This week I am doing a teaching session on advocacy, in our Professional practice module on the MSc Public Health – Health Promotion.  We have, inevitably, discussed advocacy before on the course – it’s one of the three main activities of health promotion outlined by the Ottawa Charter. This teaching session will reinforce some earlier teaching and also get students to think about how they can incorporate advocacy into their professional practice. 

One talking point regarding advocacy is the potential contradiction that we believe that people have within them the capacity to take control of their health for themselves – to be empowered – so why do people also need advocates?

Two examples might explore this point – firstly the celebrity chef and activist Jamie Oliver’s campaign on obesity and better school meals, and secondly the work of organizations such as Survival, which campaign for the rights of indigenous peoples.

I admire the achievements of Jamie Oliver – he has chosen to spend his time giving a chance to young people from difficult backgrounds to develop a career in the restaurant business and he has lobbied the UK government for over a decade, to provide better school meals in order to tackle the obesity epidemic among children. He has asserted recently that he’s mystified that academies (schools which are freed from local authority controls) are being allowed to determine what food should be on offer, whereas local authority schools need to conform to national guidelines. As one million children now attend academies, this affects a lot of children. He complains in the Observer newspaper (22.04.12) that the coalition government is doing ‘nothing’ to tackle the obesity crisis.

Jamie Oliver certainly has impact. His books sell in more than 100 countries and his television series called School Dinners was shown in 80 countries.  One spinoff has been his Ministry of Food projects, and Bradford, one of our neighbouring towns, hosts one of these, in a shop on a shopping street. It provides food and cooking sessions for all sorts of people who want to learn about food – boys who have been in young offenders institutes, recent widowers, mothers who have never learnt to cook and children. The Bradford Centre, mostly funded by the local council is doing a lot to tackle the skills and knowledge deficits around this basic life skill of being able to cater for yourself, but its funding is not secure, and elsewhere, despite Oliver’s wish for such a centre in all cities, Ministries of food haven’t materialized.

Jamie Oliver has achieved a huge amount, however, and his role as a celebrity has obviously helped. He has access to politicians and other key players that most advocates can only dream about. He gets things done – often fuelled by his own money. Again, not all advocates can do this. But here is one young man with a passion for food, a good team behind him and a lot of media-savvy. He creates momentum and media interest, so that professional bodes such as the Academy of Medical Royal Colleges can add its concern over ‘junk food’ and obesity and question the senior politicians such as the Health Secretary Andrew Lansley who seems to prefer to develop ‘responsibility deals’ with the food industry rather than tackle the issues through legislation.

The other example of advocacy is of a small London-based NGO, Survival International, which advocates on behalf of indigenous peoples whose way of life is threatened. Recently it has been advocating and campaigning on behalf of the Awá people of the Amazon. They are described as the world’s most threatened ‘tribe’, almost at the point of extinction and one of only two nomadic hunter-gatherer tribes left in the Amazon. Back in 1982 the European Union gave Brazil $600 million to build a railway from the iron ore mines in the Carajás Mountains to the coast. The railway cut through the Awá’s lands that in turn brought roads, and with it, loggers. Not only has a third of the rainforest in the Awá territory been felled but also the Awá have been subjected to disease. Awá people also report violence, massacres and whole families being wiped out by the land grabbers. Although Brazil seems to be making some inroads into stopping illegal logging, much more needs to be done. Europe has been part of causing this problem. It needs to be part of finding solutions. Another celebrity, the actor Colin Firth, has become involved as an advocate, arguing that one man – the Brazilian minister of justice – can take action to keep out the loggers. But time is running out and the Awá people are despairing – they cannot achieve what they need without advocates and without outside help. The largest least-contacted tribe in the Amazon, the Yanomami, survived due to a 20-year campaign that secured the protection of their lands in 1992. The Awá need a similar effort.

It is not only in less developed regions that indigenous peoples are threatened. As of now, the UN has decided to investigate the situation facing Native Americans, the first time in its history that the UN has done so. The USA has 2.7 million Native Americans, living in areas with a range of social problems, often on marginalized land, with high unemployment, poor health and other social ills. The mission will be headed by Prof Anaya of the University of Arizona, and will see how the UN declaration on the rights of indigenous peoples, which the US signed up to in 2010, is being upheld. Thus the UN can also play a major role as an advocate for those groups facing health injustice and threats to their wellbeing.

There are many excellent guides to doing advocacy and how to incorporate it into health promotion practice. We use the one by Ritu Sharma, for example, An Introduction to Advocacy: A Training Guide, (produced by Support for Analysis and Research in Africa (SARA)␣ Health and Human Resources Analysis in Africa (HHRAA)␣ USAID, Africa Bureau, Office of Sustainable Development), which is available on the web.