a research report [executive summary only]

PreparedonbehalfofTheColoradoTrustbySparkPolicyInstitute

Contributingauthorsinclude: JewlyaLynn,Ph.D.

PilarStellaIngargiola,MPH,OneGiving

HealthAdvocacyFieldAssessmentAResearchReport[ExecutiveSummaryOnly]

October2013

A R

esea

rch

Rep

ort

HealthAdvocacyFieldAssessment

PreparedbySparkPolicyInstitute|www.sparkpolicy.com

ThankyoutothefollowingSparkteammembersfortheirinvolvementintheinterviewprocess,managingthedataandreviewingthedraftreport:

KiranObee,JasonVahling,RebeccaKahn,NataliePortmanMarsh,andRachaelMoore.


PreparedbySparkPolicyInstitute|www.sparkpolicy.com 1|P a g e

As The Colorado Trust explores a field building strategy, one of the first steps is mapping theadvocacy field. In this field mapping process, which focused on mapping the health and healthequityadvocacyfields,theadvocateshadtheopportunitytoparticipateinasurvey(madewidelyavailable) and an interview (with 30 selected advocates). They were asked about the fivedimensionsofadvocacyfields,asdefinedinabriefpublishedbyTheTrust(Beer,Ingargiola,&Beer,2012).Thisreportsharesthefindingsoftheinterviews,buildingonthefindingsofthesurveyandintegratingmanyoftheexamplesandideassharedinpreviousreportssupportedbyTheColoradoTrust.Foralistof interviewees,pleaseseeAppendixA.Thefollowingdefinitionsareusedforthefivedimensionsoffieldbuilding(Beer,Ingargiola&Lynn,2013):

• Field Frame. A common frame of reference through which organizations identifythemselvesasafieldandaspartofacommonenterprise.

• Infrastructure.Thearrayofadvocacyskillsneededtomakeprogressonawidevarietyofpolicyissuesthroughoutallstagesofthepolicyprocesses.

• Connectivity.Thecapacityofdifferentactorstocommunicateandcooperateinawaythatallowsskillsandresourcestobemarshaledinincreasinglyproductivewaysovertime.

• Composition.Thevarietyofvoicesthatcanparticipatemeaningfullyandhaveinfluenceinthepolicyprocess. Thismay include representingdifferentdemographic, socio-economic,geographic,disabilityandsectorinterests.

• AdaptiveCapacity. The ability to conduct sound political analysis, select the tactics bestsuitedforaparticularsituation,andadapttotheshiftingmovesoftheopposition,allies,andpotentialallies.

1.DEFININGTHEFIELDANDITSFRAMEBasedontheresultsoftheinterviews,buildingontheresultsofthesurvey,thefieldasrelatestohealthadvocacyinColoradoandthefieldasrelatestohealthequityinColoradomaynotbeonefieldincurrentpractice.Whilethetwofieldscouldbeseenasone,withacentralhealthadvocacycoreand a periphery, an equally legitimate choice would be to look at the organizations and see adifferentadvocacyfieldentirely.

TableES-1.ComparingthefieldsandtheirframesHealthAdvocacyField EquityField

• Astronghealthadvocacycommunitywithleadingorganizationsthatplaydistinctandcomplementaryrolesandabroadernetworkofsupportingorganizations

• Definedbytheissuesofhealthandhealthcare

• Prioritizesissueslikecoverage,qualityofcare,accesstocare,andaffordability

• Verylooselydefinedandconnectednetworkoforganizationsthatarepositionedtobuildthepowerandvoiceofpopulationsexperiencinghealthdisparities• Definedbyissuesofdisparitiesandequity• Prioritizesmanyissuesincludinghealthandsocialissuesthataffecthealthandotherlifeoutcomes,suchaseducation,income,environment,housing,andfoodsecurityjusttonameafew



A small number of organizations appear to sit in both fields – they have advocacy capacitythemselves and engagewith both the organizations on the periphery and themoremainstreamadvocates. Additionally, a few of the mainstream advocacy organizations have taken it uponthemselvestoreachintotheequityfieldanddrawuponothersinordertoachievetheiradvocacywins,includingCCLPandCCHI.

2.NETWORKORGANIZATIONS

Many advocacy organizations have specific populations as the focus of their work. Theorganizationsfocusedonadvocacyforchildrenareamongthemostwellconnectedorganizationsinthe network. In contrast, organizations representing people of color are largely outside of theadvocacynetwork(FigureES-1).TheorganizationsadvocatingforNativeAmericans(bottomrightofthevisual)areverywellconnectedtoeachotheryetfairlyisolatedfromthenetworkasawhole.TheorganizationsadvocatingforAsianAmericanandAfricanAmericanpopulationsaregenerallyconnectedtootherorganizationsadvocatingforpeopleofcolor,butrarelyconnectedintothemainadvocacy network. In fact, in order gain access to the main advocacy network, they have to gothrough other groupswho also have narrow advocacy foci.Multi-cultural organizations are alsogenerally isolated, relying on limited connections that fail to reach to the core center of theadvocacynetwork.OrganizationsadvocatingforLatinosarescatteredthroughouttheperipheryofthenetwork,butaclusterareconnectedontherightside.Thisgrouphasdirecttiesintothecoreofthe advocacy network indicating it has greater involvement with mainstream advocacyorganizations.

FigureES-1



3.DIAGNOSINGTHESTRENGTHSANDWEAKNESSESOFTHEFIELD

Afieldmappingstrategyseeks todiagnose thestrengthsandweaknessesofa field, revealing theopportunitiestoleverageandissuestoovercomeasthefieldisbuilt.Thistypeofmappinginformsnotonlypotentialfundingstrategies,butalsowheretodeployauxiliaryresourcestobuildthefield.

Dimension SummaryofFindings

InfluenceoverPolicyAgenda

Groupswithgreatestinfluenceinclude:• Executivebranch,regulatorysystemandinsurancecompanies.• Advocates(mostoftennamedwereCCHI,CCMU,CCLP).• Industrygroups(ColoradoHospitalAssociation,ColoradoMedicalSociety).• Funders,includingTheColoradoHealthFoundationandTheColoradoTrust.Withinperipherygroups,organizationsidentifiedasraisingthepowerandvoiceofLatinosweremorelikelytobeseenashavinginfluencethanorganizationsfocusedonotherpopulations.

FramingRelatedtoHealthEquity

Interviewees described how their organization focuses on health equity through alens thatwasmoreaboutequitableaccess tohealthcare thansocialdeterminantsofhealth. A few organizations within this network have missions that allow for abroaderfocusthanjusthealthcarewerenotedaspursuingtheissuesinsiloedways,ratherthanbringingthemtogether.

Infrastructure

• Organizationsontheperipherylackcapacitytoengageinadvocacy.Inadditiontofunding,thesegroupsneedanincreasedunderstandingofadvocacyinordertomorefullyparticipate.

• Shared messaging is needed and there are some examples of it happening.Messagesneedtobecollaborativelydeveloped,relevanttocommunitiesofcolorandmorewidelytranslated.

• Policymakereducationisanareawithcapacity,butprimarilyamongmainstreamadvocates.Mainstreamadvocatesreportedthatahealthequityframewouldnotbeusefulinthissetting.Peripherygroupslackthecapacity,credibility,influenceandaccesstopolicymakers.

• Grassroots engagement is generally weak with significant disconnects betweenadvocates and the communities they seek to recruit. Mainstream intervieweesbelieve the community is not interested in participating, while peripheryorganizations reported advocates don’t understand race, privilege and how tospeaktocommunities.

• Ballot initiatives, voter outreach, and voter canvassingare areas of low capacityandmanyintervieweesareconcernedaboutthisaspartofsuccessfuladvocacyishaving the right people elected as legislators and there is a need to havecommunities of color engaged andvoting.Where capacity exists, it is primarilyamongorganizationsengagingtheLatinocommunity.

• Publicengagementisanotherareawithroomforgrowthwithalackofstrategies,challengeswithfindingtherightchannelsofinformationsharing,anddifferencesofopinionbetweenmainstreamandperipheryorganizationsonhowtoaddressthechallenges.

• Political and policy analysiswas identified as largely focusing on coverage andcare.Theintervieweescalledforamorevisionaryanalysistodrivepolicy.



Dimension SummaryofFindings

• Coalitionsandpartnershipsareareasofbothstrengthandgreaterneed.TheCivicEngagementRoundtablewashighlightedasanexampleofapartnership,aswasProjectHealthColorado.

Connectivity

Connectivityacrossthesedifferentorganizationsiscomplex.Itisnotjustaquestionof whether relationships exist, but when they exist, who initiates them and theperceptionsandconsequencesoftherelationships.Barrierstoconnectivityinclude:• Limitedcapacityamongperipheryorganizations.• Issueframing.• Lack of mutual understanding about each other’s contexts and disconnects

betweenmissions.• Lackofdiversityamongstaffatcentraladvocacyorganizations.• Unspoken dynamic of conflicts based on individual personalities and

organizationalactions.

AdaptiveCapacity

Limited adaptive capacity was reported, with only four organizations beingrepeatedlyidentifiedashavingcapacity:CCLP,CCC,CCMUandCCHI.Adaptivecapacitydescribedastheabilitytoturnonadime,transitionpriorities,haveaproactiveagendaandebbandflowasneeded.

CompositionIntervieweeswidely agree that the health advocacy arena is composed of a “sea ofwhitepeople”andneedstodiversify.Individualsarethedriversoftheadvocacyfield,notorganizations.

StrengthsandWeaknessesbyPopulationGroup

Interviewees were asked which groups are positioned to raise the power and voice of specificpopulationsexperiencinghealthdisparities.Overall,moreorganizationswithgreatercapacityandconnectivity were identified related to Latino communities than any other groups experiencingdisparities. Organizations raising the power and voice of Native Americans were particularlyisolated and low capacity, as were organizations raising the power and voice of AsianAmerican/Pacific Islander communities. Very little adaptive capacitywas reported across all theorganizationsraisingthepowerandvoiceofdifferentpopulationsexperiencingdisparities.

While the connectivity, infrastructure, and adaptive capacity were all low, it may be thatintervieweeslackedsufficientknowledgeofsomeofthesecommunities.



FigureES-1.Summaryofinterviewees’perceptionsaboutorganizationstheybelievearebuildingthepowerandvoiceofdifferentpopulationgroups

4.STRATEGIESFORBUILDINGTHEFIELD

Asfieldbuildingisnotnewinpractice,thereareexamplestrategiesthatTheTrustcanlooktoastheydeveloptheirapproaches.Someofthesestrategiesalignwellwiththerecommendationsandthoughtsoftheinterviewees.Someconflictwiththeinterviewees’feedbackandothersareoutsidetherangeofwhatintervieweesidentifiedasimportant.

Strategy BriefDescription

1.Changingthesetoforganizationsworkingtoinfluencethepolicydomain.

The core of this strategy is to engage organizations ininfluencing policy that previouslywere disengaged, either dueto a lack of capacity or lack of priority on the issue. Withoutdedicatedandsufficientresources forperipheryorganizations,participating in advocacy capacity building, much less beingactiveandinfluentialadvocates,isunlikelytohappen.

2.Changingthesetofindividualsworkingtoinfluencethepolicydomain.

Leadership development strategies have potential not only todiversifythefield,butalsotodevelopadvocateswithkeyskills,such as adaptive capacity, that are needed in the field morebroadly.

3.Engagingthefieldindevelopingacommonframefocusedonhealthequity.

Fieldframesarenotmessages,butratherframesofreferencesthatshapehowadvocatesseethemselvesandothersaspartofasharedfield.TheTrustcouldworkwithgranteestouncover,expand,andexplorethefieldframe.Aframingeffortmayneedtobeginwithlearningbeforeanequityframeisevenpossible.

# of Orgs Identified

Connectivity to interviewees

Adaptive Capacity

Use of HE Framing

Grassroots/ Mobilizing

Messaging/ Communications

Political/Policy Analysis & Lobbying

Latinos (25)

Latinos

Latinos

Latinos Latinos

Latinos

Latinos

Rural (8)

Rural

Rural

Rural

Rural

Rural Rural Native Americans

(5)

Native Americans Native

Americans Native

Americans

Native Americans

Native Americans Native

Americans

Asian/PI (5)

Asian/PI

Asian/PI

Asian/PI Asian/PI Asian/PI Asian/PI

African Americans (10) African

Americans

African Americans

African Americans

African Americans

African Americans

African Americans

Low Income (14)

Low Income

Low Income

Low Income

Low Income

Low Income

Low Income

Immigrants/ Refugees (12)

Immigrants/ Refugees









4.Engagingthefieldasawholeinopportunitiesfortechnicalassistance,notjustgrantees.

TechnicalassistancethatisbroadlydisseminatedmayallowTheTrusttoreachmoreoftheseorganizationsthanfundingalonewouldpermit.However,givencapacityissuesidentified,thisstrategymightfailtoengagesomeorevenmanyoftheseorganizationsiftheirbasicstaffingcapacityneedsarenotmet.

5.Targetingresourcestospecificgapsininfrastructure,whilebuildingconnectivityamongjustthoseorganizations.

MirroringtherecentworkofProjectHealthColorado,asimilarstrategycouldfocuson:

• Overcomingthecapacitygapsamongtheequityfield,• Building a base of advocacy time and skills for multipleorganizations.

Thisapproachwouldallowforagroupofperipheryadvocatestobuildthecapacitytodeveloptheirpolicyprioritiestogether,withouttheinfluenceofmainstreamadvocatesandtheirtypicalstrategies.

6.Changingthebodyofknowledgeandexperiencethatadvocatesdrawuponthroughcreatinga“hub”

Whilethisconcepthasintuitiveappeal–placingtheresponsibilityforbuildingthecapacityofthefieldinanorganizationoutsideofthefoundationandinoneorganization,ratherthanacoalition,whichcouldbemessierandslowertomove,itmaynotresonateintheColoradocontextduetopowerdynamicsandlimitedfundingfortheadvocacyfield.

7.Changingthebodyofknowledgeandexperiencethatadvocatesdrawuponbyprovidingnewinformationandtechnicalassistance.

Mainstreamadvocatesprimarilysupportedcontinuedinvestmentinconveningsforlearningpurposeswithsomesupportforfundingdatastrategies.Peripheryorganizationsoverwhelminglysupportedbuildingskillsandcapacitiesofindividualorganizationstoengageinadvocacy,buildingknowledgeamongthepublicandpolicymakersofhealthdisparities,andcontinuingtofunddatastrategies.

8.Changethebodyofknowledgethatadvocatesdrawuponbyprovidingassistancetothefieldtodevelopanddeploysharedmessaging.

Developingasharedmessageby:• Bringingorganizationstogethertodevelopit;• Focusingonaccessiblelanguagethatthepublicwill

understand;• Usingdataandevaluationtoguidemessagedevelopment;• Focusthecontentofthemessageoncommunities,notwhat

funderswant;and• Createmessagingthatresonateswithdiversegroups.

9.Changinghowtheadvocatesconnectandinteractthroughconvenings.

Developingaconveningstrategythathassomecombinationoflearning,relationshipbuilding,andtakingactiontogether.Considerusingdifferentconveningapproacheswithdifferentparticipantsovertimeasthefieldisbuilt.

10.Changinghowtheadvocatesconnectandinteractthroughstrategicuseofshort-termtransactionalcampaigns.

Basedonthebeliefthatengagingadvocatesinasharedstrategywillhelpthemtobuildnewhabitsofinteraction.Onlyencouragedbymainstreamadvocates,whichmaysuggestalackofreadinessamongperipheryadvocatestoundertakespecificpolicyprioritiesbeforetheircapacityishigher.




11.Changinghowtheadvocatesconnectandinteractbyfundingcollaborationsandcoalitions,notindividualgrantees.

Requiringorcreatingstrongincentivesforcollaboration.Thisstrategymaybeprematureormay,atleast,requiresomecarefulthoughtinordertoensurethelessinfluentialorganizationsarefullpartnersinthecollaborations.

12.Designfundingmechanismstosupportadaptation.

Considergeneraloperatingsupport,multiyearfunding,andrapidturnaroundfundingtoallowforgreateradaptivityinadvocacyorganizations.

13.Supportingadvocatestoleadthedevelopmentofafieldbuildingstrategy.

Overcomehesitationsaboutintentionsbehindtheprocessandlong-termdisconnectsbetweenfundersandcommunitiesofcolorbyengagingadvocatesintheprocessofdevelopingthestrategy.Itmayalsohelpwithsomeofthedynamicsofdistrustanddislikeamongadvocatesinthefield.

14.Activelyengaginginbuildingtheframing,connectivityandevenadaptivityandcompositionofthefieldofhealthadvocacyandequityfunders.

Convenethefoundationcommunitytotalkaboutwhatwaslearnedinthemappinganddevelopalignedstrategiesforbuildingtheadvocacyfieldorfields.Worktogethertobuildconnectivityandadaptivecapacityamongthefunders.

5.DEPLOYINGANDSEQUENCINGSTRATEGIES

Thedecisionsabouthowtodefinethefield,deploythestrategies,andsequencethestrategiesarejustasimportantaswhichstrategiestodeploy.Witheachchoicemade,TheTrustwillbeshiftingthepowerdynamicswithinthefieldandcausingbothintendedandunintendedconsequences.Thiswouldbe trueof any funding strategyandcertainlyof any fundingstrategy inadvocacy.What isdifferent is that the focus on field building creates an opportunity for funding strategies to bedesignedwithawarenessaboutthewaythatfundingchoiceswillinfluenceanentirefield,notjustanorganizationorsmallsubsetoforganizations.

Deploymentchoices,suchasthetypesofcapacitytobuild,whentoengageadvocates,whethertodoconnectivitystrategiesbeforeoraftercapacitystrategies,whetherTheTrustispartofthefieldor a neutral convener, etc. will have significant impacts on the outcomes. The possibleconsequences of these types of decisions include the extent to which advocates buy in to thestrategy, whether capacities are developed in isolation or in a field context, the extent towhichpolicyprioritiescontinuetobedrivenbymainstreamadvocatesratherthanbyperipherygroups,andtheoverallpowerdynamicsofthefield.

6.NEXTSTEPS

Although this reporthighlightsmany strategies andopportunities, a somekeydecisionsmustbemadebeforeanyofthestrategiescanbedesigned,includingthedesiredoutcomesofthestrategy,thedefinitionofthefield,theidentificationofwhoneedstobeinvolvedindevelopingthefundingstrategyandatwhatpoint,andthetimehorizonforbuildingthefield.



Oncethestrategyismorefullydesigned,whetherinpartnershipwithadvocatesandotherfundersor largely by The Trust’s staff and leadership, in addition to implementing the strategy, anevaluation will be needed. Questions to explore include which dimensions are priorities for theTrust and given those, what evaluation strategies can provide the most useful information; theextent towhich real-time informationwill be useful; and how advocateswill be involved in theevaluation.

AsTheTrust seeks to answer thesequestions, therearemany fundersnationally thathavegonethrough a similar process – mapping, defining a strategy, implementing and evaluating. Anopportunity exists to learn from these funders aboutwhat hasworked for themaswell aswhattheywouldhavedonedifferently.

REFERENCESBeer,T.,Ingargiola,P.S.,andFlynnBeer,M.(2012).Advocacy&publicpolicygrantmaking:Matching

processtopurpose.Denver,CO:TheColoradoTrust.

Beer,T.,Ingargiola,P.S.,andLynn,J.(2013).Fieldbuildinginadvocacy:Framingthe2013Dialogue.PreparedbybehalfofTheCenterforEvaluationInnovationforthe2013FieldBuildinginAdvocacyConvening.

APPENDIXAThankyoutotheintervieweesfortheirparticipationinthisproject:• Dr.JandelAllen-Davis,VicePresidentofGovernmentandExternalRelations,KaiserPermanente

Colorado• ElisabethArenales,Director,HealthProgram,ColoradoCenterforLawandPolicy• HeidiBaskfield,ExecutiveDirectorofAdvocacy,StrategyandExternalAffairs,Children’sHospital

Colorado• CodyBelzley,VicePresidentofHealthInitiatives,ColoradoChildren’sCampaign• KellyBrough,PresidentandCEO,DenverMetroChamberofCommerce• WadeBuchanan,President,TheBellPolicyCenter• MonicaBuhlig,DirectorofBasicHumanNeeds,DenverFoundation• BradClark,ExecutiveDirector,OneColorado• WhitneyConnor,SeniorProgramOfficer–Health;JanetLopez,ProgramOfficer–Education;and

ElsaHolguin,SeniorProgramOfficer-Child&FamilyDevelopment;RoseCommunityFoundation• DeborahCostin,ExecutiveDirector,ColoradoAssociationforSchool-BasedHealthCare• Denise(Dede)dePercin,ExecutiveDirector,ColoradoConsumerHealthInitiative• CorrineFowler,EconomicJusticeDirector,ColoradoProgressiveCoalition• KelliFritts,AssociateStateDirectorforAdvocacy,AmericanAssociationofRetiredPersons• JimGarcia,ExecutiveDirector,ClinicaTepeyac



• RudyGonzales,ExecutiveDirector,ServiciosdeLaRaza• GabrielGuillaume,VicePresidentofCommunityInvestments,LiveWellColorado• GretchenHammer,ExecutiveDirector,ColoradoCoalitionfortheMedicallyUnderserved• AliciaHaywood,PolicyandAdvocacyManager,ColoradoRuralHealthCenter• NitaHenry,ExecutiveDirectorofCareerServiceAuthority,CityandCountyofDenverandFounder/

DirectorofTheKaleidoscopeProject• SusanHill,VicePresidentofPrograms,CaringforColoradoFoundation• JohnJewett,BehavioralHealthSupervisor,DenverIndianFamilyResourceCenter• MoeKeller,VicePresidentforPolicy,MentalHealthAmericaofColorado• AshlinMalouf-Spinden,AssociateDirector,TogetherColorado• LorezMeinhold,CommunityPartnershipsOfficeDirector/DeputyExecutiveDirector,The

DepartmentofHealthCarePolicyandFinancing• OliviaMendoza,ExecutiveDirector,ColoradoLatinoLeadership,AdvocacyandResearch

Organization• SamMurillo,FamilyNavigatoratChildren’sHospital,FamilyVoicesColorado• MauricioPalacio,Director,OfficeofHealthEquity,ColoradoDepartmentofPublicHealthand

Environment• KathyUnderhill,ExecutiveDirector,HungerFreeColorado• LisaVanRaemdonck,ExecutiveDirector,ColoradoAssociationofLocalPublicHealthOfficialsand

ThePublicHealthAllianceofColorado• ChristineWanifuchi,ChiefExecutiveOfficer,AsianPacificDevelopmentCenter

a research report [executive summary only]

Documents