Getting Health Profession Workforce Diversity on the Public Agenda:
A Communications Toolkit
Introduction
For more than a year, a multi-disciplinary team of researchers examined health professions
workforce diversity (HPWD) in California from virtually every aspect of the issue. This Public
Health Institute initiative, Connecting the Dots: California Initiative to Increase Health
Professions Workforce Diversity (http://www.calendow.org/Article.aspx?id=2290), included an
examination of K-12 challenges and promising practices, a range of post secondary and
workplace issues and practice as well as issues in strategic communications and HPWD.
As part of the research to support strategic communications, a report was developed by The
Praxis Project titled, If It’s a Pipeline, Why Isn’t There More Diversity At the Other End?
Framing the Agenda for Health Professions Workforce Diversity (www.thepraxisproject.org)
that examined current challenges in framing HPWD and made recommendations for advocates
working to advance HPWD issues in the policy arena.
This guide is based on the report’s findings and is designed to help you tell the story of why
health profession workforce diversity is important, how key institutions like government, schools
and hospitals have affected diversity in the health professions and what can be done to make a
difference. The guide focuses on news media and public education as the primary vehicles for
engaging potential stakeholders on these issues. The emphasis of this guide is on
communications to support changing policy and practice and not as much on increasing
awareness about opportunities in the health professions. Although making people aware of
health profession opportunities is important, this guide focuses on building public support for
more effective programs and dedicated resources to HPWD as an important way to ensure that
we have enough competent health professionals with the experience they need to effectively care
for everyone in our communities.
The guide is in three parts. The first section provides a brief summary of the issues and the
findings that frame the communications strategy overall outlines messages and framing
opportunities. The second section focuses on preparation for engaging the media and overall
goal setting. The third and final section includes resource materials including a template for a
media plan, a sample spokesperson practice exercise, tips on working with journalists and other
ideas for strengthening your media infrastructure.
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WHAT’S AT STAKE: Ensuring Quality Health Care for All Californians
As an advocate, you already know that California, like the rest of the nation, is facing an acute
shortage in health professionals and that the health workforce we have is not diverse enough to
adequately serve California’s current population – much less the even more diverse state we will
have in the future.
The data confirms what we know from experience: the higher up you go on the health
professional continuum, the whiter the field. People of color are mostly in support professions as
assistants and Whites (and to a much lesser extent, Chinese, Asian Indians and Pakistanis)
comprise the vast majority of the physician/surgeon workforce.1
For those unfamiliar with the issue, the lack of HPWD diversity may seem natural, even
unavoidable. Misconceptions about race, culture and ability shape how many see these issues.
Lack of awareness of the barriers facing underrepresented communities (like racism, economic
issues and inequitable funding for public schools) exacerbate these misconceptions.
Figure 1 (below) examines some of the many “stories” that shape how people “hear” what we
have to say about HPWD issues.
Concepts of the
proper role for
government and
public investment
– especially re:
creating equity
Concepts of
fairness re: equal
access to quality
education for
children of color
Concepts of gender
and race inequity:
degree of belief
that it needs to/can
be addressed
Concepts of
diversity,
multiculturalism
changing
demographics
Health
Professions
Workforce
Diversity
relates to…
Concern about
access to quality,
culturally
competent health
care now and in
the future
Concepts of
fairness re:
affirmative action
special programs
for recruitment/
retention post-12
Associations
between quality
care and diversity
(patient-provider
concordance, race
and competence)
Concepts of access
to equity,
opportunity,
equality: degree of
support for
intervention, $
1
Data from Bates, T., Hailer, L., et.al. Quantitative Assessment of Diversity in Selected Health Professions in
California, UCSF Center for Health Professions, San Francisco, September 2007
http://www.calendow.org/uploadedFiles/Publications/By_Topic/Culturally_Competent_Health_Systems/Workforce
_Diversity/SelectedHealthProfessionsinCA.pdf
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I. Getting Ready for Media Advocacy
"The idea is to link it to the problems that are already being covered…how is it affecting what
the rest of us are getting?”
- Jim Brewer, reporter, San Francisco Chronicle
Using the media to tell stories for policy change is often called media advocacy. Media
advocacy is just one part of a comprehensive change strategy that should also include
mobilization and community organizing to build public support for change; and research and
policy development to help identify the most effective policies and decisionmaking structures
with which to work.
Know your territory. When we asked health journalists for advice on effectively framing health
professions workforce diversity, we heard again and again how important it was to link our
stories to issues of current interest. There is only one way to connect or piggyback on existing
news and that is to pay attention to what is being reported.
Imagine driving cross country and having no idea what direction to go, what month it is or what
the weather will be. Framing your issue without first monitoring media coverage of it is much
the same thing. Good media advocacy requires some surveying of the terrain and a system for
tracking coverage and media outlets.

Keep an updated media list with names. You can start with the many published media lists
available online, through bookstores or nonprofit associations. Calls should be made to local
outlets that are important to your efforts to get the names of key contacts. Routine calls
should be made to update lists as personnel moves frequently.

Track coverage at least monthly. Some electronic services will track major news outlets in
online databases for a fee. Many local papers, especially ethnic and other community press,
are not a part of these services but can often be tracked using google or other search engines.
It makes sense to regularly monitor (i.e., read, watch, subscribe to) key outlets in your area.

Monitor with a mission. Look for how HWPD and the related issues in Figure 1 are covered
in papers or on broadcast news. Look at who’s quoted, how are they quoted and how much;
whether the reporter had a grasp of the issue’s complexity/importance; and the overall angle
or frame of the story.
Map out key reporters and outlets. Review your monitoring and identify the media outlets and
reporters that are covering related issues. If there are key outlets that are missing, note that, too.
The sample chart below offers one, relatively simple way to organize your findings. The grade
allows you to summarize the overall impression of the coverage as it relates to what you are
trying to communicate. Outlets and/or journalist can be prioritized by a combination of grade
and outlet importance in your communications plan. When prioritizing, outlets that already have
a good track record are important to cultivate. Outlets that have been resistant may be lower
priority, unless they are critical to your efforts. In cases of negative or resistant outlets, be sure
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to identify whether it’s the outlet or the reporter and plan education and relationship building
efforts accordingly.
Outlet/Reporter
Eagle News/Joe
Smith
Daily Sheet
Figure 2: Media Monitoring Analysis
Issues Covered
Trend
Grade
Race and
Does a good
B
education,
job/gets it. No
population
health issues yet
changes
No local
Only reprinting
F
coverage of
wire stories
related issues in
last year. Lost
health reporter in
staff cuts
Next Steps
Send information
on education and
HPWD and call to
follow up
Look at who is
left on staff and
identify potential
people to
cultivate. Perhaps
talk with editor.
Identify clear issues and solutions. Be prepared to talk about what’s at stake and the solutions
we are offering to address this crisis – especially given the public funding crunch.
Journalist Interviews’ Key Take Home Lessons for HPWD Advocates
Provide clear examples of what is at stake/why HPWD matters for as broad an audience as
possible. Journalists are often writing for multiple audiences and these audiences should be kept
in mind when framing and pitching news stories. Always ask, why should someone care about
this? The answers should inform story development at its core.
Identify diverse spokespersons that illustrate the stories we are trying to tell. Journalists
want to tell compelling, visually rich stories. Although data is important, we need to convey
what the data mean in human terms with good stories and compelling characters -- and without
losing our focus on the role of institutions and public policies. The key is to ensure that
spokespersons tell their story in ways that complement and elucidate the larger context.
Develop relationships with journalists over time by providing information and sources they
can use – even when the story is not directly about HPWD. Journalists need good, reliable
information and sources. Many of us are well connected to a wide range of helpful sources,
especially on health and education issues. With consistent, strategic relationship building,
advocates can expand the ranks of journalists who understand HPWD and its relationship to a
number of important issues they cover.
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II. Framing Our Message
A pipeline conjures up images of fluid, uninterrupted movement from point A to B – nearly the
opposite of what is actually occurring with regard to HPWD. Truth be told, with navigating the
rules, the schools, the costs and the pressure, the road to becoming a health professional
(especially at the higher echelons) looks more like an obstacle course than a pipeline.
Of course, we want a pipeline. We need a pipeline – a set of networks so interconnected, sturdy
and efficient that everyone who chooses can flow through this system and have the necessary
support to come out the other end ready to serve. Still, it will be important to convey that the
pipeline is a work in progress. It is a goal, not yet a reality. However, there is an upside to this
message: we already possess most of the know-how we need to make it a reality. We just need
to come together and make it a priority.
In addition to re-examining our metaphors, there is also the need for clearer, simpler language to
describe HPWD efforts – especially to those outside of the field. This will require taking a break
from the level of detail and precision required for generating policy briefs or research and
focusing instead on language that speaks to people at the level of their emotion. This does not
mean developing emotive messages in isolation from policy goals. On the contrary, it is
important to maintain consistency between each level of communication; meaning,
communication messages should not contradict messages at the level of policy detail and vice
versa.
It is important to note that a message is not a soundbite but an overarching theme that can be
communicated using soundbites. For example, a soundbite might be, "We roll the dice hoping
that we’ll end up with enough doctors from the small pool of people who can afford to prepare
for and pay for medical school. But it isn’t good policy and it isn’t good sense.” The message,
in this case, is that current policies to address the physician shortage are short sighted,
impractical and puts us all at risk. The underlying values communicated are the need we all
share for security, to have the services we need when we need them and to have sensible public
policy.
Following (Figure 5) is a chart of message examples at each level of discourse along four
message themes.
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Figure 5: Examples of Communicating at Levels 1-3
Message Themes
Level 1 (values)
Level 2 (issue)
Level 3 (policy)
There is a lot at stake. We
must act now to avoid a
health care crisis and
ensure that there are
enough providers for every
community.
Every community matters
The future of our health
care depends on how we
face this challenge
together (set aside bias,
etc.)
Policy goals and
recommendations re:
improving networks and
collaboration; funding
equity
Our solution is fair,
practical and sensible: we
must increase the number
of providers from our
communities so that we
have a knowledgeable
[could also use culturally
competent] health
workforce that reflects our
state. (A health workforce
that looks like California)
This is about Californians
caring for California
We need a health
workforce that is truly
representative. Achieving
this means we have to
clear the road blocks to
opportunities in the health
professions
Policy goals and
recommendations re:
improving support
systems/policies to
increase the number of
students, professionals,
faculty, etc., along the
“pipeline”
We have the know-how to
get this done
Ingenuity, initiative,
rolling up our sleeves,
“just do it”
Communicating about
successful programs and
pilots
Working together, we can
do it.
Sharing the work, taking
responsibility, also rolling
up our sleeves
All over the state, there are
success stories. With the
right investment, we can
take success to scale
The Legislature, health
care sector, etc. all have
important roles to play.
We need you to play them.
Safety, valuing
community, fairness,
caring for others,
compassion, etc.
Local pride, common
heritage, caring for
neighbors, common sense
Communicating about
successful collaborations
and targeted briefings on
policy options
These simplified messages for conveying issues around HPWD are grounded in change
communications principles that prioritize communicating action2. Messages to advance policy
and/or institutional change must focus on the institutional roots of the issue and offer concrete,
understandable “solutions” with change actors in mind. It does no good to develop messages
promoting individual responsibility for an effort that requires action by legislators. Actions and
messages must reinforce one another.
Good messages are affective -- they touch us emotionally. They are effective -- they convey what
we need them to. They connect with shared dreams and beliefs. They surface the promise and
possibilities in our coming together. Good messages also communicate "what can be done" so
that those who are normally outside the process understand what they can do to have more power
inside the process. Again, this requires that communication and strategies are integrated.
For more on change communications, see Wallack, L. and Woodruff, K., et.al. News for a Change: An Advocate’s
Guide to Working With the Media, Sage Publications, 1999 and Themba, M. “The Bridge Just Beyond: Constructing
Communications for Social Change,” www.thepraxisproject.org.
2
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Communicating Along the Pathways of Change
The first step in developing an integrated, action oriented communications strategy is to identify
actions and decision pathways where change must likely occur. We began mapping change
agents by examining the core group of informants for the other inquiries and developing a list of
corresponding key decisionmakers to implement emerging recommendations from the
informants and researchers in each of the inquiries (Figure 6 below).
Figure 6: Moving From Informant Audiences to Decisionmaker Audiences
Informant Audiences: Stakeholders
With Critical Perspectives
Corresponding Decisionmakers: Actors
With Power to Shape the Issue
Health professions educators at
academic institutions
Faculty Senate, Department Chairs,
Administrators, Chancellor, President,
Trustees/Regents, Accreditation
Faculty members who take on
“diversity enriching courses”
Health professions educators at
provider organizations
Professional Associations, Provider Boards
Health professions students from
community college along the continuum
through medical school
Campus and Statewide Student Associations
Pre-health and non-health related declared
underrepresented minority students from
each of the public university and college
systems, private college and high schools
Entry to mid-level professionals such as
community health workers, associate
degree nurses or medical assistants;
Unions and Professional Organizations
Practicing underrepresented minority
graduates from California health profession
schools.
Health/Public Health Departments
County Board of Supervisors, Health
Directors, City Council, State Director
Community Health Centers
Directors, Community Boards, Boards of
Directors, Accreditation and Licensing
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Informant Audiences: Stakeholders
With Critical Perspectives
Corresponding Decisionmakers: Actors
With Power to Shape the Issue
Health plans (Senior Administrators and
CEOs, Boards of Directors, Senior
Human Resource Directors)
Administrators and Human Resource Directors
Programs and Regulatory Agencies
Commissioners, Boards of Directors, Senior
Administrators, Legislature
Teaching Hospitals
Boards of Trustees, President, Senior
Administrators,
News Media
Editors, Publishers, Community Affairs
Directors, Editorial Boards, Media
Associations and Professional Organizations
including ethnic media formations
Legislators/Elected Officials
Governor, State Legislature, City Councils,
County Boards, Mayors, Legislative Caucuses,
State Congressional Delegation, Elected
Official Associations (ethnic and affinity)
Accreditation Bodies
Governing Boards, Senior staff, Legislative
Oversight Committees, Legislature, Governor
K-12 Programs to support students
going into health careers
School Boards, Superintendents, Accreditation,
State Board, State Legislature and City
Councils
Surfacing the Change Model. The project design implies a change model or approach to
addressing these issues that has at least four elements:
1) Connecting practitioners/administrators with effective practice and other resources;
2) Connecting health related faculty, health workers and potential health workers with
recruitment and retention resources;
3) Through media, research dissemination and other communications strategies, help build
political will by investing HPWD issues with a sense of public urgency and priority; and
4) Connecting policymakers at all levels with good information and policies/models that increase
funding and other supports for HPWD initiatives.
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Practitioners, mostly captured in the left column (above), play a critical role in implementing
HPWD practice and policies and advancing these issues from the “ground up” as identified in
Change Model elements 1 and 2.
Given the set of findings from each of the inquiry areas, it is clear that actors in the left column
believe dedicated funding and policy priorities are critical to moving HPWD issues forward,
therefore helping to articulate an agenda for the audiences on the right. As a result,
communication strategies targeting “practitioner” audiences should focus on engaging them in
public agenda setting. In addition, a number of recommendations focus on strengthening practice
in ways that lead to increased coordination and capacity across a variety of networks including
K-12, the private sector, academia and so forth. This points to another critical communication
objective: connecting these practitioners with good practice and practitioner networks.
The audiences on the right, then, constitute primary decisionmaker audiences with whom to
communicate and engage mostly around change model Components 3 and 4. As decision
makers, they will need a range of materials, resources and contacts in order to facilitate informed
policymaking across the policy spectrum. Not shown here, but critically important are other,
broader publics discussed above who have an important role to play in agenda setting as well.
In this framework, key communications objectives would look much like those outlined in
Figure 7 (below).
Figure 7: HPWD Communications Objectives for Change Agents
Practitioners*
What We Need to
Communicate
Where on the support
continuum
Policymakers
Where on the support
continuum
Unaware/on the fence and
overall
it’s important, it matters, it’s
reasonable, necessary, fair
and practical
Contemplating action/ ready
to act
Who else has done it, how they Contemplating action/ ready
did it (political and
to act
programmatic details), jump
in the water is fine
Actively engaged in HPWD
efforts
Kudos, support, affirmation
Actively engaged in HPWD
that they are part of a growing efforts
movement
Opposed to HPWD efforts
This is an unreasonable,
outmoded and marginalized
position
* Of course, there are practitioners that also set policy
Unaware/on the fence
Opposed to HPWD efforts
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PLANNING RESOURCE MATERIALS
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MEDIA PLANNING CONSIDERATIONS: A Checklist
Write here your main three program goals:
List three goals for your work with the media. At least one should be related to your program goals:
Whom do you want to reach? Remember any targets you identified.
Organization/
Constituency
Why do we want
them?
What do we want
them to do?
What do they
care about?
(values,
vulnerabilities)
What/whom
do they read, watch,
listen to?
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What are you trying to communicate? Try to distill your message into a 25-word (maximum) statement that will get the
point across. Remember: a message is not the same as a soundbite. It is the overall theme you are trying to
communicate.
What are good images for conveying this message?
Who are good spokespeople for conveying the message?
What are the best media for conveying this message for each target?
(List targets and choose one or more that fit. Try to focus on not more than three)

Large Academic Publications

Professional development or journal articles

News media: ___ print ___ radio ___ television __ on-line __ opinion
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
Entertainment media

Other on-line media

Personal networks

Other ________________________________________________
List arguments of the opposition:
Develop two soundbites that convey your message and address important issues raised by the opposition. (Remember:
you are not debating them. You are delivering the message.)
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Planning
List upcoming events and products, date they are scheduled to be completed and whether they have any piggybacking
opportunities:
Event/Product
Date to be done
Media opportunities
List other events and products you know about (annual conferences, anniversaries, etc., that provide opportunities to
communicate with others and advance your goals:
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Organize these events in chronological order and prioritize which are the communications opportunities you’d like to
follow up on.
Identify what tasks need to be done and by whom in order to complete the follow up:
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About The Praxis Project
The Praxis Project is a non-profit organization based in Washington, DC. We are an
intermediary working to support local policy advocacy as part of a comprehensive strategy for
change. Our emphasis is on developing fields of work in ways that encourage multi-level, transdisciplinary learning and collaboration. We work to identify "fulcrum" points, approaches that
help lift and advance a wide range of work like meta-messaging -- communication strategies that
cut across campaigns and issues for greater "echo" and impact. For more information or
questions about this toolkit, please contact us at (202) 234-5921 or visit us on the web at
www.thepraxisproject.org
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