Advocacy and Systems Change

Advocacy for health is the organized effort to win political commitment, policy support, social acceptance and resources for a health goal. Together with systems change, it is the part of health promotion that seeks to alter the rules, institutions and power relations that determine the conditions for health, rather than only the behaviour of individuals.

Definition

Advocacy for health is the combination of individual and social actions designed to gain political commitment, policy support, social acceptance and systems support for a particular health goal or programme; systems change refers to advocacy and other action aimed at modifying the structures, policies and norms of a system rather than its individual outputs.

Scope

This topic covers advocacy as a health-promotion strategy and the broader idea of systems change: building coalitions, shaping public policy, mobilizing communities, and shifting institutional norms toward health equity. It is reference-educational, describing the functions and frameworks of advocacy rather than instructing on a specific campaign.

Core questions

• What functions does advocacy perform in health promotion?
• How do advocacy and community mobilization translate into policy and systems change?
• Who holds power over the determinants of health, and how is it influenced?
• How are advocacy efforts and their effects evaluated?

Key concepts

• Advocacy as a health-promotion function
• Coalition building and community mobilization
• Policy and agenda setting
• Empowerment and community organizing
• Systems change and norm shift
• Intersectoral partnership

Key theories

Advocacy as a route to reducing health inequalities

Advocacy links health promotion to the political and structural causes of inequality, working to change policies and power relations rather than only individual circumstances.

Mechanisms

Advocacy operates by raising an issue onto the public and policy agenda, framing it persuasively, building coalitions and mobilizing constituencies, and bringing organized pressure or partnership to bear on decision-makers and institutions. When successful, it changes laws, budgets, organizational practices and social norms — the system-level conditions that shape health — and so connects health promotion to the upstream and structural determinants. Participatory approaches, such as community-based participatory research, link affected communities to this process and can strengthen both legitimacy and impact.

Clinical relevance

Advocacy explains how health professionals and organizations can contribute to changing the conditions that produce illness, beyond direct care, by supporting policy and systems change. The topic describes a population-level and political strategy and is not a basis for individual diagnostic or treatment decisions.

History

Advocacy was named one of the three core actions of health promotion — alongside enabling and mediating — in the WHO Ottawa Charter of 1986. Carlisle's 2000 framework connected advocacy explicitly to health inequalities, and the WHO Commission on Social Determinants of Health (2008) underscored political and intersectoral action, while community-based participatory research developed advocacy's grounding in affected communities.

Debates

How to evaluate advocacy

Because advocacy works through long, contingent political processes, there is debate over how to attribute policy or systems changes to advocacy efforts and which indicators meaningfully capture its contribution.

Key figures

• Sandra Carlisle
• Nina Wallerstein
• Michael Marmot

Seminal works

• who-ottawa-1986
• carlisle-2000
• marmot-2008-csdh

Frequently asked questions

What is advocacy in health promotion?

It is organized individual and social action to gain political commitment, policy support, social acceptance and resources for a health goal; the Ottawa Charter lists it as one of the core actions of health promotion.

How does advocacy relate to systems change?

Advocacy is a principal means of achieving systems change: by influencing policy, institutions and norms, it aims to alter the structural conditions that shape health rather than only individual behaviour.