In the words of HealthConnect Fellowship Lead Mentor Rick Kozin, “Our vision for system change is driven by our values of the world as it ought to be. But, to successfully create this change, we must work in the world as it is.” As a result, advocates often face a tension between whether their vision justifies the tactics to achieve it.

Here are a few ways HealthConnect Fellows have navigated the line created by this tension to make progress toward their ultimate goals.

Navigating diplomacy in an agitator role.

By nature, Mr. Daniel Hoffman-Zinnel describes himself as a peacekeeper, but he will take on a more direct role if he’s passionate about the issue. And he’s found himself having to speak up more often to encourage leaders to think about the impact of their decisions on those who are marginalized. He has found a way to agitate while still creating space to collaborate.

For example, Hoffman-Zinnel, CEO of Proteus, an organization that supports the well-being of migrant farmworkers, and his staff wanted to make sure state partners and agencies took steps to keep farmworkers safe after seeing in the spring significant disparities in who COVID-19 was impacting in Iowa. Proteus engaged researchers, doctors, and others who had relationships with leaders to raise the issue. By having their partners speak up and offer guidance to leaders, Proteus was able to step into a meeting to have a collaborative discussion. These conversations led to a strategy that resulted in no farmworker deaths over the summer.

Building a coalition among those who may disagree.

As Community Impact Officer of Health at United Way of Central Iowa, Ms. Erin Drinnin is often building coalitions to create a stronger voice for system change. In doing so, she has found value in bringing together partners who don’t always agree to consider new ideas and to unite around issues of common concern so that they can achieve bigger advocacy goals.

“My perspective has been how do we build allies,” says Drinnin. “How do we build trusting relationships so we can pursue some shared goals.”

Drinnin’s often neutral role in conversations allows her to ask questions that encourages discussion on topics of disagreement and to work toward shared understanding. In building a coalition around oral health, one of the key tactics Drinnin also has had to work through is how much of a voice does each organization have to ensure that those most impacted by the issues have a chance to be heard and that each voice has an equal say in making decisions. The steering committee structure was created to give one seat to each of the stronger advocacy organizations so that other voices also have voting power.

By working to build stronger relationships among advocates, Drinnin is preparing for when there is a line between what individuals impacted by issues need and what organizations are willing to advocate for, so the group can have open dialogue about those concerns. Creating this common ground is already leading to advocacy efforts in this state Legislative session to require public officials to notify the public when fluoridation is shut off in their community’s water.

Using mission to guide tactics

Ms. Lina Tucker Reinders stepped into the Executive Director role of the Iowa Public Health Association (IPHA) in 2019 learning the harsh perception that her organization’s voice at the Capitol was considered fringe or irrelevant. With the mission to unite and strengthen the voice for public health in Iowa, she’s worked hard to position the organization as a valuable part of conversations on public health issues.

The response to the pandemic in Iowa has not always recognized public health officials’ expertise and work, and Tucker Reinders’ board has had to navigate whether to react strongly to that response or to gently nudge decision makers to recognize the value of public health officials. Tucker Reinders has taken a visible role in media, offering the public health perspective in stories about the pandemic response and has maintained a consistent voice in responding to the decisions elected officials have made.

Recently, Iowa Public Health Association wrote an open letter to the Governor condemning her roll back of COVID-19 restrictions. The organization also sent a letter to state elected officials encouraging them to reconsider their position on not having a mask mandate at the state capitol but did so in a way that thanked them for their service and reminded them that they are role models. While Tucker Reinders doesn’t expect their decisions to change, she understands the importance of the association being present in their conversations.

When the pandemic ends, Tucker Reinders believes the public health field will face a long period of recovery as professionals reach the breaking point of frustration and exhaustion. Knowing the long-term goal of advocating for the field, she plans to continue this approach of being that persistent voice that over time, elevates the status of the field.