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The Letter ‘P’ and Pediatric Advocacy

Updated: May 1, 2020

Read Dr. Moira Szilagyi's speech after she received the APA Public Policy and Advocacy Award in 2016.

"It is with deep gratitude on behalf of every child who needs our voice that I accept this wonderful award from the Academic Pediatrics Association (APA) Policy Council. Thank you so much for this amazing recognition. I didn’t start out to be an advocate. It just kind of snuck up on me. The first time I thought of myself this way was after being invited to give a talk on advocacy in 2001. At first, I thought it was a mistake—what did I know about advocacy? But, then I read a little and reflected on my work over the previous 15 years and voil'a! New millennium, new self-concept.

I can honestly say that it has taken several villages to raise this child and family advocate. I have been blessed over the past 30 years with many collaborators, colleagues, and mentors at the local, state, and national levels who helped, advised, cajoled, critiqued, and catalyzed advocacy efforts. Because there is not time to thank them all, I will thank a few standouts:

Dr. Thomas McInerny, who got me involved with the American Academy of Pediatrics (AAP) in New York State; Dr. Lou Cooper, who found funding to create a forum for advocacy efforts around foster care; Cindy Lewis, and Diane Larter, my child welfare mentors and educators. My pediatric chairs at the University of Rochester, doctors Lissa McAnarney and Nina Schor, who were major partners in growing and sustaining a pediatric medical home for children in foster care despite some political resistance; I thank them for always putting the children first; all of my colleagues on the AAP Council on Foster Care, Adoption and Kinship Care; the AAP Washington office and all the wonderful Elk Grove staff from whom it has been a joy to learn and inspiring to work with on behalf of children, especially Dr. Mary Crane and Zach Laris; my husband, Peter, who is the love of my life and my biggest advocate; and of course, all of the children and caregivers who inspired every effort, large and small, over many years and continue to do so.

Because I have a few minutes, I would like to share a few thoughts with the younger pediatric professionals in the audience because you are the future of our profession and for our patients. The 4 pillars of the APA are advocacy, clinical care, education and research.

Why advocacy? Why do doctors need to get involved? Because of how busy we all are with the other 3 pillars, can’t someone else do this part? Well, they do. But the very important thing we bring to this pillar is our science.

We have the science and, therefore, the facts that can inform our advocacy colleagues, policy makers, regulators, and legislators. (1,2) And, the other objection is that no one gets promoted or paid for being an advocate. Well, sadly this is true. And, yet it is advocacy that can actualize and spread the work of the other pillars and lead to real change. So, today, in honor of Sesame Street, we shall focus on the letter P. I know advocacy starts with A but policy starts with P. So here is my list of Ps for pediatric advocacy.


Find your passion. Whether it is an advocacy issue or one of the other pillars, find something that you are passionate about. It makes coming to work each day worthwhile and interesting. Sometimes, in a serendipitous moment, if you keep your eyes open, this work will find you. Improving care for children in foster care as the means to improving their outcomes became the passion of my professional life. And, all because of a patient.


Attuned attentive listening to or acute observation of the circumstances of our patients or their parents is often the spark for what might become our advocacy issue. In my case, it was a question from a teen in foster care: “What did I do when I was 6 months old to end up in foster care?”


It was in trying to answer that question, to gather the facts for this one patient, that I perused the literature and asked questions and learned about the depth of needs of the children and the shortcomings of the systems serving them, including the health care system.


Advocacy takes partnerships. Sometimes the partners are obvious, and sometimes they are a surprise. Find professionals, families, and youth who share your vision and learn from them. Find common ground, a shared mission. In the world of foster care, we have some unexpected allies—it is one of the few truly bipartisan issues in Congress. Who knew? And you will need partnerships, because advocacy itself takes patience and persistence. Don’t take no for an answer, because you won’t get anything done. But, you might need to find a new partner, a different message, a new voice when you confront it.


Lofty goals of improving outcomes or health care are usually best achieved by being broken down into smaller doable pieces. Partners are not only great emotional support; they can help to develop a strategic plan, or what we might call a pathway to get to the larger goal. And, don’t be afraid to start small while dreaming big. Small successes build credibility and confidence. It feels a bit odd to say this while standing in front of Benard Dreyer, who has put ending childhood poverty at the top of the AAP’s and APA’s policy agendas—talk about dreaming big! (3,4) But, Benard and his colleagues took the time to develop a plan—working on doable steps to achieve the prize."

Policy Points

The AAP legislative conference taught me years ago to develop three talking points.

  1. Nowadays, we tweet one at a time. Both work. Choose your words well.

  2. Be positive. Run them by some people. This is your marketing strategy.

  3. Be polite and positive. First of all, it’s nicer. And, being pompous, preachy, or persnickety often alienates those who would otherwise be helpful (I have always wanted to use the word, persnickety, in a talk—mission accomplished!).

So, in case you missed all of those P words: listen to your patients, find your passion, peruse what is known and learn, find partners, be patient and persistent, develop your plan or pathway to your goal along with some succinct policy points, and always be polite and positive.

Because, until every child is well-nourished, well- educated, in optimal health, fully immunized, and living in a safe and nurturing community and family, we have an awful lot of work to do.



  1. Keller DM. Policy, politics, and procedure: our role in building systems that improve the health of children. Acad Pediatr. 2014;14:425–429.

  2. Zuckerman B. Growing up poor: a pediatric response. Acad Pediatr. 2014;14:431–435.

  3. Dreyer BP. To create a better world for children and families: the case for ending childhood poverty. Acad Pediatr. 2013;13:83–90.

  4. Dreyer B, Chung PJ, Szilagyi P, et al. Child poverty in the United States today: introduction and executive summary. Acad Pediatr. 2016;16(3 suppl):S1–S5.

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