Case studies

In Alabama, United States, a public health community coalition targeting breast and cervical cancer prevention engaged in grassroots advocacy to influence policy and legislation for smoke-free spaces (Wynn et al., 2011).

This coalition was made up of local stakeholders, including an interdisciplinary committee of government officials, faith-based organizations, academics, researchers and volunteers. Their collective efforts were effective in part because the people involved were receptive to change. 

There was a strong impetus for change caused by these concurrent factors:

• data showing an unequal burden of cancers among Black Americans due in part to higher rates of tobacco use and second-hand smoke exposure.
• recognition that the risk of cancers could be lowered by: implementing evidence-informed strategies; increasing public awareness and advocacy; and promoting healthy public policy.  
• the coalition’s commitment to creating social change by improving the health and well-being of the community to achieve positive health outcomes.
• public support for the establishment of legislated smoke-free areas, evident from the results of local and national Gallup polls.
• an understanding of the powerful impact of social movement actions to create change.

This receptivity to change led the coalition to engage in social movement actions. They became empowered by learning strategies to lead change; they realized the power of their collective voices and mobilized actions. They felt their actions were timely and needed due to the data indicating rising cancer levels amongst Black Americans. They were committed to taking action to address and rectify health inequities.                

Advocacy for humane death and dying care practices led to the valuing and realization of hospice and palliative care services in South Australia in the 1990s (Elsey, 1998). Early hospice and palliative care advocates pressed for comprehensive community services provided by knowledgeable, humane and compassionate care providers who understood and supported the need for an alternative to medical practices in this area.

Advocates also recognized the need for funding, legislation, support of relevant volunteer organizations, and capacity-building in health professionals to ensure effective delivery of hospice and palliative care services.

The Kahnawake Schools Diabetes Prevention Project (ksdpp.org) in the First Nations reserve of the Mohawks of the Kahnawake in Quebec, Canada aims to prevent type 2 diabetes in Kahnawake by empowering community members to care for their health. Project leaders were informed at the outset by evidence that demonstrated a two-fold higher risk of diabetes and diabetes-related complications in adults (Tremblay et al., 2018). 

To be meaningful for community members, the change was rooted in the values and traditions of Kanien’kehá:ka beliefs, incorporating a holistic approach of spiritual, emotional, physical and mental dimensions that reflect wellbeing. The project’s focus aligned with the value of protecting and promoting the health of future generations. By linking the change in values, families and other community members were more invested in the cause.