The pursuit of health equity requires public health and medical professionals to become adept at policy in their health advocacy work. The American Public Health Association (APHA), in fact, defines policy work as one of its 10 essential public health services. APHA says professionals should be capable of “creating, championing and implementing policies, plans and laws”.

At the University of Kansas Medical Center, the (Sexual) Health Empowerment team [known as the (S)HE] works to address the sexual and reproductive health disparities of women with a history of incarceration. We do this through extensive education, outreach, and networking. But we are also increasingly engaged in policy and advocacy work.

Our team is learning a lot about how to become adept at policy in our health advocacy work. Here we share information about tools we use to guide our new policy work, including helpful frameworks that inform how we engage in policy and useful tools to track legislation.

More about our policy work

Our team at (S)HE focuses on the health of women who are currently, or were recently, incarcerated, taking into account all facets of life that can contribute to their health. In order to improve health outcomes, we try to tackle issues one at a time.

We begin by identifying individual issues about which we will gather and summarize data. We then seek to dig into the legislation via social media and tracking sites – narrowing down contacts within the legislature. Finally, we work to involve advocacy groups, who can work directly, face-to-face with policymakers.

We also engage directly with the community. For example, our work involves educating incarcerated women on preventive cancer screenings in the community. We also use existing networks and educational methods to address policies surrounding prison sentencing parameters and community access to health care. We also regularly partner with community organizations to increase voter registration and participation. 

Helpful policy frameworks

The (S)HE team draws upon models that focus on evidence-based policymaking. For example, Lavis et al. help traverse the boundary of research and activism through the use of “policy briefs”. These are concise summaries of research data that answer questions about relevance, cost and implementation efficacy, data utilization and quality, and local applicability/equity. Using these methods, we are currently formulating policy briefs to address our areas of focus. 

Another resource we utilize is Crowley, Scott, and Fishbein’s (2018) Research-to-Policy Collaboration network that addresses the need for immediacy via a “rapid response team”. They argue that the lack of person-to-person contact between policymakers and researchers has created a “mistrust” of researchers. Their researcher network offers prevention-oriented evidence to policy-makers through engagement with legislative offices. We are not currently engaged in this network; however, it offers an invaluable framework and potential resource going forward. 

Finally, Brownson, Chriqui, and Stamatakis (2011) emphasize that policymakers need guidance in determining the validity and applicability of data to their policymaking. They encourage researchers to help legislators rely on systematic reviews rather than single studies, as interest groups and political advisers tend to do. We have appreciated their recommendation that researchers, who may not be used to the advocacy and legislative process, focus on three things in their policy work:

• Identify the problem and describe why it is worthy of policy intervention
• Outline how to solve the problem through alternative policy
• Acknowledge the many political influences inside and outside the government

How we track legislation

Because our team is striving to be more involved in policy formation, we need to keep up with on-the-docket legislation, locally and at the state level. Reviewing individual legislative committee websites is extremely time consuming. And many policy tracking sites exist that can help, but at a financial cost. This is unsustainable for many. Instead, we use resources such as free legislation tracking sites, correspondence with tracking site staff, social media surfing, and (of course) trial and error. 

Tracking policy has been most efficient for us when we choose narrowly selected key terms and phrases. Sites like LegiScan, GovTrack, and the National Conference of State Legislatures have been useful starting points. To categorize resources for dissemination, shared spreadsheets have helped us to compare our city/state policies concerning criminal justice and health to those of ideal states. Some examples of resources include the Prison Policy Initiative, the Sentencing Project, and The Marshall Project.  

Inspiring our activism

As researchers, advocates and medical professionals, we must be cognizant of historical and persistent health inequities in the United States due to systems of oppression and racism. And we must recognize that research alone cannot address the injustice. Policy has a clear, sizable impact on the health of the population, and so we must become adept at policy in health advocacy. As our team’s Dr. Joshua Freeman wrote in 2012, we must uphold the declarations of medical and public health associations that have committed to advocacy.

Sierra Stites, MPH, is a research associate at the University of Kansas Medical Center. Her research focuses on community-driven solutions to health inequities caused by mass incarceration.

Joshua Freeman, MD, is a family physician, health policy researcher, social justice activist and writer.

He is Professor Emeritus at the University of Kansas Medical Center (KUMC) in Kansas City, where he served as the Alice M. Patterson MD and Harold L. Patterson MD Professor and Chair of the Department of Family Medicine from 2002-2016 and was also Professor in the Departments of Preventive Medicine and Public Health and of Health Policy and Management. He is currently Clinical Professor of Family and Community Medicine at the University of Arizona College of Medicine in Tucson.

Dr. Freeman has been an officer in national family medicine organizations, was a Fulbright Scholar in Brazil, and served on the Board of Trustees of Roosevelt University in Chicago. His interests are in health inequities, minority health, social determinants of health, workforce and faculty development.

Dr. Freeman publishes a widely-read blog, “Medicine and Social Justice” (www.medicinesocialjustice.blogspot.com) and is the author of the book, “Health, Medicine and Justice: Designing a fair and equitable healthcare system”

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