The message should be tailored to each audience, in an appropriate format and should include a specific action for that particular audience. 
    • Identifying target audiences. The main audience are the decision-makers with the authority to affect the outcome of the goal and aims directly. It is important to understand their decision-making processes and to organize your efforts in line with this. 
    • Demonstrating the credibility of your organization in advocating on an issue. You should be able to demonstrate a clear platform for tackling the issues you are supporting. This can be from experience of working in the area affected by the issues or partnership with other organizations working in the area. You need to clearly explain and demonstrate who you represent and why policymakers should take your positions seriously. 
    • Effective use of information. This should be from a source that your target audience believe is credible. It should focus on a few questions that can be answered and provide the information the policymakers will need. Ideally it should be presented in a way that emphasizes the lessons learned.

    5 Advocacy Tools
    Methods and approaches to advocacy work will depend on the type of organization you are and the advocacy plan you have developed. In advocacy it is important to be clear about who is responsible for what and to ask (advocate) for what is appropriate and reasonable. Described below are summaries of some practical advocacy tools that you can use. We have divided the tools into five areas. In practice, an advocacy strategy would involve a variety of tools from some, or all, of these areas. 
    1. Directly influencing policy
    2. Monitoring state performance
    3. Providing information and training
    4. Demonstrating good practice
    5. Public education and raising awareness

    5a Directly influencing policy
    The tools included in this section are those which you can use to directly talk to the policymakers, ideally, at times when they are open to ideas or in a position to make the policy changes you want to make. Many countries have health-care systems that are in a state of change and sometimes this can provide good opportunities for changing or creating policy. Below we have described some of the main tools that provide effective influence.

    Understand your law- or rule-making process
    It is important to understand the effects of an existing policy or law and how it is put into practice. It is also important to understand and to be able to explain the likely effects of proposed new policies or laws. Policies and laws may not always be written down. In some instances, actual practice may be based on traditional laws and customs or decisions communicated without being written down. These kinds of policies are harder to analyse as there may be basic disagreement on exactly what is the current policy. See Annex 2 Analysing a law, policy or regulation.

    You should try to:
    a. agree what the policy or law is, or how it is to be put into practice;
    b. analyse the policy and how it is put into practice;
    c. suggest how it might be improved;
    d. suggest how it might be implemented better; and
    e. aim to get it written down, to avoid future misunderstandings. 

    Position papers
    A position paper is a formal, written record of your opinion. In certain situations, a position paper may help show that a coalition of many different allies support the same advocacy aims. Position papers are written to be read by the people the advocacy is targeted at. Depending on particular circumstances, position papers may be:
    1. left with an individual decision-maker at the end of a face-to-face meeting to summarize the main points of your message;
    2. sent to local or national governments during consultation;
    3. sent to people in influence, in response to a policy or action, to explain an alternative or supporting a position; or
    4. given to delegates or committee members at a meeting or conference — whether or not you are allowed to speak at the meeting.

    See Annex 3 Developing an effective position paper.

    Working inside the system
    Being part of a decision-making body can be one of the most effective ways of influencing a change in policy. Decisions affecting your advocacy issue may be made in many different situations, for example, subcommittees and working groups, district health committees, social welfare committees, advisory committees to government agencies. It is important to find out when and how decisions are made, and then to find out if your representatives can take part in key meetings. This involvement can help further credibility and demonstrate good faith on the part of your organization. It may also be possible to invite members of decision-making bodies to become involved in your organization or coalition.

    Direct contact
    Making direct contact, and building a professional relationship with those people responsible for taking the decisions you want to influence is another very effective way of achieving change in policy. There are two main ways of doing this — writing letters or emails, and asking for a face-to-face meeting.

    5b Monitoring performance
    Even when adequate policies are in place or appropriate guidelines are accepted, actual practice may not match up to these. Highlighting these differences can be an important method for encouraging an improvement in practice. The key to using these tools are:
    • understand very well what international or national guidelines have been accepted;
    • know which policies are intended to guide improvements in practice; and
    • have clear and credible means of gathering information on putting policies into practice.

    Improving government transparency
    Activities can include discovering, publishing and passing on information about occupational health and medicine related legislation and legal conditions. Improved transparency in government may contribute to more effective health policies by helping people monitor how resources are used.

    Monitoring guidelines and policies in other states
    International comparisons are often powerful tools. You can measure how policies are put into practice and compare this with how it is done in other countries, or even with geographic regions of the same country. This idea can also serve to see if you have dealt with your obligation to adopt national policies and international guidelines.

    Public involvement
    This approach supports those who have been affected by workplace health issues to demand with government and Companies for better services.

    5c Providing information and training
    Much of the advocacy work you will carry out is about informing and educating decision-makers on issues such as what occupational health and medicine is and what policies are needed to support organizations to provide appropriate palliative care. Often, changes in policy can be brought about when officials better understand the issues involved and the reasons why particular policies present difficulties for providers of palliative care. The key to using these tools is to:
    • target the decision-makers and those who influence them;
    • make sure the facts you use are correct and up to date; and
    • provide information from sources your decision-makers will trust.

    Producing reports
    Reports that draw together research and highlight situations can be an effective tool to highlight the main issues to those with an interest. They can be an effective way of illustrating differences between countries that may be a useful tool in lobbying government officials.

    Websites and keeping databases of information
    Many organizations, particularly those concerned with campaigning and advocacy, use their websites to make information available to others, and to gather and bring together information. Increasingly, social media such as Twitter and Facebook, have become important supportive tools for communicating messages broadly. 

    Inviting the main decision-makers to go to international meetings
    Providing the means for decision-makers to access information at an international level and to network with decision-makers from other countries can allow them to make comparisons with other countries and see what can be achieved. This tool is particularly important in countries with fewer resources where lack of finance can be a real obstacle to gaining access to up-to-date information and ideas.

    Organizing conferences to educate decision-makers
    Organizing conferences and workshops within your own country for decision-makers and practitioners can be a successful way of bringing groups together to learn from one another. It also provides a forum for sharing knowledge, ideas and guidelines and for generally raising awareness among the main elected and government officials. 

    Giving professionals access to information
    Often, an authority may support a policy of occupational health and medicine as a practice but lacks the resources to provide the information and the support health-care professionals need. By providing access to the appropriate information and training materials, in the correct language, you can improve occupational health and medicine practice. 

    Releasing statements and findings
    The outcomes of conferences and workshops can include a ‘summary of findings’. These findings may be a statement of intent or presentation of the situation you want to work toward, and to which you would like to encourage others to work co-operatively.

    5d Demonstrating good practice
    Excellence in providing clinical care and in your own work is crucial as a platform from which to advocate for a change in policy. Showing how good occupational health and medicine can be cost-effective can also be an important catalyst for change. The key to using these tools is to:
    1. have impeccable occupational health and medicine policy and practice of your own or of the organizations you represent;
    2. communicate effectively how practice could be included in national policies; and
    3. be able to present information that shows the differences that keeping to the principles and practice of OM can generate. 

    Improving state performance
    The quality and effectiveness of public services and spending can be contributed to by working direct with government in shaping, paying for and delivering public services in a number of ways. This can take the form of public-private partnerships in which civil society organizations work closely with state institutions in designing and providing health and educational services This can include moving funds from among client groups and other sources and providing services direct.

    Starting a service and proving how it can work in practice
    A method of advocacy that has proved effective is to use what space is available to develop solutions to problems. In other words, to start a service independently to demonstrate how it can work in practice. Once the service is running effectively, you can ask the authorities to start funding it or to take it into the state health service.

    5e Public education and raising awareness
    If influencing public opinion is an important part of your advocacy strategy, you will need to use the media. Policy-makers often pay close attention to the media so using the media may help you to reach several target audiences at once. Using the media will allow you to reach large numbers of people and should help you to get the public’s attention about an issue. It may also help you to gain credibility with your main target audiences. Using the media also brings risks as there is always the possibility that your organization or cause will be inaccurately or unfavourably represented.

    Media strategy
    There are several ways in which you can use the media and the methods you choose will depend on the audience you want to reach, the media that is accessible to you and the nature of your message. You need to consider all of these factors and develop a media strategy. This can include actions such as:
    1. interest a reporter in your story;
    2. pitch a story to the media;
    3. issuing press releases;
    4. be available for interviews;
    5. hold press conferences; and
    6. write a commentary or position statement.

    See Annex 5 How to write and use a press release and Annex 6 How to carry out a media interview.

    It is important that you:
    1. target the right media and journalists;
    2. give the media information in the format they want;
    3. provide good spokespeople;
    4. time things correctly;
    5. know the deadlines for each media outlet;
    6. monitor your media coverage;
    7. link your media campaign with other relevant events; and
    8. make available pictures that tell your story.

    Raising your profile and fundraising events 
    These can be on a local, national or international level. Organising an event provides a focus around which to direct public and media attention to a cause.

    A set day on which to focus attention
    Set a day for a particular cause to raise awareness of the main issues related to that cause. Often this type of event for raising awareness is held every year, for example, World Aids Day.

    Public education through the arts
    You can use the arts to highlight the issues around injury, illness and occupational health to the general public. By using plays, television programmes, films and other art forms to get across issues, you can use the mass media effectively to reach large portions of a population with important messages.


    ANNEX 1: CHOOSING THE MOST APPROPRIATE ISSUES AND METHODS FOR ADVOCACY

    Choosing the topics
    In general, advocacy efforts will be most successful when your board considers the potential for advocacy from a number of different viewpoints. For example, your members may include university faculty, corporate medical directors from a variety of industries, employees of government agencies, physician employees of hospitals and large medical groups, and proprietors of single or small group practices who are small business owners as well as doctors. These members may see the same issue in very different ways. As a result, you might target those positions that have the broad support of your members, and avoid starting advocacy work on issues that may unnecessarily divide your members.

    Examples of possible advocacy issues
    Below is a working list of issues that may be of special interest to you, and that you may be able to influence through an effective advocacy program. You should develop your own list and priorities. It can also be helpful for you to focus your efforts by preparing a more formal advocacy agenda (one page is best) that serves as a public statement of the changes needed. You could then post the agenda on your website and circulate it to a variety of audiences, including members, elected officials, and key government staff. 
     Procedures and rules relating to workers’ compensation and similar programs
     Proper recognition of OM services in health-insurance programmes and in medical-fee and payment schedules
     Including OM services in electronic medical record systems
     Issues related to scope of practice in the area of OM affecting doctors and other health-care providers, including occupational health nurses, doctors’ assistants and so on. 
     Proper recognition of OM as a specialty of medicine, including making sure an adequate supply of OM-trained doctors and adequate funding for graduate medical education 
     Funding for occupational or environmental clinics 
     Disability evaluations, sick notes and fitness‐for‐duty issues 
     Environmental issues including human exposure to chemical or physical agents and pesticides, air and water pollutants, dangerous materials and dangerous waste 
     Public-health issues with an environmental component (such as land-use issues, the built environment, global climate change, and others) 

    Choosing the Best Methods
    Once you have chosen an issue appropriate for advocacy, you will need to choose the methods that are likely to be most effective. There are no simple rules for choosing these methods. It will depend on factors such as:
    1. the nature of the particular advocacy issue itself;
    2. the specific aim; 
    3. the target person, group or institution;
    4. the availability of scientific or other evidence to support the aim; 
    5. the skills and resources of your staff, leaders or coalition; and 
    6. timing – for example, external political events, when a law is still in draft form, immediately before a budgeting process, time of year, and stage of advocacy process. 

    Putting advocacy to work 
    To help show how the potential topics and tools might work together, below is an example of a potential advocacy issue along with brief comments on strengths and weaknesses of some of the methods described above. You might find this useful as you evaluate the relative merits of your own advocacy agenda and plans. Remember that every case (issue) is different and that the specific approaches need to be tailored accordingly. Tools, of course, are not mutually exclusive. 

    Advocacy aim: Persuade large companies to end their practice of compulsory testing and so refusing to hire, or dismissing, HIV-positive workers. Direct targets of campaign: General Managers of companies. Indirect targets of campaign: Labour unions, boards of directors, human resource managers.

    Methods: Strengths and Weaknesses

    1. Analysing and influencing laws and policies or how they are put into practice 
    You might be able to present scientific evidence on the potential spread of HIV. Also powerful, would be any available evidence to show that HIV-infected workers do not have reduced productivity. (High-performance employees, that currently test positive, would be excellent examples.) It might be possible to make the case that limiting a pool of potential employees might negatively affect a company’s longer-term financial performance. The advocacy team will need to be aware that company managers may be inherently resistant to criticism of company policies and dismiss the analyses as not being relevant (in other words, “you don’t understand our business”). These approaches will also not be especially useful for managers who view formal policies, in any form, as an intrusion on their management style. 

    2. Developing a position paper or set of briefing notes
    This approach can be very effective for making a presentation to senior directors and managers. Position papers can also be well received by journalists who often rely on these documents for developing articles and so on. Having a written document also helps make sure that your public statements can be shared (reviewed) beforehand and agreed to by potential allies. On the downside you should recognize that some managers will resist reading documents produced by outside organizations. Also these documents can easily be lost or discarded. By definition such an approach limits the ability of those who will benefit from the advocacy work (the beneficiaries) to be personally involved. 

    3. Working from the inside
    Contacting someone from inside the organization as part of your advocacy efforts can be very powerful, as some managers will listen more closely to people they know. There may be special opportunities within labour unions to help with this. This approach would be limited if a company’s traditional practice has been for major policy issues to be made by managers and directors who believe there is little need for broader input. 

    4. Presentation, lobbying or face-to-face meetings
    Opportunities to present the ‘human face’ of the issue and to build a personal relationship are potentially valuable. These opportunities may provide the best way for beneficiaries to explain their case directly (in other words, to tell their side of the story in personal terms).  You should be aware that these efforts can often take considerable time and managers may view themselves as being too busy. Similarly it can be challenging to get permission to carry out a presentation to a board of directors as those agendas are often tightly controlled. 

    5. Using drama 
    Relaying personal stories, or even performing music, poetry, and so on, can be an effective communication tool. You would usually arrange this activity in connection with an all-employee or labour union meeting. Emotional appeal works with some managers. On the other side, some decision-makers might feel that emotional appeals are unscientific and below their standing in the corporate world — as drama is only for the illiterate. Some managers and directors might decide, that these presentations are not worth their time.

    6. Issuing a press release
    For organizations wanting public support, a formal press release can be a useful tool. Most organizations have electronic tools that help them sort press releases by topic and this can mean that your release gets brought to the attention of the right people. These press releases can be relatively quick to put together and are fairly cost-effective. Of course, press releases are only of value when you want the public to take notice. It is critically important to be writing about something that would truly be viewed as newsworthy. General press releases can be easily ignored and create a negative perception of your organization.

    7. Media interviews 
    Organized media interviews, whether by phone or in person, carry many of the same benefits as a press release. They are especially useful when the issue needs a human face and when you have someone particularly experienced in carrying out these interviews. They are generally inexpensive especially nowadays with the availability of remote technology. As again with press releases, it is important that you are giving a message of compelling interest. Media interviews can backfire if you are not completely prepared or if the journalists choose to present the material from a different or competing viewpoint. In these cases you may end up devoting considerable energy to deal with an unflattering interview. 

    8. Organizing a press conference
    A press conference may, in some ways, be seen as a combination of a press release and a media interview. They carry the same benefits and are especially useful if you were, for example, to be announcing the launch of a major campaign. They are great opportunities to present evidence and to have that presentation widely reported. These events are also good opportunities to showcase beneficiaries or allies and give them public recognition for their support. In general, press conferences are difficult to organize and can be relatively expensive. You may be responsible for finding a venue, renting equipment, and for providing food and drinks. As many press organizations have reduced staff, there is also a risk that few journalists would attend. If this happened, it may end up giving the impression that the event was a failure. 


    ANNEX 2: ANALYSING LAW, POLICY OR REGULATIONS
    The first step in analysing and influencing a piece of legislation or policy is to understand what it is actually saying. A thorough understanding of ‘what needs to be accomplished is critical before starting any of the particular advocacy methods described elsewhere in this document (for example, setting up meetings, drafting position papers and carrying out media interviews). 

    Depending on the nature of a proposed new policy, you might carry out an initial review. However, if the proposal deals with a highly technical issue, you may need to assign the review to a special task force, or hire appropriate specialists from inside, or in some cases, from outside your organization. You will need to be selective in which proposals you choose for analysis as this process can be time-consuming and involve a lot of resources. 

    Questions to ask when reading public policy or legislation: 
    The following list of questions may help you analyse a policy or legislation, and decide what role, if any, you might pursue. 
    • What is the main purpose of the proposal? What problem (or problems) is it aiming to fix? 
    • Does this proposal affect us or our membership in an important way? Is pursuing it consistent with our strategic plan and advocacy action agenda? 
    • Can we offer special expertise in a way that is likely to make a difference? Do we have the time and resources to spend on this issue?
    • How did this issue first come to the notice of decision-makers? 
    • Who benefits from this legislation or policy (if anyone)? 
    • Who is disadvantaged (if anyone)?
    • Who supports this law or policy, and why? 
    • What are the costs (direct and indirect) and who will pay those costs?
    • What will be the expectations five years from now of enforcing this? What are the consequences of not acting?
    • Is the proposal practical? Are the appropriate systems and tools in place so that it might be put into practice effectively?
    • Can it be enforced? If so, by whom, and how? 
    • What is the penalty for not keeping to this law or policy? 
    • Is this something the public will be able to understand? Does the proposal contain a way to evaluate its effect and to make necessary adjustments? 
    • Is the law or policy consistent with your own country’s bill of rights or constitution?

    ANNEX 3: DEVELOPING AN EFFECTIVE POSITION PAPER
    A position paper is a formal written record of the opinion of an organization with many potential uses. Developing position papers is an important part of your role, and should become more routine and efficient with time and experience. 

    Format and Style
    The format below should be generally acceptable. Occasionally, you may prefer a particular format or style and that preference should be accommodated, whenever possible. Ideally a position paper should be provided on your formal (letterhead) stationery, written in full sentences and in a style that would be readable by a wide variety of audiences. These documents are often left behind at the meeting and present a permanent record of your positions, and demonstrate how effectively you are able to present them. 
    1. Summary statement of main recommendation: One to two sentences are generally enough. 
    2. Background: Explanation of why the position paper has been written. List of laws, international treaties, decrees, policies, and so on, which support the recommendation.
    3. Evidence supporting the recommendations: Quantitative evidence (for example, facts and figures) and qualitative evidence (for example, case studies, personal testimonies, anecdotes and examples). Always make sure to provide details of where the information has come from. 
    4. Development of your position: A logical explanation of how the evidence leads to the recommendations. Anticipate questions and provide responses in a proactive way. 
    5. Recommendations: Provide specific, realistic actions that the decision-maker can take now and in the future.
    6. A list of other organizations and individuals supporting this position paper. 
    7. A contact name: website URL, address, phone number, email address, where available.
    8. A brief summary of your organization (or coalition): Who you represent and your mission and goals.

    Briefing Notes
    As opposed to formal position papers, briefing notes are sometimes developed so people within your organization, or within your alliance, can deliver advocacy messages. No external distribution is intended and may be expressly forbidden. As a result, it is acceptable to write notes instead of full sentences, and to use bullet points. Follow the same format as above, but also: 
    • emphasize the most important points – for example, using bold type and underlining; 
    • suggest possible strategies, tactics and minimum demands that cannot be compromised;
    • include possible questions that might be asked, and suggested answers;
    • include problematic issues that might arise, and suggest how to deal with them; and
    • make sure these briefing notes are kept confidential.

    General advice 
    • Position papers and briefing notes should be as short as possible. People are less likely to read them if they are too long.
    • Do not assume that the reader knows the subject well – make sure that you include enough background information for the reader to understand the issue without needing to carry out more research. Try to keep this information brief and organize it in a way that will generally be viewed as being helpful. 
    • Separate fact from opinion. Provide supporting evidence to back up facts, and write opinions as quotes where appropriate.

    ANNEX 4: SETTING UP AND CARRYING OUT A FACE-TO-FACE MEETING
    Face-to-face meetings for the purposes of recruiting potential allies, or making a case direct to decision-makers, are one of the most powerful tools available to you. It is critical that the meeting is organized properly, carried out at the right time in the advocacy effort, and that you are fully prepared. The following are some basic steps that you might follow, again recognizing that each situation is different and steps may need to be modified accordingly.

    Ask for a Meeting
    Send an official letter explaining what your advocacy goal is and why you would like a meeting. Follow up with a phone call. Often you will not get a meeting with the ‘direct target’ but with one of their staff (an indirect target). Always agree to meet with the staff, and treat them in the same way as you would treat the decision-maker. 

    Prepare for the meeting 
    Step 1: Know Your Target
    Analyse your target. Understand what it is that they are trying to achieve and work to present your case in a constructive way. Consider using the questions and table headings in the advocacy framework.

    Step 2: Focus Your Message 
    Choose your main aim and develop a simple message that clearly expresses the following. 
    • What you want to achieve
    • Why you want to achieve it (the benefits of taking action, or the negative effects of doing nothing, evidence for the problem — statistics and anecdotes)
    • How you propose to achieve it
    • What action you want the target person to take 

    Step 3: Choose the Right Messenger
    Often the messenger is as important as the message. If a friend arranged the meeting, you might consider asking them to come to the meeting with you. Or someone directly affected by the issue or problem may be able to personalise the issue and help get the decision-maker’s attention. Make sure the messenger has the authority to speak on your behalf, has appropriate negotiation skills and an attitude or style that will result in a positive outcome.

    Step 4: Prepare and Practice
    • Send a briefing to the official you are going to be meeting explaining what your organization does, your concerns and what you want to deal with at the meeting. Be familiar with the issues you want to discuss and what you have outlined in your request for a meeting.
    • Rehearse your message with colleagues or friends. Ask someone to role-play the meeting, pretending to be the decision-maker, asking difficult and challenging questions. 
    • Arrive early and use this time to contact the most important people in the official’s office.
    • Take written copies of your advocacy message and supporting documents and leave extra copies with officials. Leave behind your formal position paper, if you have developed one on the particular topic of concern. 
    • If possible go with someone to the meeting but don’t take a third person. Agree beforehand who will present what and, in particular, who will speak. 

    During the Meeting
    • Take charge of the meeting and work to stay on the topic. You will have a limited time to present your case. Don’t waste valuable time with small talk.
    • Be prepared to give background information. Don’t assume the official knows your issue in any substantial detail. 
    • Be clear and concise about asking the official for specific action, for example, raising the issue in the legislature, making a public statement, talking to other officials on your behalf.
    • Encourage questions, try to involve the people you are meeting with as much as possible. Try and find a personal connection.
    • Don’t go beyond your allotted time unless the official says they want you to.
    • End the meeting by asking for a response by a certain date or making some other arrangement for a follow-up discussion. You might also invite them out of the office to see the issue or problem first-hand and to show them why you need their support. While it is probably unlikely that they will accept your offer, the step of having done so may generate good faith and help create a lasting impression. 

    After the Meeting
    • Write to the people you met, thanking them for the meeting (even if the person was not helpful), briefly summarizing your main points and any supporting comments made by the target person, especially any promises to take action. Tell the target person what you plan to do next, promise to keep them informed, and express the hope that you will be able to work together on the issue in future. Keep the official informed of what is happening as appropriate. Keep the link open.
    • Document your encounter and debrief your colleagues. Discuss what went well, what could have been done better and what the next steps are.


    ANNEX 5: PREPARING AND DISTRIBUTING A PRESS RELEASE 
    Distributing a press release can be an effective way to share your messages with the public. While some organizations may keep their own lists of outlets and distribute their releases direct, it is becoming more common that press releases are developed and sent electronically through a news wire service. Journalists who monitor these systems will have certain key words that will direct the many thousands of daily releases to their attention. 

    Whichever method is more common in your country, the main elements of writing a press release are the same. The most important point is that your press release must be considered to be newsworthy. In other words, it must contain a message that a journalist would find interesting and that would make them want to take your message and fashion it into some type of news story. 

    An example of a newsworthy item might be where you have taken a formal position on a controversial or developing public policy issue. The public will be interested in knowing the scientific, evidence-based views of an important national medical specialty society, like occupational medicine. Again, a press release can be an effective way of sharing that information with the community. In general, notices of meetings or conferences or releasing new products or services would not be considered to be newsworthy and should be communicated in a way other than a formal press release. Distributing press releases that are ignored or not seen as relevant can create a negative image of your organization that might make it increasingly difficult to command the proper attention of the print media in the future. 

    Content 
    Work to capture the reader’s attention by writing a simple and compelling headline. This will help the journalist understand the story immediately. The first few sentences of the press release should summarise the most important facts.
    • Who is involved?
    • What is happening?
    • Where is it happening?
    • When is it happening?
    • Why is it happening?

    The main part of the press release should then explain these points in further detail. This information helps to persuade the journalist of the facts and importance of the subject, and why it is of interest. Quotes can often make a press release more interesting and appealing to the journalist, because they may not have access to the relevant people. Direct quotations from people involved in the issue or activity: 
    • should express an opinion, fact, or be able to support the view you have expressed in your press release;
    • allow you to give strong opinions that would look wrong in ordinary text; and
    • give a human dimension to the story.

    Usually a quote from your president or other leader would be appropriate. You might also quote other individuals, as they support your arguments, but make sure you get appropriate permission.

    Style 
    • Use short sentences of no more than 20 words.
    • Use short paragraphs of no more than two to three sentences.
    • Mimic the format and story structure from a typical, well-read, newspaper article.
    • Use a good case study or anecdote as evidence to support your point of view.

    Presentation 
    • Use an official letterhead.
    • Make sure that it is well laid-out and easy to read.
    • Provide ‘links’ to information on your website that might provide more information for the reader.
    • Provide a bit of background about your organization.
    • Provide a contact name, phone and fax number, and email address if they are available.
    • Give an embargo time (the day and time from which the journalists are allowed to use the information). 

    Photographs 
    • Include photographs of the main people or places mentioned in the press release if they are particularly relevant to the points you are making. Visuals can often boost the power of your words. 


    ANNEX 6: HOW TO CARRY OUT A MEDIA INTERVIEW
    Preparing for the interview:
    Find out the answers to the following kinds of questions before any interview. 
    • Where and when will the interview take place?
    • How long will the interview be?
    • Who else, if anyone, is being interviewed?
    • Will the discussion or interview follow a film or be linked to another story?
    • Why have they chosen the subject and you for the interview?
    • Will the interview be broadcast live?

    Find out about the journalist who will be interviewing you and do the following: 
    • Investigate their audience — who are the targets among their audience and what kind of information do you need to get across?
    • Contact them and agree the subject to be discussed. Remember that the interview starts as soon as you begin talking to a journalist. There is no such thing as off the record. Define the issues clearly. Ask the journalist what kind of questions they will ask and whether they will be supportive or argumentative. Prepare appropriate information beforehand — for example, statistics, facts, a personal story, etc.
    • Make a list of the main messages you want to get across with 3 or 4 important points for each.
    • Prepare catchy sentences (sound-bites) that summarise your message.
    • Check that you have up-to-date information on your issue.
    • Work closely with your colleagues to develop a draft list of possible questions. Prepare answers to these and practise developing responses to them.

    What to do during the interview:
    • Try to keep calm and composed.
    • Remember that the journalist is not your target – the target will either be influential people listening or watching or the general public as indirect targets.
    • Remember that you have the facts you need and that you know more than the journalist does about your issue. Keep your answers concise and short, using simple language, without jargon or acronyms. Do not get side-tracked – keep to your main points. If a question strays from your topic, try to move back to the area you want to talk about – for example, “I think what you are asking about is important but the main issue is...”
    • If you need time to think about a response, repeat the question before responding.
    • Always bring the journalist back to your main messages or points — repetition is a way of getting your message across.

    Differences Between Media
    Press interviews: These tend to be more relaxed than radio or TV interviews. If you make a mistake, say so and answer again.

    Radio interviews: In a studio, the studio manager will give you specific instructions about where to sit, how to use the microphone, and so on. Sometimes this is done with little time to spare. However, take your time and be sure you understand the instructions. Ask what the first question will be to help you concentrate. You can take notes with you – but try not to rustle the pages. (Brief notes on postcards are often helpful.) If you make a mistake during a recorded interview, you can ask to try the answer again. If it is live you can say, “Perhaps I might explain that answer,” and continue.

    TV interviews: The same rules apply as for radio interviews but you can be seen! TV interviews are usually shorter than radio interviews. The interview may be pre-recorded or live.

    January 2018