Interview by Cristi Carman

Sue Gallagher has a broad range of advocacy and policy experience; she has worked on issues as
varied as suicide prevention, the development of traffic safety materials for native Spanish-speakers,
and building capacity in state and local health agencies. In addition to working at the Massachusetts
Department of Health for years, Sue was chosen to be a Robert Woods Johnson Health Policy Fellow and worked with Senator Durbin of Illinois. As an internationally recognized expert on child and adolescent injury prevention, she has founded several injury prevention organizations and research centers, was chair of the American Public Health Association’s Injury Control and Emergency Health Services Section and worked with the Institute of Medicine to create the Reducing the Burden of Injury report. Now as the Director of the MS Health Communication program at TUSM, Sue has invaluable insights and expertise to offer students and community health advocates.

Cristi: Tell us about your connection to public health advocacy.
Sue: I became interested in advocacy when I worked at the State Health Department. I was amazed at how much we take for granted and the need for advocacy to get and keep public health issues on the agenda. I realized that a lot more than data is needed in order to be listened to and to make an impact. My interest has always been bridging the gap between research and policy and practice in whatever area of public health I worked. So advocacy is a natural fit; if you want to bridge that gap, you’re always trying to advocate for what is effective and efficient.

Cristi: How did you become involved?
Sue: The state health department changed my life and gave me a whole new perspective on public health and advocacy. One issue I was particularly involved in early on, in the late 70s, early 80s, was improving existing data systems – what is included on injury causation medical records and how it is coded. For instance, death certificates show the external cause of injury and are coded as such, which is the area I was working in. But when you looked at hospitalizations and emergency room visits, records usually included the cause of injury, but were not coded as such because there was not a requirement. The cause of injury is the missing link in injury prevention so in that way the records didn’t really help identify many aspects of this public health issue. Only the nature of the injury was coded, so you’d know there was a skull fracture but you wouldn’t know if the individual was hurt on the playground, in sports or in a car crash. I found out that no state in the country had a requirement for external cause coding and Massachusetts only had about 9% of external causes reported. I got more involved in the American Public Health Association and also started meeting other people who had identified the same problem in their states. And then I wound up leading a national initiative – we were able to get 26 states to adopt a mandate over a five year period and now most of those states have good external cause coding to understand and prioritize their injury problems based on both incidence and treatment costs. What was the impetus for my taking this on? Each state has a maternal and child health block grant and a needs assessment is conducted every five years to prioritize funding from federal dollars. Injuries, which are the leading cause of death for children and teens, never came up. I realized that was because statewide population-based data on nonfatal injuries was not available. The external cause of injury was not being coded.

Cristi: What lessons have you drawn from your advocacy experience?
Sue: It takes a long time to get changes made and persistence pays off. Drawing from my U.S. Senate experience: legislative assistants and fellows are very reliant on advocacy groups to come to them because they can’t possibly keep up on every single topic. When policymakers want to know what the climate is on an issue or to make a decision on an issue, advocacy groups can provide the pros and cons very easily. I learned how important advocacy groups are in policy making when I needed the latest and accurate information for floor debate or when determining what really should be included in a bill.. And the more groups you can bring together on an issue for critical mass, the more it strengthens the effort to get a bill passed or to get change. It takes time – but if you stick with it, you can get it done. Compromise is critical.

Cristi: What do you think the most valuable skills are in advocacy?
Sue: Very good communication skills, both written and oral, are important. You need to be able to convey what you want to say in a way that resonates with the person you’re talking to. Know your facts about the person in order to develop an approach. You need to be able to analyze an issue and succinctly get your message across, using only a few sentences to state the problem, describe how others feel and what the opposition is thinking, and propose possible ways of addressing the problem. It’s important to be succinct and to carefully choose your message. Also an ability to discuss both sides of an issue. An ability to bring groups of people together to collaborate around an issue. And the ability to translate research and synthesize it briefly for your audience.

Cristi: Are there any resources you can recommend to student who are interested in advocacy?
Sue: The Massachusetts General Legislature’s website has a lot of information relevant to state legislation. The Massachusetts Public Health Association website makes a lot of resources and information available on advocacy and a variety of public health issues. The advocacy section of the APHA’s website and the APHA Guide for Effective Public Health Advocacy are both great, useful tools.  The Thomas website is where you should start for the federal level. And the advocacy section of the Research America website has many advocacy tips and tools.

Cristi: Any final words of wisdom for aspiring advocates?
Sue: You can’t do advocacy piecemeal. Have a strategy and be persistent. Persistence will pay off. But understand that you will most likely need to compromise. Identify a champion to work with and don’t be discouraged because change takes a long time.