The Responsibility to Advocate—and to Advocate Responsibly

Much of my research concerns interventions to help vulnerable populations—people in severe poverty, people with disabilities and chronic health conditions, people who inject drugs or are otherwise at risk of HIV, and people living with psychiatric disorders. These vulnerable men and women face many predictable threats to their health and well-being. Some of these threats arise from our political system itself, which demonstrates such a tenuous commitment to meeting their basic needs.

Health policy scholars have long debated whether policy advocacy is compatible with rigorous scholarship. Some analysts have assiduously avoided open advocacy of specific policies for fear that their objectivity would be called into question, while others have embraced evidence-informed advocacy of policy positions. Each of us must decide on our own answers to some difficult questions. How should one combine the necessity for scholarly rigor with the necessary pursuit of social justice, the desire for policy impact, and one’s own professional and personal goals?

My own path includes political action: writing op-eds, position papers, and petitions, distributing social media messages defending the Affordable Care Act, and promoting universal coverage. I wouldn’t foist this activist path on others. Many colleagues have excellent reasons to steer clear of the partisan and political fray. Others are advocates in a different way, advising political candidates and office-holders.

I can’t offer a uniform roadmap, either, but I can offer a few insights based on my own experience.

Advocacy Brings Personal Benefits and Costs

I have certainly experienced both. My journalism has widened my social network. It has sharpened my writing—no small skill as we compete for attention in spaces where no one has to read our work. I hope my advocacy has helped me put a human face on my scholarship and build relationships with new stakeholders. The social media platform I have gained through advocacy allows me to publicize the work of students and junior colleagues that deserves wider attention.

I hope my advocacy has made me more interesting to my students. Ironically, it gives me some bona fides to present worthy conservative policy ideas that my generally progressive students easily dismiss. I’ve learned much about American politics, as I spend my own money on political advertisements and work in the political trenches to change policy.

I’ve paid some costs, too. I was once the “health policy expert Harold Pollack.” I’m now the “liberal health policy expert Harold Pollack.” That has cost me some professional opportunities. And I don’t care for the anti-Semitic hate messages and tweets that I receive because of my advocacy. My colleagues who are women, who are Muslim, or who are people of color receive much worse.

Mind the Day Job

Each of us must decide how to allocate our time, our most scarce resource. Policy advocacy can complement your day job of scholarly research; it’s no substitute for it. Such advocacy is more valued by our universities and by foundation funders than it was 15 years ago. Still, when you do visible advocacy, your department chair, your colleagues, and your grant and tenure reviewers may wonder about your focus and your productivity. So, I happily discuss my op-eds and my politics everywhere but in my annual merit review. That document is down to business about the grants, scholarly contributions, and teaching I’m paid to do. My colleagues are entitled to no less.

Integrity and Transparency

We should hold our advocacy to no less rigorous standards of integrity and transparency that we hold our academic work. That is sometimes easy to forget. There are immediate rewards to becoming a propagandist or another loud voice on social media. Our political allies don’t need us for that. And there are often long-term costs.

The partisan temptations are real. As the cognitive psychologists remind us, these are propelled by an impressive combination of motivated reasoning, group-think, and confirmation bias.¹ It’s easy to write politically congenial talking points arguing that expanded coverage will reduce emergency room use. Many people did precisely that. Progressives were rightly embarrassed when the Oregon Health Insurance Experiment found the opposite result.² There was never much reason to expect a different result, or even to believe this was a proper health policy goal.

Whether you’re writing an op-ed or a journal article, people are entitled to rely on your work without fear that you’ve manipulated them or shaded things, even if what you wrote is narrowly correct. Judiciousness and civility matter, too. Platforms such as Twitter promote discord and incivility. If you loudly fight on social media, that’s how people will come to see you. That’s personally and professionally unwise.

Some academic leaders believe that a studied nonpartisan stance or political neutrality are essential to scholarly integrity. The concern is understandable, but I believe misplaced. One can find shoddy research motivated by political bias. There is plenty of research motivated by financial conflicts, by the desire for professional advancement, by disciplinary conformity, by relationships with policymakers and funders, and by the simple human desire to hype minor or statistically questionable results. In any event, political bias is no less likely or destructive when it is furtive or submerged.

Be True to Yourself

I submit this essay two years to the day after publishing an article in The Nation making the case for nonviolent civil disobedience should our federal government move to deport young undocumented immigrants who participate in the Deferred Action for Childhood Arrivals (DACA) program.³

That article explained why I believed I should chain myself to the federal courthouse should such policies come to pass. It also considered more prosaic matters. I noted conversations I had with a university official, who explained that as long as I didn’t damage university property, neglect my teaching, or charge jail time to an NIH grant, I would likely be fine. I was protected by my university’s commitment to free speech and by the immense privilege of my academic tenure. How else might my personal and professional life change if I went to jail? What might happen to my next NIH grant? I hope to never know.

Advocacy comes from a very personal place. My own path is influenced by the past 15 years of caring for a disabled loved one who relies on Social Security and Medicaid.⁴ In a just society, we all protect each other from life risks that would crush any one of us, were we forced to face them alone. The American taxpayer had my back when a family tragedy struck. Advocating for others who lack my platform and my privilege is my way to pass it on.

References

1. KahanDM. Ideology, motivated reasoning, and cognitive reflection: an experimental study. Judgm Decis Mak. 2013;8:407-424.
2. Taubman SL,AllenHA,Wright BJ, Baicker K, and Finkelstein AM. Medicaid increases emergency-department use: evidence from Oregon’s Health Insurance Experiment. Science. 2014;343(6168):263-268.
3. Pollack H. Thinking about committing civil disobedience in the age of Trump. The Nation. December 21, 2016. https://www.thenation.com/article/thinking-about-committing-civil-disobedience-in-the-age-of-trump/. Accessed December 20, 2018.
4. Pollack VP, Pollack HA. Bringing Vincent home. Health Aff (Millwood). 2006;25(1):231-236.

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