Developing a Health Advocacy Campaign

Running head: THE WIDESPREAD VICE NURS 6050: Policy and Advocacy for Improving Population Health Developing an Advocacy Campaign The Widespread Vice Dr. Julie Grissom Walden University Isaac Kuffour Week 4 Assignment December 25th, 2018 1 THE WIDESPREAD VICE 2 I. The Opioid Epidemic In October 2018, the White House declared opioid abuse a national emergency. Opioids are painkillers containing oxycodone and synthesized fentanyl, which is a powerful painkiller. The availability of this drug has made it easy for use for medical purposes and recreational purposes, due to its high addiction risk. The drug has a sedative effect which regulates a part of the brain responsible for respiration, and hence its abuse has been linked to respiratory failures and consequent death. The opioid abuse has been an area of healthcare concern in the US(Cicero and Ellis, 2015). The crisis has been caused by the increased related deaths of the drug since its use in the 90s and later on abuse that spiraled out of control. In the modern world, the opioid is responsible for over 72,000 deaths in the US according to the CDC reports of 2017. Veterans are more likely to abuse the drug due to the prescription for the medication to help with post-combat injuries. Since women are more likely to experience pain, they are more likely to use and abuse the drug than men. The young adults of between 18 and 25 years are the most abusers of the drug. There have been rising cases of adverse effects on newborns due to the abuse of the drug during pregnancy. Developing a Health Advocacy Campaign

More than 2 million Americans have abused the drug in one way or the other(Pacula, 2017). More the, 130 people died as a result of the drug abuse in 2016 all through to 2017, according to the CDC. In 2017 more than 11 million Americans misused prescription drugs. Currently, around 115 Americans lose their lives daily due to adverse effects of opioid misuse. II. Turn the tide Campaign THE WIDESPREAD VICE 3 This campaign is an initiative by American women healthcare providers targeting the public opioid crisis. The campaign is nationwide, and it addresses education against the abuse of opioids to empower people on the risk and preventive strategies against addiction. Secondly, the screening of our patients will enable healthcare providers to use evidence-based practices to help the victims. Thirdly the campaign seeks to start a dialogue and keep people talking about the abuse of the prescription drugs and addressing the stigma associated with the abuse of opioids. The campaign aims at decreasing cases of the violation of the drug through the AMA taskforce that seeks to reduce opioid abuse. III. The Rx Awareness campaign The Rx campaign was launched by the CDC in 2017, to combat the epidemic of prescription opioid abuse. The communication campaign’s primary objective was to increase awareness and build knowledge on the risks associated with the violence of the opioids and the related deaths associated with overdoses. The program will also target to reach out to people of all demographics with real-life narrations of people who have been affected by the disorder and the people who have successfully overcome addiction. Videos, audio content, banners, and social media initiatives were used nationwide to reach as many people as possible. Thus the result of the campaign was to improve access to prevention, treatment, recovery from addiction and appropriate procedures. Developing a Health Advocacy Campaign

The campaign also targets at enhancing the availability of overdose enhancing drugs, improving dissemination of relevant data and reports about the vice and providing relevant research on ache and opioid addiction as well as evidence-based solutions. IV. Attributes that made those campaigns effective: a. Turn the tide campaign attributes THE WIDESPREAD VICE 4 The campaign was effective due to the proximity of the opioid abusers, and the US is responsible for prescribing the drugs including opioids to patients with different ailments. Their intervention in developing a campaign against the vice is a significant boost for the war against the opioids abuse from patients and especially women and pregnant mothers who may abuse the drug to avoid pain or aches(Pacula, 2017). Moreover, the campaign can target women who are more vulnerable as they understand them better and hence can recommend viable strategies to patients who may be addicted to the opioids abuse and those who fall within the risk class. b. The Rx Awareness campaign attributes The Rx awareness campaign was successful due to the strategies used to advocate against the abuse of opioids abuse. First, the use of communications strategies such as reports, banners, social media and real-life experiences to reach out to the affected population made the campaign effective. Secondly, the CDC being a government agency was better positioned in fighting the vice due to their strength in possessing firsthand information regarding the affected people all over the US(Zdanowicz, 2015). The campaign also targeted the states with the most significant number of opioid abuse and was able to employ narrative strategies to make sure the message is delivered to the victims. Developing a Health Advocacy Campaign

Indeed, the heartbreaking stories were effective in creating awareness among the vulnerable groups and for the people who are interested in beating the addictive habit. V. A description of the public health issue and proposed policy solution a. “It’s not cool” Campaign The rates of opioid misuse and addiction are on the rise as over 100 million Americans suffer from chronic pain and are at the risk of using and possibly misusing prescriptions to opioids. According to the National Institute of Drugs Abuse, more than 115 individuals die from THE WIDESPREAD VICE 5 the epidemic every day. Over 11 million people misused the drug, and the number is rising. Over 2.1 Million people are currently living with the disorder, and over 40% of drug overdoses have been linked to opioid overdose. The cost of the opioid epidemic surpassed $ 500 billion in 2017 regarding economic costs(Zdanowicz, 2015). Indeed with a third of the US population using painkillers, it is crucial to stemming the vice early. Indeed the most vulnerable people of addiction are young people, and hence this campaign will target the young people in a nationwide campaign in the US. VI. Campaign objectives and policy recommendations: a. The goals of the campaign will be to:

• Improving the distribution of naloxone to help the youth trapped in addiction and enhance the addiction management capacities • Training and involvement of health service providers to lend a helping hand in reaching out to the affected individuals to offer help to the victims and highly vulnerable youth • Step up awareness through youth programs and events that are centered on the youth and the most vulnerable people such as women b.

Public policy Changes recommendations: • Advocate for policy regulation of the use of opioids to recommend development of alternative painkillers which will not be as addictive. • It is coming up with digital prescription monitoring to enable easy tracking of abuse cases. This will make it difficult for the abusers to access the drug multiple times for abuse. • Funding to increase of addiction rehabilitation centers for the opioid abuse addicted patients THE WIDESPREAD VICE 6 References The prescription opioid addiction and abuse epidemic: how it happened and what we can do about it. (2015). The Pharmaceutical Journal. doi:10.1211/pj.2015.20068579 Cicero, T. J., & Ellis, M. S. (2015). Abuse-Deterrent Formulations and the Prescription Opioid Abuse Epidemic in the United States. JAMA Psychiatry, 72(5), 424. doi:10.1001/jamapsychiatry.2014.3043 Pacula, R. (2017). Funding Considerations in the Fight Against the Opioid Epidemic: What the Science Tells Us. doi:10.7249/ct469 Zdanowicz, M. M. (2015). Prescription Opioid Abuse and the Heroin Epidemic in the USA. Journal of Community & Public Health Nursing, 1(1). doi:10.4172/24719846.1000e BREAST CANCER AMONG FEMALES NURS 6050: Policy and Advocacy for Improving Population Health Part 2 – Developing an Advocacy Campaign Dr. Julie Grissom Walden University Isaac Kuffour Week 7 Assignment January 8th, 2019 1 BREAST CANCER AMONG THE FEMALE ADULT POPULATION 2 Modification of an Existing Policy As the issue of breast cancer continues to be an ongoing epidemic problem in the world, constant awareness and advocacy campaign becomes crucial in containing this disease. However, the experience of public health practitioners suggests that use of local data can be a vital component in achieving policy objectives in cancer screening, tobacco control and promotion of physical activity (Brownson et al., 2011 pp. 33-43). An overview of the New STEPS (Strength Through Education, Physical Fitness, and Support), which is a local primary prevention adapted evidencebased program and intervention community-based 12-week supervised program, that includes progressive resistance training, balance training, and flexibility exercises that can improve physical fitness and breast cancer awareness among women 40 years and older in Appalachia region of Pennsylvania seem promising. On the other hand, Every Woman Matters’ (EWM) which is a state secondary prevention strategy designed by the Nebraska Department of Health that provides a low-cost mammography and Pap smear services to medically under-served women which are affordable by low-income women, have also statistically proven effective. “Numerous studies have shown that being physically active during and after breast cancer diagnosis has physical and psychological benefits for breast cancer survivors; approximately 20 min of moderate-intensity physical activity once a day can decrease the risk of death after breast cancer diagnosis by 40–50 % (McGuire, Leypoldt, Narducci, and Ward, 2007 pp. 8).

Also, in 2001, a Nebraska law mandated that women diagnosed with breast cancer through EWM receive treatment through the state Medicaid program (Bhuyan, Stimpson, Rajaram, and Lin pp. 3). While these above-highlighted points may sound impressive, the shortcoming stems from the fact that “a significant gap will remain for women who are uninsured and underinsured. This gap presents an important policy consideration for states that are not expanding their state Medicaid programs, BREAST CANCER AMONG THE FEMALE ADULT POPULATION 3 including Nebraska. It is estimated that in 2014, about 25,000 women in Nebraska will have no access to affordable health-care (Bhuyan et al., pp. 35). Of note, between 2010 and 2013, the federal funding for the National Breast and Cervical Cancer Early Detection Program NBCCEDP screening program was reduced by around 10 %. Due to lack of funding, in many states, lowincome women seeking cancer screening, diagnostics, and treatment are being put on waiting lists, and even being turned away by clinics (Bhuyan et al., pp. 36). For EWM, it was reported that “in low-resource areas, participant expenses can be burdensome, making program funding critical for success.

Program costs can be kept low by using available community facilities and community resources” (McGuire, Leypoldt, Narducci, and Ward, 2007). These explanations and statistical data signify a problem with inadequate funding for these programs, thus, requiring a funding campaign to be established in support for a continuation and ensuring the effectiveness of these programs. Impact of Existing Laws on Advocacy Evidently, allocation of funds has played an amount of factor in delivering quality healthcare in the United States. The Nebraska Administrative Code, Title 181, Chapter 40, Code 004 under the Availability of Funds states that, participation in the screening mammography program is subject to the availability of funds in the Mammography Screening Cash Fund. In the event funds are not available, applicants who meet the eligibility criteria will be placed on a waiting list in order of date of receipt of the application by the department. Waiting list applicants must meet eligibility standards at the time funds become available to reimburse for screening mammography services (Nebraska Department of Health). While considering this as a key factor in the hindrance of a successful progression of the EWM in this state, some other existing federal enactment, decrees, and policies tend to compliment this as a secondary, just as seen in “November BREAST CANCER AMONG THE FEMALE ADULT POPULATION 4 2009, while in the midst of acrimonious congressional debates over the Affordable Care Act (ACA), the US Preventive Services Task Force (USPSTF) updated its breast cancer screening guidelines. The Task Force recommended biennial mammography screening for women of average risk aged 50 to 74years, sparking a torrent of criticism (Lin, and Gostin, 2016). A campaign persuading to ensure access to a no-cost for the primary and secondary breast cancer prevention strategies in a debate, based on evidence-base of producing quality and effective results, rather than the existing government or political consideration and decision, about what women need, would be my focus of agenda for this lobby. If this step towards this change is not taken by the government, then it triggers a question of ‘life and death,’ where life seems to be more promising to women due to science and evidence, but political disturbances against this perceived knowledge has hindered a shared-decision between both parties, thus, subjecting more lives to harm from non-enactment to these preventative measures.

The Three Legs of Lobbying Setting out a campaign to advocate a policy, which will influence the government to consider funding a no cost cancer prevention strategy utilizing the three legs of lobbying, would be considered for this approach. These three legs of lobbying include the Professional Lobbyist, Grassroots Lobbyists, and The Role of Money. Utilizing Professional Lobbyist involves setting out professionals as a group, who are already directly involved in the action plan of eradicating breast cancer, and who would likely influence the government positively at this level. It was mentioned earlier that EWM in Nebraska community utilized pharmacies to enroll medically under-served women into a state-based breast and cervical cancer-screening program. Moreover, it was part of my action plan earlier to hire nurses at a lesser pay rate compared to the pharmacist, and enforce them to go around churches, BREAST CANCER AMONG THE FEMALE ADULT POPULATION 5 worksites, homeless shelters, senior centers, commodity sites, and many other places women gather to teach and encourage women about breast cancer awareness and the recommended screening required. These two groups as a union i.e. the American Nurses Association (ANA), and American Pharmacists Association (APhA) could collide with other groups and society like Cancer Society of America, National Breast Cancer Foundation, and the American Breast Cancer Foundation for a no cost cancer prevention strategy. On the other hand, exercising a campaign within the Grassroots Lobbyists would entail selecting paid officials that are well organized and informed about breast cancer and how to persuade the government. Professional nurses are well knowledgeable about breast cancer and could add as valuable resources to these elected officials. This stage of advocacy entails patience, endurance, and perseverance, as many years may pass by before a law protested for would come through. Although importantly, in this stage, timing is often the key to success and having a timely ‘head-up’ about what is transpiring behind the scenes can mean the difference between success and failure (Milstead, 2013 pp. 56). Lastly, The Role of Money would be the final step of this campaign, where releasing money is a key determinant of the successful end of this campaign. This money would, in turn, be utilized in fulfilling these proposed objectives. Obstacles during the Legislative Process The approval of a new or an adjustment to an existing policy through a campaign in the legislative process is most likely going to be vigorous and challenging due to some obstacles, especially when the government might consider themselves facing other diverse sets of issues in the society they consider more important and of higher priorities. Moreover, protesting for a campaign requires a financial commitment. Teams like organized nursing interests and National Association of Community Pharmacists who might practically be the facilitators for the campaign BREAST CANCER AMONG THE FEMALE ADULT POPULATION 6 for the New STEP and EWM program might not be able to raise enough funds through contributions for a political campaign. Finally, the gravity at which this intended campaign is successfully communicated through the legislative policy makers by local data, statistics, and proper education about the severity of the mortality of the disease and its financial burden to the economy is essential to the winning of the protest. Developing a Health Advocacy Campaign

Conclusion Breast cancer continues to be an epidemic problem across the world, but a high portion of the burden is preventable. With a continuous approach towards informed education and policy interventions to cut down the mortality rate by providing access to a no-cost primary and secondary preventive measures, and making healthy choices more available to the predisposed population would be a key factor in containing this life-threatening disease. BREAST CANCER AMONG THE FEMALE ADULT POPULATION 7 References Brownson, R., Dodson, E., Stamatakis, K., Casey, C., Elliott, M., Luke, D., & … Kreuter, M. (2011). Communicating evidence-based information on cancer prevention to state-level policy makers. Journal Of The National Cancer Institute, 103(4), 306-316. McGuire, T., Leypoldt, M., Narducci, W., & Ward, K. (2007). Accessing rural populations: role of the community pharmacist in a breast and cervical cancer screening programme. Journal Of Evaluation In Clinical Practice, 13(1), 146-149 Bhuyan, S., Stimpson, J., Rajaram, S., & Lin, G. (n.d). Mortality outcome among medically underserved women screened through a publicly funded breast cancer control program, 1997-2007. Breast Cancer Research And Treatment, 146(1), 221-227. Nebraska Department of Health Title 181, Nebraska Administrative Code, Governing the Screening Mammography Program Nebraska Administrative code retrieved from http://www.sos.ne.gov/rules-and-regs/regsearch/Rules/Health_and_Human_Service Lin, K. W., & Gostin, L. O. (2016). A Public Health Framework for Screening Mammography: Evidence-Based vs Politically Mandated Care. JAMA: Journal Of The American Medical Association, 315(10), 977-978. doi:10.1001/jama.2016.0322 Milstead, J. A. (2013). Health policy and politics: A nurse’s guide (Laureate Education, Inc., custom ed.). Sudbury, MA: Jones and Developing a Health Advocacy Campaign