In 1905, a Boston-based physician named Richard Cabot decided that medicine could do more to meet the social needs of patients.
With his own money, he hired a nurse, Garnet Pelton, who began to see patients in his clinic. Not long after, a social worker named Ida Cannon joined. The goal was to improve patients’ health by addressing social needs: “hygiene teaching,” “infant feeding,” “help for patients needing work” and “assistance to patients needing treatment after discharge.” They started, for example, a lunch counter at the clinic where hungry patients could enjoy milk and crackers, for five cents, while waiting to see a doctor. Soon, a committee of physicians, nurses, social workers and volunteers was formed to oversee the hospital’s “nonmedical” department, which provided various social supports.
Around the same time, in New York, a nurse named Lillian Wald and a social reformer, Florence Kelley, had an idea for a new federal agency to address maternal and infant mortality, child labor and early childhood education. They approached President Theodore Roosevelt with a proposal for the United States Children’s Bureau, as it would be called, which took an integrated medical and social approach to improving child and maternal wellbeing. Over the decades, it has brought together physicians, nurses, public health practitioners, and midwives to support these goals. The Children’s Bureau is believed to have played a role in the large decline in infant mortality in the first half of the 20th century.
These efforts stand as early exemplars of the power of interdisciplinary advocacy to improve patients’ lives. Today, they are still noteworthy for their impact—but also because they are few and far between.
Health professionals are increasingly expected to care for patients in teams. The number and complexity of diagnoses and treatments today means that clinicians are more specialized than in the past, but also that collaboration among them is critical. At the same time, there has been growing recognition of the many social and economic factors that influence health: employment and wages; housing and nutrition; insurance and access to care; and increasingly, medical misinformation and vaccine hesitancy.
These twin forces—the growing complexity of medical science and a more sophisticated understanding of the socioeconomic conditions that influence health—mean that clinicians of various educational backgrounds must work together to engage not only in team-based care but also in team-based advocacy.
Health professionals with different training—physicians, nurses, pharmacists, social workers, public health practitioners—have generally not done enough to jointly advocate for systems- and policy-level change. Instead, they have often advocated separately and for sometimes conflicting goals: nurse practitioners lobbying for expanded scope-of-practice laws, medical subspecialists battling over relative value units. Tensions persist both within and between health professions, and social and cultural silos between different types of clinicians—as well as the activation energy needed to organize across professional lines—prevent more collaborative advocacy on behalf of patients.
But health professionals can and should embrace more “all hands on deck” opportunities to support patients’ interests. It may not be possible to align objectives on every issue, but health professionals could start with those for which there is relative consensus: coverage expansion, drug prices, gun safety, vaccinations, and funding for biomedical research.
There is political power in numbers. While there are only about one million physicians in the United States, there are four million nurses and another one million physician assistants, pharmacists and physical therapists. Social workers number nearly 700,000, about half of whom work in health care. Clinicians are among the most trusted professionals in society and may have an outsize influence on the public consciousness. Speaking as a single voice, even on just a handful of issues, could have a transformative effect for public health and social well-being. This is true for well-known issues like the opioid epidemic and drug prices, as well as those less discussed but also worthy of public attention: school nutrition, tobacco taxes and neighborhood walkability.
There is also moral power in collective action. Team-based advocacy can create a sense of community and camaraderie among health professionals, and in some cases, organizing can help prevent clinician burnout, particularly when focused on persistent frustrations clinicians encounter when trying to improve the health of patients. Patients, many of whom have lost trust in the health care system, may be encouraged to see health professionals presenting a united front, and placing their interests above the financial interests of industry stakeholders.
Such team-based advocacy may seem unlikely, but there is reason to believe such an approach could be effective. Research suggests that clinicians increasingly believe health advocacy is part of their role as professionals and that these efforts have the potential to influence the health of their patients. Yet a disconnect remains: most do not participate in public health or advocacy initiatives.
Team-based advocacy should occur at three levels: individual, local and national. First, health professionals should engage at the level of individual patient interactions. This might include, for example, clinicians coming together to correct medical misinformation. The director of the Centers for Disease Control and Prevention recently issued a call for all health professionals to encourage parents to vaccinate their children amid the largest measles outbreak in decades. Prior work on tobacco control suggests that smoking cessation is correlated with the number of times a patient is advised to stop smoking by a clinician. Repeated messages debunking medical myths from various clinicians could limit the harm caused by medical misinformation.
Second, health professionals of different backgrounds can join together to build local coalitions to improve conditions within their communities. This approach has the advantage of drawing upon real, existing relationships among people and groups to create change. Such clinical coalitions might work to develop robust partnerships with community organizations to address local issues. For example, Health Professionals for Equality and Community Empowerment is an interdisciplinary group taking on reproductive health care and immigrant rights in Santa Rosa.
Finally, some issues will likely require united advocacy to produce changes at the national level, such as reducing drug prices, protecting patients from financial burden of care, and improving the health of immigrants. For instance, national associations for physicians, nurses, social workers and pharmacists could band together to issue a forceful repudiation of living conditions in migrant detention facilities. Issues that are most contentious may also be most impactful—but could benefit from establishing partnership through advocacy on less controversial topics.
The idea that social and economic policies influence health and well-being is not new. But interprofessional efforts create a new avenue for advocating on behalf of patients. Speaking with a unified voice—particularly during critical “all hands on deck” moments—is likely to be more effective than the siloed efforts of individual professional organizations.