Public health advocacy is a core function of public health and plays a crucial role in shaping policies, raising awareness, and ensuring equitable health outcomes. Often, however, public health professionals are unsure of the legal boundaries separating public health advocacy, education, and lobbying. This uncertainty arises due to the lack of understanding around the differences among education, advocacy, and lobbying and what actions are permitted under the law. Understanding these distinctions ensures the advocacy of public health professionals and organizations does not unintentionally cross the line into lobbying.
In this Q&A, Shannan Piccolo, Senior Attorney for the Network for Public Health Law’s Mid-States Region, discusses key differences between public health education, advocacy, and lobbying.
Q: How is advocacy a core function of public health?
Answer:
Both Healthy People 2030 and the 10 essential public health services list advocacy as one of the essential functions of public health. A key aspect of Healthy People 2030 includes policy development and implementation which is accomplished through advocacy. One of the three core functions of the 10 essential public health services is policy development — supporting equitable laws, policies, and plans and using legal and regulatory actions to protect and promote health. Additionally, public health advocacy is a vital tool for addressing social determinants of health and reducing health disparities.
Q: What are the differences between public health education, advocacy, and lobbying?
Answer:
Public health education focuses on providing factual, unbiased information to the public. This information can be used to encourage voluntary change in behaviors, to promote well-being, and disease prevention. Education may include trainings, informational materials, and community outreach. Examples are outreach about the benefits of vaccines, handwashing promotion, and anti-vaping campaigns.
Public Health advocacy influences policies, systems, and environments to promote equity and better health outcomes for all. It involves raising awareness, mobilizing support, and encouraging decision-makers to act on health-related issues. Advocacy efforts may include presenting data and research, community engagement, and working with decision-makers and organizations. For example, promoting clean air regulations by presenting research on air pollution’s health effects.
Public Health lobbying attempts to influence active legislation. This includes activities such as meeting with lawmakers, testifying at hearings, or encouraging people to contact their representatives. There are two main types of lobbying: direct and grassroots. Direct lobbying is engaging directly with legislators to influence specific legislation. Grassroots lobbying mobilizes the public to influence legislative issues. An example of direct lobbying is asking a legislator to support a bill that regulates flavored tobacco products.
Broadly speaking, another way to think about the difference between these activities is:
- Education informs and empowers.
- Advocacy supports systemic change and policy development when there is no proposed legislation.
- Lobbying directly influences active legislation and is often subject to more regulations and reporting requirements, especially for organizations receiving federal funding.
Q: How do I know what is considered lobbying in my state?
Answer:
Each state has its own laws governing the definition of lobbying and lobbyist, lobbying registration requirements, and lobbying exceptions. Most states define lobbying as having communication with legislators for the purpose of influencing legislation. However, definitions vary regarding who qualifies as a lobbyist and the type and timing of registration required to serve as a lobbyist. It is important to determine whether as a public health professional you are permitted to engage in lobbying and, if there is no prohibition regarding your ability to lobby, what the registration or licensing requirements are. In addition to state laws, it is also important to determine whether the Lobbying Disclosure Act of 1995 or the Hatch Act apply; whether there are any state, local or organizational rules; and whether any funding or grants your organization is receiving prohibit lobbying activities.
For example, in Montana there is no prohibition of lobbying by paid public health professionals, but there are licensing requirements. A public health professional in Montana must obtain a license if they are paid for the time they engage in lobbying activities, and the amount is equal to the amount set forth in the statute. Additionally, any public health professional who communicates with the Montana legislature or a legislator in support of or against the introduction or enactment of legislation or an official action is considered to be engaging in lobbying, unless the communication falls under one of the exceptions. One such exception is when the communication is in response to a direct request by the legislature, legislator, or public official and does not express support of or opposition to legislation. As such, unsolicited informational testimony at a Montana legislative hearing is considered lobbying. However, the statutory definition of lobbying only includes communication with state representatives and senators. This means a public health professional in Montana can communicate support for or opposition to executive branch regulation or rules without engaging in lobbying. The same goes for any local legislation, although there may be local laws governing such activity.
Q: Where is the line between public health education/advocacy and public health lobbying?
Answer:
The line between advocacy and lobbying can be blurry, as the two are closely related but are legally and functionally different. Advocacy focuses on education and awareness, while lobbying attempts to influence legislation. However, these distinctions can be difficult to determine in practice. Here are some examples to help illustrate the difference.
| Public Health Education or Advocacy | Public Health Lobbying |
| Running a public campaign to promote the importance of childhood vaccines. | Contacting your representative and asking them to vote against a proposed bill that would remove childhood vaccine mandates. |
| Publishing op-eds or articles about the dangers of vaping among youth. | Urging your representatives to vote yes on a specific bill that includes e-cigarettes in the state’s indoor clean air act. |
| Sharing infographics on social media about the benefits of clean air policies. | Organizing a public campaign to mobilize residents to contact their city commissioner in support of a law requiring electric car charging stations throughout the city. |
| Facilitating a community meeting to discuss expanding mental health services and implementing a crisis response team to reduce ER visits and improve health outcomes. | Testifying before the legislature in support of the allocation of $10 million to mental health programs in the state’s budget. |
| Presenting research at a public meeting regarding the life-long benefits of pre-kindergarten. | Sending a letter to a policymaker urging them to co-sponsor a bill for mandatory pre-kindergarten. |
* State laws may affect the above examples.
See the links below for additional information:
2018-gov-advocacy-toolkit.pdf
Advocacy in Action Course – Society for Public Health Education – SOPHE
Policy-Development-Support-Fact-Sheet.pdf
PH-Advocacy-Scan-Summary-Final-October-2023.pdf
50 State Scan — Frey Evaluation, LLC
Lobbying and Other Political Activity by Government Employees in Michigan – Network for Public Health Law
This post was written by Shannan Piccolo, J.D., Senior Attorney, Network for Public Health Law—Mid-States Region.
The Network promotes public health and health equity through non-partisan educational resources and technical assistance. These materials provided are provided solely for educational purposes and do not constitute legal advice. The Network’s provision of these materials does not create an attorney-client relationship with you or any other person and is subject to the Network’s Disclaimer.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not represent the views of (and should not be attributed to) RWJF.
