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The need for effective advocacy on the part of health professionals has never been greater. The recent COVID-19 pandemic has made the connection between human health and social conditions clear, while highlighting the limitations of biomedical interventions to address those conditions. Efforts to increase the frequency and effectiveness of advocacy activities by health professionals have been hampered by the lack of a practical framework to define and develop advocacy competencies among trainees as well as to plan and execute advocacy activities. The authors of this article propose a framework which defines advocacy as occurring across three domains of influence (practice, community, and government) using three categories of advocacy skills (policy, communication, and relationships). When these skills are successfully applied in the appropriate domains of influence, the resulting change falls into three levels: individual, adjacent, and structural. The authors assert that this framework is immediately applicable to a broad variety of health professionals, educators, researchers, organizations, and professional societies as they individually and collectively seek to improve the health and well-being of those they care for.

Children are vulnerable to a myriad of environmental exposures that impact health and development. With a deeper appreciation of social determinants and influencers of health, pediatricians are exploring new practices to identify exposures that could put children at risk and to better understand opportunities for intervention to alleviate detrimental outcomes. Unfortunately, identifying the risk and understanding the health impact of an environmental exposure are just the first steps alerting potential need for an intervention. Reducing or eliminating the exposure often requires behavior change to modify the environment or perhaps policy change to modify the behavior.

The escalating use and misuse of opioids in the United States has led to a public health crisis with adverse health outcomes, including neonatal abstinence syndrome (NAS).1 NAS is a multisystem withdrawal syndrome experienced by infants shortly after birth when antenatal exposure to illegal or prescription drugs is abruptly discontinued at delivery.2 Negative sequelae are both short term and long term, including inadequate feeding, disruption of social and behavioral development, and poor school performance.3,4 With the rise of the opioid epidemic nationally, rural communities have been especially impacted due to exacerbation of well-documented, deeply rooted health disparities.5,6