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On Advocacy

by Fall Ferguson, JD, MA

One of the joys of being a teacher is that I am offered endless opportunities to learn from my students and our interactions.

I teach a course on health care policy for students pursuing a master’s degree in health education. People interested in health policy generally pursue an MPH (Master’s in Public Health) or a degree in public policy of some kind. So, it’s fairly typical for me to encounter resistance: students who want to be health educators often don’t understand why they need to learn about health policy. My experience teaching the course this quarter wound up deepening and expanding my understanding of advocacy.


Even more than in past years, some of the students balked at the idea of engaging in policy arguments in class and in their assignments, which were to write a series of blog posts about health policy and then give a presentation on the subject matter of one of the blog posts. I encouraged those students who didn’t like the assignments to talk about the sources of their resistance. Some students said they don’t feel comfortable with confrontation and conflict. Others said that the system was so broken that there was no point in arguing for change. Many said that policy arguments are not health education, so why study it or practice it?

I listened and let them know that I heard their concerns. I agreed that policy arguments do not constitute health education, but then I turned it around, saying that health education is a form of advocacy. I cited Gandhi’s famous quotation that we need to be the change we wish to see in the world, and asserted that understanding the system and its effects is essential because health educators need to be part of the change we wish to see. I let them know that I hoped to convince them of that by the end of the quarter, and left it at that.

The Price of Silence about “Things That Matter”

Two events in the interim between the first and second classes of the quarter gave me new insights on advocacy. The first of these events was Martin Luther King Jr. Day (celebrated in the U.S. on January 21, 2013 this year). There were radio programs and articles about MLK Jr. everywhere, and his views on the need to speak out against injustice struck a particular chord given what I had been trying to articulate to my students:

“Our lives begin to end the day we become silent about things that matter.”

I began to reflect on the personal toll of running silent when I could have spoken out. I have run silent on “things that matter” for a variety of reasons in my life, including fear, overwhelm, or a sense of futility, and sometimes because it just wasn’t convenient to speak out.

The thing is, looking back, silence has never really worked out well for me. The emotional and physiological tolls of a self-imposed gag order are high indeed. I also live with regrets for not having spoken out at times. Advocacy is another one of those things that we can put in the category of regretting inaction much more than action, even when the action turns out to be less than skillful or less than effective. (Note: I am not judging anyone for not speaking out, especially when doing so is unsafe; that is something each of us gets to decide for ourselves.)

In addition to these private consequences of silence, there are public consequences as well. In the words of Elie Wiesel, “We must always take sides. Neutrality helps the oppressor, never the victim. Silence encourages the tormentor, never the tormented.”

Shaping the Debate

The second event in the interim period between the first two classes that made me reflect on advocacy was President Obama’s Second Inaugural address, in which he charged U.S. citizens with the “obligation” of advocacy:

“You and I, as citizens, have the power to set this country’s course. You and I, as citizens, have the obligation to shape the debates of our time – not only with the votes we cast, but with the voices we lift in defense of our most ancient values and enduring ideals.” 

advocacy image

Although I did talk about the concept of “advocacy” during that first class, I had framed the actual assignment as a “policy argument” – I had even put up a PowerPoint slide that posed the question “Why argue?” With some help from MLK Jr. and President Obama, I realized this framing as “argument” was not aligned with my intention for the course. What I really want to do is inspire students to “shape the debates.” Advocacy has an element of “argument,” to be sure, but is not in its essence about conflict; it’s about conviction, hope, and public debate. According to, the word “advocate” can be defined as follows:

Verb: to speak or write in favor of; support or urge by argument; recommend publicly
Noun: a person who speaks or writes in support or defense of a person, cause, etc.

History is on the side of the advocates. My great-grandmother didn’t have the right to vote until she was about the age I am now. That same great-grandmother, whose father fought in the Civil War, lived long enough to witness the civil rights movement of the 1950s and 1960s. I was born shortly before Stonewall, and this year I heard an African American President speak on behalf of gay rights in his Inaugural Address.

An advocate is by definition an optimist: we believe we can make a difference. Change doesn’t always come quickly, and people suffer while we are advocating. But the suffering doesn’t go away when we avoid advocacy. It only goes away when we bear witness and try to change the world. It’s become a truism that we should never doubt that one person can make a difference. But it’s not just about the Gandhis or Martin Luther King, Jrs. Effective advocacy requires a collective, a community—concerned groups of citizens coming together to shape the debate.

Teaching Advocacy

I brought these thoughts back to the students in the second class and we continued the conversation about advocacy throughout the quarter. By the way, their blog posts and presentations blew me away this year—engaged and impassioned essays about health issues they really care about. In our last class, they divided into small groups and came up with “wishlists” of advocacy activities directed at creating a functional and just U.S. health care system. We wrote their ideas on the chalkboard; at least half of the activities they came up with were educational in nature. I pointed this out to them and reminded them of the challenge I had set for myself in the first class, namely, to prove to them that health education is a form of advocacy. They smiled and nodded; if I had been holding a microphone at that point I would have been tempted to drop it on the floor and walk out of the room.

The course is over now, and one of the students stopped by my office as I was writing this. (Some of you more cynical readers may not believe me, but this really happened.) She had just returned from a trip to Washington DC advocating for LGBTQ civil rights. Before the trip, I had given her some information about some of the health implications for people who experience stigma and bias and pointed her to a recent article I had seen in the American Journal of Public Health about the health implications of denying people the right to marry. The experience of advocacy on her trip was transformative, she said.  She asked about finding an internship that combines health education and advocacy.

I have long understood that my HAES work and my work in ASDAH were forms of advocacy. I now understand that my work as a teacher is another form of advocacy, not so much in the content of what I teach, but in creating a space in which students find their voices to shape the debate.

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