From The Field A P R I L 7 , 2 0 0 3 Giving Voice to the Voiceless: The Case for Advocacy Funding RUTH HOLTON The California Wellness Foundation F unding in the public policy arena has always been an fraction of the proposed cuts. These advocacy organizations integral part of achieving The California Wellness were able to respond because they had support from us and Foundation’s mission “to improve the health of the other foundations. people of California by making grants for health promotion, wellness education and disease prevention.” It is also an GRANTMAKING ACTIVITIES important complement to our funding of the provision of The three main areas of our public policy grantmaking are: direct preventive health services, which was mandated to be at public education campaigns, policy research and analysis, least half of our annual grantmaking in the conversion order and advocacy. The public education campaign and the that established the foundation. Many long-term, sustainable research/analysis elements of our strategy lay the groundwork solutions for the issues that health foundations are addressing, and provide the tools for the advocacy component – the focus such as building healthy communities, bringing effective of this article. programs to scale, improving the delivery of service, and increasing access to health and social services, involve changing Funding for advocacy at both the state and local levels can public policy. We strongly believe we have the potential to help ensure that policymakers are responsive to the health improve the health of far more Californians through grants for needs of underserved populations. One can’t simply hope public policy work than we could ever hope to reach through policymakers will do the right thing – public policy is compli- funding direct services alone. cated. Policymakers may not know there is a problem or what the solutions might be. Just as all other vested interests are making their case to policymakers and educating opinion ADVOCACY IN ACTION leaders, so must those who represent the interests of the under- A good example of influencing policy is the effect of advocacy served. If their voice is missing, their needs are easily ignored. efforts of many grantees around last year’s state budget debate. Grants to advocacy organizations provide resources to educate California was facing a $24 billion deficit. Governor Gray policymakers and the media; monitor the actions of adminis- Davis proposed budget cuts and changes in eligibility rules that trative agencies; organize those who are affected and engage would have resulted in more than 500,000 eligible recipients them in the policy process; and build coalitions needed to being denied care through Medi-Cal, California’s state advance an issue. Medicaid program. Health advocacy organizations documented Over the years, successes of organizations funded by The the impact of the proposed cuts; organized a broad-based coali- California Wellness Foundation have included: a statewide tion of service providers, consumer groups, and grassroots and ban on the production and sale of “Saturday Night Special” faith-based organizations to educate policymakers and opinion handguns; significant reductions in the barriers to applying for leaders; held press conferences in communities across the state and remaining on Healthy Families, California’s version of the to highlight what would happen to local services; and brought SCHIP program, and Medi-Cal; and increased funding for 4,000 low-income people to Sacramento to tell their stories and health care for the uninsured – all achievements that will put a human face on the numbers in the budget. They even benefit millions of Californians. succeeded in getting editorials written about complex applica- At the local level, grantees have successfully advocated for tion procedures being proposed that would increase barriers to tobacco settlement dollars to be used to expand access to enrollment. Their efforts paid off. The budget that was passed health care. Furthermore, many of the foundation’s strategic by the legislature and signed by the governor contained only a funding initiatives had community action program compo- nents – community collaboratives primarily made up of were they even receptive to the idea. It was only when they youth working to build healthier communities – that under- saw the importance of policy to achieving their long-term took advocacy efforts that resulted in a restriction on the goals that they became interested. Technical assistance number of liquor stores permitted in a community, the build- providers were then able to help them develop effective ing of a pedestrian bridge over a major freeway so that approaches. Particularly important was training on using children could get to school safely, and funding to address media to build public support for their efforts. problem gambling. • Engaging community members in advocacy has We also encourage health service organizations that long-term benefits. Changing public policy can be an receive grants to engage in advocacy, as they have a unique empowering experience. Once community members have perspective about what policies work and what needs to be experienced a public policy success, they are more likely to improved. They can document the problems and make a stay engaged in efforts to improve their communities and case for improving the system. Policymakers often respect the hold policymakers accountable. Many of the youth involved input of service providers because their solutions are more in community action programs have learned the advocacy likely to be grounded in reality. Since there is a lot of confu- skills they need to make their communities better places in sion about what level of advocacy is permissible for 501(c)(3) which to live. nonprofits among those organizations that are unaccustomed to it, we occasionally send grantees information about the • Organizations with expertise working with youth are regulations governing advocacy activities. generally more effective in engaging youth in advocacy than are organizations whose primary expertise is policy. LESSONS LEARNED When youth are trained in the “how-tos” of advocacy, they The following are some of our lessons learned: can be very effective. This is especially true when they are allowed to identify the issues of concern and are part of • Core operating support provides important flexibility developing the proposed solutions. Youth do not want to be for advocacy grantees. Given the inherently unpredictable used as props. Organizations that are inexperienced working nature of factors that influence the political process, it is with youth often have difficulty giving up the control neces- important that advocacy organizations have the capacity to sary to take full advantage of the resources youth bring, thus respond quickly to advance their policy agendas when win- making it a frustrating experience for both parties. dows of opportunity occur. Grants for core support enable organizations to take advantage of such opportunities. The One of the most important things to remember when funding secondary benefit of core support grants is that they can advocacy is that policy changes do not happen overnight. It be used for all advocacy activities, including lobbying to takes time – years – to change policy. It took six years for the extent permitted by a nonprofit organization’s 501(c)(3) violence prevention advocates to achieve their goal of a state status. This frees the grantee from the burden of segregating ban on the production of “Saturday Night Special” handguns. its expenses related to lobbying from its overall budget. To The work of advocacy organizations needs to be funded even protect the grantor foundation, it is important to include when immediate success isn’t likely. The policy climate can the statement in the grant agreement letter that the funds change rapidly – just look at how quickly states went from are not earmarked for any attempt to influence legislation. surpluses to deficits. Organizations need to be in place and • An important ingredient of a successful advocacy effort have the capacity to take advantage of windows of opportunity. is engaging the grassroots. In an era of term limits, policy- If the opportunities are not there, they need to keep the issues makers may be less likely to have knowledge of the issues, alive. Progress may be slow, but when change happens, mil- so it is particularly important that policymakers hear from lions of people benefit. their constituents. Constituents put a face on the issues, and their solutions are seen as grounded in reality. Many state- focused policy groups, however, do not have a grassroots capacity and need to learn how to seek out and work with grassroots organizations. Grassroots organizations, in turn, rarely have the resources to get engaged in state policy Ruth Holton is director of public policy and a program issues. It is important to provide resources to both types of director for special projects at The California Wellness groups so that they can work effectively with each other. Foundation. • Demystifying the policy process is key to engaging Views from the Field is offered by GIH as a forum community members in advocacy. For most people, the for health grantmakers to share insights and experiences. If policymaking process is a mystery that can make participa- you are interested in participating, please contact Angela tion intimidating. Many of The California Wellness Saunders, GIH’s communications manager, at 202.452.8331 Foundation’s community action program grantees did not or asaunders@gih.org. initially design projects that involved public policy, nor