1. Working with Community Coalitions J. Gary Wheeler, MD, MPS Little Rock, Arkansas

2. 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

3. How things happen By choice By fiat/force By incentives Uncontrolled events

4. Choice Washing clothes

5. Fiat/force Speed Limits

6. Incentives Tax Code

7. Social Change: Ecologic Model MD RN

8. Models 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

9. Advantages/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

10. The overlooked factor: community So, polls really are important

11. Benefits and Challenges of Coalitions Benefits –Strength in numbers –… relationships –….diversity –….resources Challenges –Autonomy –Different Goals –Efficiency

12. 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

13. 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

14. Why physicians? We are often the only advocates for patients We may have more freedom to speak compared to others

15. Effective interactions Attendance Contribute (resources) Help connect Schmooze Accept role as an equal partner Eye on the prize

16. 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.

17. Most important lessons Remember to say thanks