Module 5

Advocacy and Taking Action

Turning analysis into a decision memo that could actually move money.

Module Focus

This module is different. You are not writing a school essay. You are writing something that a real decision-maker could use.

Key concept: Social Return on Investment (SROI)

Spending money now can prevent bigger costs later. Your job is to show the math.

Decision-makers usually have three questions:

How big is the problem?
Size it with numbers.
What will your plan cost?
Show the investment.
What happens if we do nothing?
Show the cost of inaction.

Learning Targets

By the end of this module, you should be able to:

  • Use a simple back-of-the-envelope calculation to estimate the size of a local problem.
  • Explain the health impact of a policy choice using a clear chain of cause and effect.
  • Compute a simple SROI-style argument: cost today versus savings later.
  • Write a one-page Action Memo that includes a trade-off and a next step.
Check Your Understanding

A good BOTE calculation should:

A BOTE calculation is not about being perfect. It is about being transparent and credible. State your assumptions, use round numbers, and show your steps.

The best definition of SROI is:

SROI compares the cost of a program today to the savings it generates later (avoided ER visits, hospitalizations, missed work, etc.). It answers: does this investment pay off?

1) Why Advocacy Needs Numbers

Advocacy often fails when it only says "this is important." Decision-makers need more than passion. They need answers to concrete questions.

The three questions every decision-maker asks:

  1. How big is the problem?
  2. What will your plan cost?
  3. What happens if we do nothing?

Your job is to answer those questions clearly, with simple math and clear logic. You do not need perfect data. You need a credible estimate that shows you have thought it through.

2) BOTE Calculations (Back of the Envelope)

A BOTE calculation is a quick estimate using simple assumptions. It is not perfect, but it is transparent and useful.

The BOTE formula

Impact ≈ How many people × How often × Cost per event

Examples of events you might estimate:

Asthma attacks
Missed school days
ER visits
Untreated depression episodes
Lead exposure cases
Days without school nurse coverage

Rules for good BOTE math:

  1. State your assumptions clearly — Transparency builds trust
  2. Use round numbers and show your steps — Easy to follow and check
  3. If uncertain, choose a conservative estimate — Under-promise beats over-promise
  4. Your goal is not to be perfect — Your goal is to be credible

3) Health Impact Thinking (HIA Style)

HIA means Health Impact Assessment. You do not need a full formal assessment. You need the core idea:

A policy changes conditions. Conditions change behavior and exposure. Behavior and exposure change health outcomes.

The HIA chain

Policy action → Environment or access changes → Behavior or exposure changes → Health outcomes change
Example chain: School nurses
Add school nurses → Faster response to asthma symptoms → Fewer emergency calls → Fewer missed school days

4) SROI Logic (Simple)

SROI means Social Return on Investment. It is the idea that spending money now can prevent bigger costs later.

Cost today
What we spend to run the program.
Savings later
Avoided costs: ER visits, hospitalizations, missed work, crisis response.

Simple SROI calculation

SROI ratio = Estimated savings ÷ Program cost
SROI > 1

Program saves more than it costs. Strong argument for funding.

SROI < 1

Can still be worth it if health benefits are large. But you must explain why.

Example: School nurse SROI

1Program cost$95,0001 nurse
2Avoided ER visits40 visits × $1,500$60,000
3Avoided missed days200 days × $150$30,000
4Total savings$60,000 + $30,000$90,000
5SROI ratio$90,000 ÷ $95,0000.95
Almost pays for itself in avoided costs aloneSROI 0.95

Interpretation: Add the non-monetary benefits (less suffering, better learning) and the case is strong.

Important: Some benefits are real but not easily priced (like reduced suffering). You can mention them, but you should still quantify what you can.

5) Trade-offs (What Makes This Real)

Every proposal has trade-offs. A strong memo states them directly.

If the city funds this, what does it not fund?
Budgets are limited. Something else gets less.
If we reduce one risk, do we increase another?
Interventions can have side effects or shift burdens.
Who benefits first, and who waits?
Prioritization means some people wait longer.

Key point: Acknowledging trade-offs makes your memo more credible, not weaker. Decision-makers know trade-offs exist. Show them you know too.

Capstone Task

One-Page Action Memo

What you will submit

A one-page memo that a city council member, school administrator, or clinic director could read in two minutes.

Pick one issue

Lead in water
Contamination affecting child development
Lack of school nurses
Delayed response to health emergencies
Asthma triggers near schools
Air quality and respiratory health
Long travel time to clinics
Access barriers to care
Food access near a neighborhood
Nutrition and chronic disease risk
Mental health counseling shortage
Unmet need and crisis escalation

Action Memo Template (required sections)

  1. Issue. What is happening, where, and who is affected? (2–3 sentences)
  2. Economic problem. Pick one: negative externality, information failure, public good, market power, or unequal access due to constraints.
  3. Proposal and trade-off. What will you do, and what are you giving up or asking others to pay?
  4. BOTE estimate. Use: People × Frequency × Cost per event. Show your steps.
  5. SROI argument. Program cost, estimated savings, SROI ratio, and one sentence explaining what it means.
  6. Next step. Who must act next and what should they approve?

Built-in numbers (use these)

You can complete the memo without additional research. Use whichever fits your issue.

Common costs
ER visit$1,500
Hospitalization$12,000
School day missed$150/day
Counseling session$120
Water filter / household / yr$80
Full-time school nurse / yr$95,000
Example frequencies
Students with asthma10%
Students with frequent anxiety5%
ER visits / yr — high-risk asthma2
Check Your Understanding

Which chain matches HIA-style thinking?

HIA thinking traces the chain: a policy changes conditions, conditions change behavior and exposure, and behavior and exposure change health outcomes. It is a clear cause-and-effect pathway.

If a program costs $100,000 and saves $200,000, the SROI ratio is:

SROI = Savings ÷ Cost = $200,000 ÷ $100,000 = 2. An SROI of 2 means every dollar spent saves two dollars in avoided costs.