University of Southern California Dissertations and Theses

Simple communication solutions for complex health issues: needed changes to improve health communications targeting Los Angeles County Hispanics

(USC Thesis Other)

Simple communication solutions for complex health issues: needed changes to improve health communications targeting Los Angeles County Hispanics

PDF

Download a page range

Download transcript

Copy asset link

Request this asset

Transcript (if available)

Content Copyright 2018 Anais Medina Diaz

SIMPLE COMMUNICATION SOLUTIONS FOR COMPLEX HEALTH ISSUES:
NEEDED CHANGES TO IMPROVE HEALTH COMMUNICATIONS TARGETING
LOS ANGELES COUNTY HISPANICS

By

Anais Medina Diaz

_________________________________________________________________________

A Thesis Presented to the
FACULTY OF THE USC GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
MASTER OF ARTS
(STRATEGIC PUBLIC RELATIONS)

December 2018

II

Dedication
The following work would not have been possible without the support of my amazing
husband, David Diaz Avelar, who supported my passion in finding ways to create healthier
environments around us by giving back to the communities that raised us.
Secondly, I’d like to dedicate this work to my late-grandfather who left us too soon
during this process. If communication and trust could have been improved during his road-to-
recovery, a path towards healthy aging may have been possible.
Lastly, the journey towards this moment in my academic and professional career would
not be possible without the sacrifices of my family and parents. With their interest, experiences
and hardships to guide the way, I trust some of the solutions found during this experience will
help advance and improve our health for generations to come.
III
Table of Contents
Dedication II
List of Figures V
Preface VI
Research Methodology VI
Defining Key Terminology VIII
Health & Disparities VIII
The “Latino-Hispanic” Community IX
Introduction 1
Chapter One: The Majority in Los Angeles County 2
Foreign Born vs Native Born 3
Success is Based on Language 4
Chapter Two: Hispanic Health 6
Destined for a Life with Chronic Illnesses 8
The Hispanic Future 11
Chapter Three: Simple Solutions for Complex Problems 13
Eat Healthy to Be Healthy 13
Food Deserts 14
Chapter Four: Same, Same but Not Different 17
Tradition Continues 17
Repeat, Repeat, Repeat 23
Message Delivered 28
Chapter Five: Determinants of Health 30
What Determines Health? 30
Los Angeles County Department of Public Health -- Key Indicators of Health 33
Communication is Key 33
Chapter Six: The California Endowment – Building Healthy Communities Initiative 36
Building Healthy Communities 37
How to Change Health – The TCE Way 39
In the Hub 43
Chapter Seven: Is the long-term investment worth it? 48
Great on Paper, but Reality is Different 49
IV
Niche Market Only 53
Chapter Eight: Recommendations 56
Conclusion 60
Bibliography 62
Appendix A: Industry Interviews 67
Appendix B: Target Audience 1:1 Interview Guide 79
Appendix C: Target Audience Key Findings 81

V
List of Figures
Figure 1: Los Angeles County Department of Public Health Service Planning Area Map VII
Figure 2: Characteristics of HINTS Study Sample 4
Figure 3: Diagnosed Diabetes Throughout the Nation 6
Figure 4: Adults Who Have Obesity in California 8
Figure 5: Adults Who Have Overweight Classifications in California 9
Figure 6: Obesity Prevalence Among 5
th
Graders by Race/Ethnicity 10
Figure 7: Consulta con Dr. Juan (Consult with Dr. Juan) 21
Figure 8: Como Evitar el Golpe de Calor (How to Avoid Heat Stroke) 22
Figure 9: Come Mejor Planificando Tus Comidas (Eat Well by Meal Prepping) 26
Figure 10: La Diabetes Tipo 2 y Los Jóvenes (Diabetes and Youth) 27
Figure 11: Social Determinants of Health Diagram 30
Figure 12: Portions of Children Living in Poor Households 31
Figure 13: Medical vs. Socio-Ecological Factors 37
Figure 14: Building Healthy Communities’ Theory of Change 40
Figure 15: #SchoolsNotPrisons Los Angeles 45
Figure 16: #IAmPossible – BHC Boyle Heights 46
Figure 17: We Demand the People’s Plan 51
Figure 18: ABC’s of the People’s Plan (Spanish) 52

VI
Preface
Research Methodology
To prepare for this thesis, the author conducted both secondary and primary research.
Before conducting primary research, the author focused secondary research on identifying
common communication practices, health trends and disparities within the Latino/Hispanic
population in Los Angeles County in the past decades. Secondary research included reviews of
professional white papers, research studies, websites, books, documentaries, blogs and reports.
Qualitative research consisted of interviews with professionals in the public relations
industry, outreach personnel in the medical field and community engagement experts.
Quantitative data presented in this paper stemmed from published research conducted by various
sources including the Los Angeles County Department of Public Health, Pew Research Center
and the Centers for Disease Control and Prevention. Following an overview of the demographics
of Los Angeles County and identification of where health disparities are considered the most
severe within the Hispanic population, the researcher conducted one-on-one interviews with
Hispanic residents from four specific geographic regions, two from each area, providing a first-
hand analysis from the group under consideration. These geographic regions are identified as
Service Planning Areas (SPA) by the Los Angeles County Department of Public Health
(LACDPH) and a total of eight exist within the County. (Figure 1) SPA 3, SPA 4, SPA 6 and
SPA 7 have the highest percentages of Hispanics within the County at 46.3%, 51.8%, 68.2% and
73.7% respectively.
1

1
Key Indicators of Health by Service Planning Area. Report. January 2017.
http://www.publichealth.lacounty.gov/ha/docs/2015LACHS/KeyIndicator/PH-KIH_2017-sec
UPDATED.pdf.
VII

Figure 1: Los Angeles County Department of Public Health Service Planning Areas (2012)
Furthermore, the author conducted an analysis of materials, websites and collateral
mentioned by the interviewees. The author also assessed samples of educational materials
distributed to educate Latinos on ways to combat or prevent diabetes and obesity, which are the
top chronic illnesses affecting this demographic group.

VIII
Defining Key Terminology
Health & Disparities
Before learning about how communicators can influence the prevalence of health
disparities in Latino communities, it is important to understand what a health disparity is and
why it exists.
The term health disparity is used most commonly in the United States, while health
inequalities is preferred in the U.K.
2
However, the term “health disparities” was not widely used
regularly until its appearance in 1985 in the Malone-Heckler Report – Report of the Secretary’s
Task Force on Black and Minority Health, in which the U.S. Department of Health and Human
Services began documenting the health disparities affecting Black and minority communities.
3

There is no single universal definition of what a health disparity is, but researchers have assigned
various meanings according to terminology used by multiple agencies in the U.S.
4
For the
purposes of this paper, a “health disparity” is defined as stated by the Centers for Disease
Control and Prevention (2011):
“a particular type of health difference that is closely linked with social, economic, and/or
environmental disadvantage. Health disparities adversely affect groups of people who
have systematically experienced greater obstacles to health based on their racial or ethnic
group; religion; socioeconomic status; gender; age; mental health; cognitive sensory or
physical ability; sexual orientation or gender identity; geographic location; or other
characteristics historically linked to discrimination or exclusion.”
5

2
LaVeist, Thomas Alexis., and Lydia A. Isaac. Race, Ethnicity, and Health: A Public Health Reader.
Jossey-Bass, 2013.
3
LaVeist and Isaac.
4
Ibid.
5
LaVeist and Isaac, 2013.
IX
In a similar fashion, the term health has various meanings. It might refer to public health,
health care, preventative care, health crisis, diseases and much more. The author of this work has
chosen to first focus on chronic illnesses affecting the targeted demographic, later shifting to the
determinants of health to emphasize why individuals’ health should not just be seen through a
single lens. While most chronic health diseases for Hispanics, and the broader public generally,
can be prevented through healthier lifestyles – the determinants of health are affected and
influenced by a variety of issues outside the health lens.

The “Latino-Hispanic” Community
According to Merriam-Webster, the word Latino refers to “a person of Latin American
origin living in the United States,” and the word Hispanic refers to “of, relation to, or being a
person of Latin American descent living in the U.S.; especially one of Cuban, Mexican, or
Puerto Rican origin.” While the Hispanic population largely consists of Mexican descent, Central
American communities are quite prevalent in Los Angeles County. Therefore, the writer will use
the terms Hispanic and Latino interchangeably.
1
Introduction
There are 88 cities and unincorporated areas throughout Los Angeles County composed
of diverse ethnicities, cultures, history and environments. The county is brimming with potential
and opportunity as it adapts to its changing demographic and population. Despite being one of
the most dynamic economies in the world, communities throughout the region also suffer from
historical disadvantages, with an estimated 18% of the population living below the federal
poverty line. Unfortunately, the number of Hispanic people living in poverty exceeds the
county’s overall average. In the author’s opinion, the impact of limited resources, access to
health care and community trauma hindering the lives of Hispanics in Los Angeles County
extend beyond their socioeconomic status into their actual life expectancy. Hispanic
communities are battling chronic conditions like diabetes and mental illness while trying to
provide secure homes in an uncertain economic environment. Yet, government agencies and
nonprofit organizations continue to repeat to these community members that they must find the
time to provide healthy meals and live active lifestyles despite the challenges in their everyday
lives.

This thesis will explore how public relations practitioners and communicators have
traditionally communicated with the Latino population regarding health and living a healthier
lifestyle. Additionally, it will analyze why, despite the advancements in medical research and
technology, Latino communities in Los Angeles County continue to suffer great health
disparities. The author will examine current practices and campaigns and provide
recommendations to enhance communications and outreach targeting Latinos to improve the
health, lifestyle and community of this group.
2
Chapter One: The Majority in Los Angeles County
Latinos are recognized as one the largest minorities in the nation, but through waves of
Hispanic population growth and migration, this diverse population is experiencing a shift from
minority to majority in some regions, including Los Angeles County.
In 2010, the U.S. Census Bureau counted 50.5 million Hispanics throughout the United
States, representing 16.3% of the population, with a growth of 43% over a decade.
6
Additionally,
the increase in the Hispanic population accounted for 56% of the nation's overall growth within
that same decade.
7
While the nation experienced a significant increase in the Hispanic population
overall, 71% of this demographic can be segmented to 100 counties across the U.S., mostly
concentrated in eight states: California, Texas, Florida, New York, Illinois, Arizona, New Jersey
and Colorado.
8
More than half of the nation’s Hispanic population resides in Southern
California, particularly in the Los Angeles-Long Beach-Anaheim area, which is home to
approximately 6 million Hispanics.
9
Although the nation’s overall Hispanic population continues
to grow, this specific demographic is growing at a slower rate within the Los Angeles region,
ranking as the slowest growing population within the top 100 counties. Texas has the second
largest group of Hispanic populations and is expected to increase within the next decade.
Researchers predict the Hispanic community will continue to grow throughout the
country. Currently, Latinos are the majority in California but the Pew Research Center predicts

6
Passel, Jeffrey S., and D’Vera Cohn. "U.S. Population Projections: 2005-2050." Pew Research Center's
Social & Demographic Trends Project. February 11, 2008.
http://www.pewsocialtrends.org/2008/02/11/us-population-projections-2005-2050/.
7
Ibid.
8
Lopez, Mark Hugo, and Anna Brown. Mapping the Latino Population, By State, County and City.
Report. Pew Research Center, 2013.
http://cssr.berkeley.edu/cwscmsreports/LatinoPracticeAdvisory/DATA_State_National/Mapping_the_Lat
ino_Population.pdf
9
Krogstad, Jens Manuel. "Key Facts about How the U.S. Hispanic Population Is Changing." Pew
Research Center. September 08, 2016. http://www.pewresearch.org/fact-tank/2016/09/08/key-facts-about-
how-the-u-s-hispanic-population-is-changing/.
3
that by 2050, Hispanics will be the nation’s largest ethnic group, making up 30% of the nation’s
population.
10,11

Hispanics of Mexican descent account for 83% of the Hispanic population in Los
Angeles County and 65% of the nation’s Hispanic population.
12
Despite the large majority of
Mexican descendants, their dominance is not mirrored in states like New York and Florida.
Puerto Ricans are the second largest Hispanic group in the nation with 5.4 million in 2015, not
including people living in Puerto Rico proper.
13
Unfortunately, while the Hispanic population
tends to suffer from greater health disparities leading to more chronic illnesses, Mexican and
Mexican-American descendants are less likely to have access to health care and health insurance
than other Hispanic people.
14

Foreign Born vs Native Born
As an entire group, Hispanics account for 46% of the County’s 10 million residents.
While the Caucasian population in California has a median age of 45, the Latino population has
an average age of 29.
15
The steady increase of the Hispanic population is accredited to a wave of
second- and third- generation Hispanics who are starting their own families and transitioning into
a new stage of their lives. Foreign-born Latinos make-up 60% of the Hispanic population in Los

10
Panzar, Javier. “It's Official: Latinos Now Outnumber Whites in California.” Los Angeles Times, Los
Angeles Times, 8 July 2015, www.latimes.com/local/california/la-me-census-latinos-20150708-
story.html.
11
Passel, Jeffrey S., and D’Vera Cohn. “U.S. Population Projections: 2005-2050.” Pew Research Center's
Social & Demographic Trends Project, Pew Research Center, 11 Feb. 2008,
www.pewsocialtrends.org/2008/02/11/us-population-projections-2005-2050/.
12
Passel and D’Vera, 2008.
13
Flores, Antonio. "How the U.S. Hispanic Population Is Changing." Pew Research Center. September
18, 2017. http://www.pewresearch.org/fact-tank/2017/09/18/how-the-u-s-hispanic-population-is-
changing/.
14
Vega, W. A., M. A. Rodriguez, and E. Gruskin. "Health Disparities in the Latino
Population." Epidemiologic Reviews31, no. 1 (2009): 99-112. doi:10.1093/epirev/mxp008.
15
Flores, 2017.
4
Angeles County and only 5% are foreign-born children.
16
Because birth rates within this
demographic are expected to continue rising in forthcoming decades, the percentage of foreign-
born Latinos within the Hispanic population in LA County will decrease by 2050.
17

Success is Based on Language
A study examining Hispanics speaking English comfortably versus not comfortably
focused on how this factor influenced what sources of health information they trusted and the
correlation to socioeconomic status, education and proficiency in the English language. (Figure
2) The study showed a Hispanic person who is comfortable speaking English is more likely to
have a higher education and socioeconomic status. Although the sample of the study, the 2005
Health Information National Trends Survey (HINTS), was recruited through a random-digital-
dial across the United States, and was administered in English and Spanish, it could still serve as
an example of current trends in Los Angeles County.
18

Figure 2: Characteristics of study sample: English-responding and Spanish- responding
Hispanics/Latinos, weighted percentages, n = 4,599

16
Ibid
17
Flores, 2017.
18
Clayman, Marla L., Jennifer A. Manganello, K. Viswanath, Bradford W. Hesse, and Neeraj K. Arora.
"Providing Health Messages to Hispanics/Latinos: Understanding the Importance of Language, Trust in
Health Information Sources, and Media Use." Journal of Health Communication15, no. Sup3 (2010):
252-63. doi:10.1080/10810730.2010.522697.
5

In its 2014-2015 Los Angeles County Health Survey Report, Los Angeles County
Department of Public Health concluded 26.6% of the County’s population spoke mostly Spanish
within their homes.
19
It is important to understand the correlation between one’s ability to speak,
write and/or read English and level of education to their socioeconomic status because this
factors into where in the County a person may live in and health behaviors they may be
predisposed to practice. Additionally, a person’s inability to comfortably comprehend the
English language can interfere with their capability of receiving the correct, relevant information
or finding trustworthy sources when searching or receiving information on health-related issues.

19
Key Indicators of Health by Service Planning Area, 2017.
6
Chapter Two: Hispanic Health
A person’s nutritional intake is more than just her meals in a given day. Nutrition, and the
practice of regularly eating nutritiously, is connected to a person’s weight, health, cancer risk,
life expectancy, mental health and other factors. Unfortunately, despite continuous research and
data suggesting that change in diets could prevent some chronic health issues, the nation
continues to see a rise in incidence of obesity and diabetes at exponential rates. According to the
Centers for Disease and Control’s Maps of Trends in Diagnosed Diabetes, in 1994, 24 states had
a prevalence of 4.5% to 6% of diabetes cases among their respective populations. Twenty years
later, all 50 U.S. states have a prevalence greater than 6.0%, with 27 states exceeding 9% --
including California. (Figure 3)

Figure 3: Diagnosed Diabetes Among US Adults 2015
Los Angeles County is no exception to this unfortunate health trend. Overweight and
obesity rates are highest within the Latinos population putting them at an even higher risk of
Age-Adjusted Prevalence of Diagnosed Diabetes
Among US Adults
<4.5% Missing data
4.5%–5.9% 6.0%–7.4%
7.5%–8.9% ≥ 9.0%
2015
http://www.cdc.gov/diabetes/data
CDC’s Division of Diabetes Translation. Diabetes Surveillance
System available at http://www.cdc.gov/diabetes/
7
developing diabetes and other chronic health conditions.
20
Recent data from the Los Angeles
County Department of Public Health’s Community Health Assessment indicates the leading
causes of death for Hispanic Angelenos include heart disease, Alzheimer’s, chronic respiratory
disease and liver disease.
21

Additionally, Hispanic children within the County register some of the highest rates of
obesity, particularly in SPA 4 – the area known as Metro Los Angeles.
22

By addressing obesity, diabetes and mental health – the leading chronic illnesses
affecting Hispanics in Los Angeles County, and throughout the nation – it may be possible to
improve and protect future generations of Hispanics and the future of the nation. Furthermore,
while these chronic illnesses are the leading health issues harming Hispanics, other ethnic
groups, including Black, African American and Native American communities in LA County
also suffer from the same issues, proving these chronic illnesses are not selective to ethnicity
but affect communities. (emphasis author’s)
23
Some studies comparing the health disparities
between foreign-born Latinos versus native-born Latinos also indicate the possibility that
exposure to American society may be contributing to the development of obesity and higher rates
of diabetes associated with Latinos in the United States.
24

20
Simon, Paul, MD, MPH. "Obesity and Park Equity in Los Angeles County." Lecture.
https://envhealthcenters.usc.edu/wp-content/uploads/2017/05/Paul-Simon-_P1.pdf.
21
Community Health Assessment 2015. Report. County of Los Angeles Department of Public Health.
112-17. Accessed November 2017. http://www.bhclongbeach.org/wp-
content/uploads/2012/06/LACDPHCommunityHealthAssessment2015Final.pdf.
22
"Childhood Obesity Trends in LA County, Children's Data Network USC." Achieving Healthy Weight
Early in Life. https://insight.livestories.com/s/childhood-obesity-trends-in-la-county-childrens-data-
network-usc/56183373a750b32489d54cdd/.
23
Community Health Assessment 2015, Report.
24
Vega, W. A., M. A. Rodriguez, and E. Gruskin. "Health Disparities in the Latino
Population." Epidemiologic Reviews31, no. 1 (2009): 99-112. doi:10.1093/epirev/mxp008.
8
Destined for a Life with Chronic Illnesses
“You can get us to exercise and get outside, but you can’t get us to change our diets. It’s part
of our culture.” – Yolanda Escobar, Pico Rivera - SPA 7 Resident

As defined by the Centers for Disease Control and Prevention (CDC), obesity and
overweightness are measured by a person’s Body Mass Index (BMI), a calculation of body fat
according to their weight and height. In terms of adult measurements, an adult is considered
overweight if his BMI is between 25.0 and <30.0, and obese if his BMI is 30.0 or higher. For
children, obesity and overweightness are measured differently since they are compared to other
children within their age group. If a child is between the 85
th
and 95
th
percentile – she is
considered overweight; if she is above the 95
th
percentile, she is considered obese.

Figure 4: Adults Who Have Obesity in California
California
Category: Obesity / Weight Status
Adults who have obesity
California - All available years
Percent of adults aged 18 years and older who have obesity †
View by: Race/Ethnicity - Hispanic
Footnotes
† Obese i s def i ned a s body ma ss i ndex ( BMI ) ≥ 30 . 0 ; BMI wa s ca l cul a ted f r om self - r epor ted wei g ht a nd hei g ht ( wei g ht
[ k g ] / hei g ht [ m² ) . Respondents r epor ti ng wei g ht < 50 pounds or ≥ 650 pounds; hei g ht < 3 f eet or ≥ 8 f eet; or BMI : <1 2
or ≥ 1 0 0 wer e ex cl uded. Pr eg na nt r espondents wer e a l so ex cl uded.
Data Source: Beha vi or a l Ri sk Fa ctor Sur vei l l a nce Sy stem ( BRFSS)
20 1 1 20 1 2 20 1 3 20 1 4 20 1 5 20 1 6
0
5
1 0
1 5
20
25
30
35
40
Value
Hi spa ni c
Race/Ethnicity
9

Figure 5: Adults Who Have Overweight Classifications in California
Within Los Angeles County, Hispanics consistently demonstrate rate increases in obesity
and overweightness compared to other ethnicities the region. (Figure 4 and Figure 5) The data
provided by the CDC shows that while rates of obesity decreased in 2013, they jumped at an
even higher rate the following three years. Subsequently, overweight cases in adults trended in
the opposite direction for years 2013 and 2014 but increased in unison with obesity rates in 2015
-- signifying a consistent increase in obesity and overweight cases for the upcoming years.
Similar data was not provided for children under 18 for the same period, but obesity and
overweight cases affecting Hispanic children were the highest compared to other ethnicities in
the County in 2015. (Figure 6)
Adults who have an overweight classification
California - All available years
Percent of adults aged 18 years and older who have an overweight classification †
View by: Total
Footnotes
† Over wei g ht i s def i ned a s body ma ss i ndex ( BMI ) ≥ 25. 0 but <30 . 0 ; BMI wa s ca lcula ted f r om self - r epor ted wei g ht a nd
hei g ht ( wei g ht [ k g ] / hei g ht [ m² ] ) . Respondents r epor ti ng wei g ht < 50 pounds or ≥ 650 pounds; hei g ht < 3 f eet or ≥ 8
f eet; or BMI : <1 2 or ≥ 1 0 0 wer e ex cluded. Pr eg na nt r espondents wer e a l so ex cl uded.
Data Source: Beha vi or a l Ri sk Fa ctor Sur vei l l a nce Sy stem ( BRFSS)
20 1 1 20 1 2 20 1 3 20 1 4 20 1 5 20 1 6
0
5
1 0
1 5
20
25
30
35
40
Value
Tot a l
10

Figure 6: Obesity Prevalence Among 5
th
Graders by Race/Ethnicity
The County features high levels of obesity throughout its population with an average of
24%, however, SPA 6 and SPA 7 demonstrated worsening numbers in 2015 at 34% and 30%,
respectively.
25
These areas consist of the South and East regions of the County, including cities
like Huntington Park, Bell, South Gate, Paramount and Expo Park - cities with large Hispanic
communities.
26, 27, 28
Contrastingly, SPA 5 covers the western region of the County including
cities like Santa Monica, Venice, and Malibu, with a 65% white majority and the lowest rates of
obesity in the County at only 10%.
Poor diet and lack of physical activity, conjointly with other factors, can also contribute
to diabetes, a chronic illness affecting Hispanics of Mexican descent at higher levels than any

25
Key Indicators of Health by Service Area, 2015.
26
Ibid.
27
Supplement to Community Health Assessment, Service Planning Area 6: South. Report. Los Angeles,
CA: County of Los Angeles Department of Public Health, 2014.
http://www.publichealth.lacounty.gov/plan/docs/SPA6Supplement.pdf.
28
Supplement to Community Health Assessment, Service Planning Area 7: East. Report. Los Angeles,
CA: County of Los Angeles Department of Public Health, 2014.
http://www.publichealth.lacounty.gov/plan/docs/SPA7Supplement.pdf.
11
other Hispanic ethnicity.
29
According to the Los Angeles County Department of Public Health,
the Hispanic population in the county suffers from diabetes more than any other ethnicity at
13.7% and this figure is expected to increase.
30
Among people dealing with the costly and
serious disease, 76% have Type 2 Diabetes, which is considered preventable if treated in the
prediabetes stage. Diabetes is also a contributor to other serious conditions, creating further
complications in kidney disease, heart disease and blindness – all leading causes of death
affecting Hispanics.
31
Additionally, the diabetes death rate within the County has worsened
collectively, with SPA 4, SPA 6 and SPA 7 showing accelerating rates. Unfortunately, numbers
for people living with diabetes could be even worse. In a nationwide report prepared by the
CDC, the prevalence of undiagnosed diabetes was high amidst Hispanics compared to non-
Hispanic whites during 2011-2014.
32

The Hispanic Future
“Diabetes is impacting thousands of residents all across Los Angeles County, particularly in
our most underserved, ethnic, and Latino communities.”
– Los Angeles County Supervisor Hilda Solis, First District
33

The alarming rate at which Hispanic children under 18 years old are being diagnosed as
overweight or obese is frightening. As Hispanic adults begin to form families, their health is
worsening and contributing habits and circumstances are being passed down to their children.
Not only are diabetes, obesity and being overweight serious health issues, their cost and

29
Estimates of Diabetes and Its Burden in the United States. Report. National Diabetes Statistics Report.
Centers for Disease Control and Prevention, 2017.
https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf.
30
Los Angeles County Department of Public Health. "Diabetes Continues to Increase in Los Angeles
County." News release, 2015. Desire Health Magazine Inc. http://dhmi.org/lacdph-diabetes/.
31
Ibid.
32
National Diabetes Statistics Report, 2017.
33
Diabetes Continues to Increase in Los Angeles County, 2015.
12
debilitating symptoms affect a person’s livelihood and interfere with quality of life, work and
any upward movement in socioeconomic status.
Given the extraordinary size, scale and scope of the problem, it seems effective public
health communication efforts could help address chronic health issues debilitating Latinos, but
the author wonders if additional improvements need to be made. Where are the gaps in education
and communication? Why is the alarming rate at which a third of the County’s population is
becoming chronically ill not demanding more attention and evaluation? And perhaps most
importantly: How could such efforts be more effective? To answer these questions, the author
will analyze communication methods and frameworks to shape recommendations aimed at
enhancing current outreach efforts to this critically ill and growing population.

13
Chapter Three: Simple Solutions for Complex Problems
Eat Healthy to Be Healthy
To combat the obesity epidemic, myriad agencies, healthcare providers, community
organizers and the Centers for Disease Control and Prevention promote -- healthier lifestyle
practices. According to the CDC, a long-term healthy lifestyle can be accomplished through
healthier eating and regular physical activity. The agency acknowledges there is no simple
solution to obesity, but that it can be influenced by the combined forces of policy, environment,
society and culture.
34
Some of the CDC’s recommended actions for individuals are to assess their
weight, achieve a healthy weight, use calorie-counting tools to keep a healthy diet and practice
physical activity basics.
35
Additionally, the agency provides grants to agencies and community-
based organizations across the nation to fund programs combating obesity at local levels through
its Racial and Ethnic Approaches to Community Health (REACH) initiative. REACH launched a
3-year campaign in 2014 to increase the capacity of communities to support programs aimed at
decreasing obesity.
In addition to government agencies like the CDC, the Obama Administration attempted
to address the obesity epidemic the White House Task Force on Childhood Obesity Within a
Generation, launched in 2010. As part of the task force’s tactics, the Let’s Move campaign
spearheaded by then-First Lady Michelle Obama aimed to 1) empower parents and caregivers; 2)
provide healthy foods in schools; 3) improve access to healthy, affordable foods; 4) and increase
physical activity.
36
While the Let’s Move campaign intended to tackle health issues through

34
"Division of Nutrition, Physical Activity, and Obesity." Centers for Disease Control and Prevention.
December 11, 2017. Accessed January 28, 2018. https://www.cdc.gov/nccdphp/dnpao/state-local-
programs/reach/index.htm.
35
Ibid.
36
Solving the Problem of Childhood Obesity Within a Generation. Report. White House Task Force on
Childhood Obesity Report to the President. Executive Office of the President of the United States, 2010.
14
policy changes, its promotion and marketing were executed as a strategic public relations
campaign. With a high-profile spokesperson in Michelle Obama, messages to raise awareness
about diabetes and childhood obesity were heard by a wide audience, increasing the chances of
those messages reaching key target audiences such as Hispanics throughout the nation.
Unfortunately, critics felt the campaign failed to create any real change and the results still won’t
be seen for a few years. Another criticism focused on the campaign’s emphasis on food deserts
and increasing the availability of healthy foods in communities lacking accessibility to
affordable, healthy food, but failure to tackle the actual barriers that were preventing these
communities from taking advantage of fresh produce.
37

Food Deserts
Food Desert is a term introduced in the mid-1990s by a British government publication
produced by the Nutrition Task Force.
38
The term then gained traction in the United States and is
now used by academics, policy makers and community-based groups to refer to urban areas
lacking fresh, healthy food.
39
The reports produced by the Nutrition Task Force state that food
deserts implicate the health of the community by denying them access to health, fresh and
affordable food. If the solution to obesity and overweight is to adopt a healthier diet, tackling
food deserts would seem like the correct approach. Policies across the nation, including the Let’s

May 2010.
https://letsmove.obamawhitehouse.archives.gov/sites/letsmove.gov/files/TaskForce_on_Childhood_Obesi
ty_May2010_FullReport.pdf.
37
Johnson, Steven Ross. "Gauging the Public Health Value of Michelle Obama's Let's Move Campaign."
Modern Healthcare. August 23, 2016.
http://www.modernhealthcare.com/article/20160823/NEWS/160829986.
38
Cummins, Steven, and Sally Macintyre. ""Food Deserts" -- Evidence and Assumption in Health Policy
Making." British Medical Journal325, no. 7361 (2002): 436-38.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123946/#.
39
Cummins and Macintyre, 2002.
15
Move campaign, are based on the premise that increasing access to healthy, fresh food in poor
and underserved areas will improve public health. However, the reports used to base these
policies were established on research conducted in the community of Hampstead, London 10
years ago – a substantially different community than Los Angeles.
40
Applying a study with such
a narrow and unique sample to the diverse population of Los Angeles County has obvious
limitations, including not considering the cultural differences within these communities. Food
deserts are certainly an issue across LA County, but this single solution approach is not the likely
solution to this complex matter.
When then-First Lady Obama announced the Healthy Food Financing Initiative in 2010,
it was modeled after a Pennsylvania program that offered grants and loans to supermarkets as an
incentive to open stores in underserved neighborhoods and help smaller markets provide fresh
foods to these at-risk communities.
41
The Healthy Food Financing Initiative provided up to $500
million in grant funding and helped increase access to fresh food. Despite these well intended
efforts, having people living closer to healthy foods didn’t necessarily live up to the grand
expectations. In a study based on 15 years of longitudinal data from the Coronary Artery Risk
Development in Young Adults (CARDIA), researchers found that while zoning restrictions on
fast food restaurants within a specific distance of low-income neighborhoods provided a
beneficial impact to health, the relationship between peoples’ accessibility to grocery stores with
fresh food and their diet was not clearly defined.
42

40
Ibid
41
Gilligan, Heather Tirado. "Getting Fresh Fruits and Vegetables Into Poor Neighborhoods Doesn't Make
Poor People Healthier." Slate Magazine. February 10, 2014.
http://www.slate.com/articles/life/food/2014/02/food_deserts_and_fresh_food_access_aren_t_the_proble
m_poverty_not_obesity.html.
42
Boone-Heinonen, Janne, P. Gordon-Larsen, J. M. Shikany, and B. M. Popkin. "Fast Food Restaurants
and Food Stores." Archives of Internal Medicine171, no. 13 (2011): 1162-170.
doi:10.1001/archinternmed.2011.283.
16
Access to healthy, affordable food in underserved communities and communities of color
is extremely important and a necessary step towards finding a solution. However, approaching
this health crisis with a single solution is not going to resolve the obesity epidemic. Despite such
findings, public health campaigns and communications efforts continue to address obesity and
overweightness through the same “healthy food leads to a healthy life” lens. Tackling food
deserts in underserved communities is a piece of the puzzle but fitting it with the remaining
pieces like access to health care, zoning restrictions on fast-food establishments and safe
neighborhoods are just as essential to leading a healthy life and preventing chronic illnesses.

17
Chapter Four: Same, Same but Not Different
The nutrition education and obesity prevention approach targeting Latinos is similar to
health campaigns established to combat the obesity epidemic throughout the nation. But that’s
the issue – it’s not different. (emphasis author’s) While few health educational campaigns
succeed in approaching the Latino audience in a culturally competent fashion, most do not.
Furthermore, truly successful campaigns tackle health issues with an entirely different approach,
a community-based approach.
While the Hispanic majority in Los Angeles County and the nation is Mexican, the
Hispanic population should not be approached as a simple, homogenized demographic. Being
culturally competent in communications is necessary when targeting any ethnicity and Latinos
are not any different. What may be relevant for Angelenos of Mexican descent, may not work for
Angelenos of Argentinian descent. Despite being Latin countries, these cultures and their values
are vastly different. Furthermore, there is a growing population of second- and third- generation
Hispanics that have acculturated and developed behaviors completely different from foreign-
born Latinos and native-born Non-Hispanic Whites.
This chapter will analyze and compare collateral materials targeting Hispanics with the
purpose of raising awareness and educating on the top chronic health illnesses affecting
Hispanics in Los Angeles County.

Tradition Continues
Sergio Segura, 69, came to the United States when he was 20 years old and settled in the
Los Angeles neighborhood of El Sereno (SPA 4). After dealing with a few health issues the past
couple of years, including a stroke, he’s made eating healthy and exercising at least six times a
18
week a part of his new, healthier lifestyle. Because of his health issues, he’s in constant
communication with his doctor and feels confident about what his doctor recommends. When he
has any follow-up questions or needs more information about a certain health topic, he uses
Google to search for the most relevant article pertaining to his query. His latest search revolved
around finding holistic and natural remedies for seasonal allergies to avoid consuming additional
prescription drugs. He found that doing specific yoga poses could help with decreasing the
severity of his allergies and incorporated the recommendations into his daily exercise regimen. In
addition to using the Internet for health information, he enjoyed reading about health issues or
health news through magazines provided by his insurance or American Association of Retired
Persons (AARP) but didn’t follow them closely enough to remember the titles of the
publications. Additionally, he found out about other health-related issues through local Spanish
television stations like Univision 34 Los Angeles.
Similarly, 63-year-old South Gate (SPA 6) resident Maria Davila prefers searching health
information she needs on the Internet and typically chooses the first option presented in the
search results. Davila, who is retired, takes advantage of any health or workout classes provided
at her local senior center or park. Although she is diabetic, she tries living a healthy lifestyle by
choosing healthier options and exercising as frequently as possible. If she’s not actively looking
for health information, she receives it on the news by watching Doctor Juan on Univision 34 or
reading it in a magazine like Women’s Day or Friends and Family Circle.
Both Davila and Segura immigrated to the United States and now live in Los Angeles
County, albeit opposite sides of the region. South Gate is located within SPA 7 and El Sereno is
in SPA 4 – regions of the County showing increasing rates of diabetes and obesity and increasing
numbers of death due to diabetes. While Segura wasn’t aware of many free or accessible
19
programs in his neighborhood that could assist in living a healthier lifestyle, he had access to a
gym and felt comfortable walking around his neighborhood. By contrast, Davila knew about
programs available to her because of the community she built at the South Gate Senior Center
and the information she received through her insurance. While both County residents relied on
traditional news media for information on health or news such as magazines and local news, they
were also very comfortable using the Internet to find information they needed and sometimes
found information on social media. However, because of Avila’s limitations in English
proficiency, she was less aware of the things to look for in terms of finding credible news and
information sources. Based on her Internet search habits, Avila could potentially be confusing a
product advertisement over a well-trusted medical website.
New technology and social media platforms are becoming new sources of information for
older Hispanic populations, especially those comfortable with the English-language. Yet,
communications targeting the Hispanic population often remains traditional in placement and
availability.
Furthermore, health communications and marketing to this population tends to remain
stagnant and generic despite studies showing the increasing rate by which the Hispanic
population consumes media. Carlos Gutierrez, Vice President of Strategy and Insights leading
Healthcare Marketing at Univision Communications Inc. recently stated that despite the drastic
difference at which Hispanics are diagnosed with diabetes -- 22.6% versus the national average
of 14.3% -- dedicated outreach and marketing towards Hispanics wasn’t improving.
43
Gutierrez
noted that in 2015, only eight brands invested in Direct-to-Consumer diabetes awareness

43
Gutierrez, Carlos. "Health Disparities among Hispanics: Diabetes." Univision Communications Inc.
July 12, 2017. https://corporate.univision.com/blog/healthcare/2016/07/26/health-disparities-among-
hispanics-time-to-close-the-gap/.
20
campaigns in the Spanish-language, compared to 16 Direct-to-Consumer campaigns in English.
44

Additionally, only 3% of pharmaceutical Direct-to-Consumer campaigns were conducted in
Spanish.
45
One may argue the difference in English versus Spanish speakers throughout the
nation should be enough justification for the discrepancy in investment. However, the Hispanic
population is at a clear disadvantage, which is reflected in the continuing disparities across the
nation, including Los Angeles County. With traditional media being a clear, reliable tool to reach
Spanish-speaking Hispanics, it is frustrating to see minimal investment in Direct-to-Consumer
diabetes awareness campaigns.
Looking further into the messages and information Segura, Davila and millions of other
Spanish-speaking Latinos in the County receive their information, it is necessary to analyze the
different tools and information provided through these outlets.
Univision, the largest Spanish-language television network in the United States with
more than 600 affiliate stations across the nation, is attempting to address the health disparities
found in Hispanic communities by incorporating health segments locally and at network level.
As a network, Univision’s Doctor Juan segments are led by Cardiologist Doctor Juan Jose
Rivera who joined Univision News as the chief medical correspondent in 2012.
46
Dr. Rivera
hosts two weekly segments on “Primer Impacto” in addition to covering health topics for news
reports on “Primer Impacto,” “Aqui y Ahora” and “Al Punto.” Additionally, Dr. Rivera’s reports
are available online and through social media.

44
Gutierrez, 2017.
45
Ibid.
46
"Renowned Cardiologist Dr. Juan José Rivera Joins Univision News as Chief Medical Correspondent."
Univision. February 12, 2013. https://corporate.univision.com/corporate/press/press-
releases/2013/02/12/renowned-cardiologist-dr-juan-jose-rivera-joins-univision-news-as-chief-medical-
correspondent/.
21

Figure 7: “Consulta con Dr. Juan: El Ejercicio ideal para cada edad”
47

(Consultation with Dr. Juan: The ideal exercise for each age)

In the news report “Consulta con Dr. Juan: El Ejercicio ideal para cada edad,” Dr. Juan
Rivera discusses the recommended exercises and time commitment for different age groups.
While the information he presents is in Spanish, straight-forward, to the point and easy to digest,
the report is also filled with stock images presenting a very generic, sterile look. In the eight
images shown within the report, only two images featured a person of color and possibly
Hispanic. While there is no standard, typical appearance that represents all Hispanics, there is
still a need for diversity in reports aiming to introduce healthy habits to this population.
Furthermore, it is unfortunate that the nationally syndicated health segment does not include
images of real people or at least greater diversity in their stock images despite being the top
Spanish-language network in the nation.

47
Rivera, Dr. Juan. "El Ejercicio Ideal Para Cada Edad." Univision. January 22, 2016.
https://www.univision.com/noticias/salud/consulta-con-dr-juan-el-ejercicio-ideal-para-cada-edad-video.

22

Figure 8: “Como Evitar el Golpe de Calor”
48

(How to Avoid Heat Stroke)
At the local level, Univision 34 Los Angeles featured a health segment with Dr. Juan
Carlos Mendez from Kaiser Permanente to discuss the signs of heat strokes and the importance
of staying cool and hydrated. While not a health issue directly related to diabetes, in times of
heat waves, older adults and families in low-income neighborhoods suffer from accessibility to
drinking water or cooling centers which could lead to serious health complications. Additionally,
those dealing with diabetes are more likely to suffer from complications of dehydration. During
the segment, real images of people around Los Angeles are used to demonstrate what needs to be
done to avoid heat strokes. There are ties back to the community that are culturally relevant,
relatable and informative adding a sense of connection between the news station and its
audience.
In May 2017, Dr. Juan Rivera announced the launch of his new network program that
would further discuss issues regarding health and an opportunity to continue recommending
healthy lifestyle changes. Additionally, he felt the program would create an opportunity for

48
"El DOC Responde." Univision 34 Los Angeles. May 1, 2016.
https://www.facebook.com/Univision34/videos/10154793172103528/.
23
viewers to build trust in his expertise and see him as more of a neighbor than a cardiologist.
Within the segment, Dr. Rivera stressed “la salud empieza en su casa” (Health begins at home).
Most obesity prevention and nutrition education campaigns share this same message of
establishing healthy habits at home. While it is important to maintain a healthy diet and regular
exercise as part of a lifestyle to prevent becoming obese, overweight or diabetic, it is not quite
that simple for working families living below the poverty line or in underserved, stressful and
dangerous neighbourhoods. Typical health communications materials, campaigns or video
segments fail to address these extenuating factors and provide recommendations with how to
deal with them at home. Additionally, the responsibility for preventing obesity or diabetes is
placed on the individual without acknowledging the different circumstances they are predisposed
to which may prevent them from following through. This may create a sense of guilt or failure on
the individual for not successfully carrying out a healthy lifestyle for themselves or their family.

Repeat, Repeat, Repeat
The 2010 White House Task Force on Childhood Obesity Report to the President
discusses how obesity affects a person’s health. Overweight and obese children are more likely
to become obese adults, which could lead to lives with increased risks for Type 2 Diabetes, heart
disease, several cancers and other illnesses.
49
What causes obesity? The report dives into early
childhood development as an important point where change and prevention can be made to
decrease the chances of a child becoming overweight or obese. Furthermore, early childhood
development doesn’t begin when a child is born but when a mother is expecting. It is in this
phase in which a mother can significantly increase the chances of their child living a healthier

49
Solving the Problem of Childhood Obesity Within a Generation, 10.
24
childhood and lifestyle. It is also in this phase where all the responsibility of keeping a family
healthy begins to solely rely on the mother. Secondly, the report cites the “American Lifestyle”
as a contributing factor to rising obesity rates. Because of the fast-paced lifestyles of most
Americans, they’re more likely to eat unhealthy, fast food plus prepared and processed food.
50

Additionally, the amount of a child’s “screen time” affects the likelihood of a child becoming
overweight and obese because of limited recreational or active time.
51
The solution, as proposed
by the White House report, focuses on an individual’s capability to make changes in their home
for their family such as eating healthy and introducing more physical activities into the family
routine.
52

The White House’s response to combating the obesity epidemic is in line with other
government-funded educational campaigns and materials distributed by advocacy organizations
in Los Angeles County. The solution is repeatedly communicated that healthy food and regular
exercise will decrease the chances of a person becoming overweight and obese because this
solution is scientifically and medically proven to be true. However, this simple regimen is
proving to be ineffective in Los Angeles County and across the nation despite the repeated
efforts to communicate these messages across agencies, programs and organizations.
Champions for Change, a program launched by the Nutrition Education and Obesity Prevention
Branch of the California Department of Public Health, aims to improve the health of families and
communities in California, particularly those at higher risk for Type 2 Diabetes, obesity and
heart disease. In addition to creating champions within communities such as fathers, mothers,
grandparents and other stakeholders, the program implements various communications activities
and campaigns, including a mass media campaign to influence healthy behavior and changes in

50
Solving the Problem of Childhood Obesity Within a Generation, 10
51
Ibid.
52
Ibid.
25
the community.
53
Champions for Change’s media campaign concentrates on using real people
and not paid actors to carry out their messaging which focuses on making small changes to their
everyday lives. As part of the media campaign, champions are provided with the materials and
collateral needed to share the key message. In Figure 9, “Come Mejor Planificando Tus
Comidas” (Eat Healthier by Meal Prepping), the program’s strategy is to take a different
approach in communicating the standard recommendation of eating healthy. Recognizing that
cooking for a family is time-consuming and stressful, the program stresses on the opportunity to
prep the meals for the week on one day to minimize the time dedicated to cooking for a family
during the week.

53
"Champions for Change Program." CDPH Public Portal. February 27, 2018.
https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/NEOPB/Pages/ChampionsforChangeProgram.aspx
.
26

Figure 9: “Come Mejor Planificando Tus Comidas”
(Eat Better by Planning Your Meals)
The content provided in the flyer is clear, relevant and uses images of real people in real
environments. While the sheet is a little long in content (Figure 9 only shows one page out of
three), these documents are meant to be informative once a person is already engaged in the
discussion. Furthermore, Champions for Change is an incredible resource for ambassadors and
the people with home they are connecting. In addition to providing ways to be active or eat
27
healthy, it provides the site visitor with tips on how they can get involved. There is a clear call-
to-action, leading visitors to become champions in their own communities through the program.

Figure 10: La Diabetes Tipo 2 y Los Jóvenes
(Type 2 Diabetes and Youth)

Similarly, the Centers for Disease Control and Prevention have produced materials that
reemphasized and reinforced recommended preventative habits. (Figure 10) In Figure 9, the
message targets the mother as one could deduce from the images provided. The message is for
her to cook meals for everyone in the family on one day and in order for the family to eat the
meals, she should share the meal options for the week on a calendar. Figure 10 directly asks the
head of household to get the entire family on board with eating healthy and exercising regularly
by approaching the topic “slow and steady” and with a positive attitude. Both collateral materials
target the family caretaker and emphasize their responsibility in ensuring their family lives a
healthy lifestyle. While the CDC’s collateral touches on how to prevent being overweight and
L a d ia b e te s tip o 2 y lo s jó v e n e s
Q u é p u e d e h a c e r
Las tasas de diabetes tipo 2 en los jóvenes están en aumento; al igua l que las tasas de obesidad. E l ries go
de diabetes puede ser hereditario, pero también pueden serlo los hábitos de una vida saludable :
Beba agua; limite las
bebidas .
C oma más fruta s
y verduras.
Limite los alimentos
altos en calorías.
Encuentre forma s de divertirs e
haciendo actividad física.
Ha g a q u e p a rtic ip e to d a la fam ilia
M a nte nga una po s itiva • A va nc e de a po c o • D ivié rta s e
28
obese, the Champions for Change flyer provides a workaround for a common issue and touches
again on the importance of eating healthy.

Message Delivered
All interviewees who participated in the study conducted for this thesis were asked to rate
the importance of living a healthy lifestyle and what influenced their perceived level of
importance. Additionally, they were asked how likely were they to follow up with a healthy food
diet and workout regimen and what factors influenced their answer. From a scale from 1 – 5,
with 1 being very unlikely and 5 very likely, all interviewees answered the first question with a
5. They cited personal goals of living a long, healthy lifestyle and being able to enjoy their later
years without having to be a burden on their family members. Additionally, they wanted to make
sure they were not so heavily reliant on prescription medications. However, all interviewees
knew the importance of eating healthy and exercising regularly to live a healthier lifestyle but
answered with either a 3 or 4 to the second question. While they had access to healthy,
affordable fresh food, the lack of time or unsafe neighborhoods prevented them from eating
healthy or exercising regularly.
Health communicators have successfully relayed the importance of exercising regularly
and eating healthy as the solution to decreasing a person’s chances from becoming obese,
overweight, diabetic or even developing depression. Communicators have attempted to suggest
how to incorporate healthy alternatives to culturally-based recipes to decrease a person’s
dependence on unhealthy ingredients and foods. Policy makers and advocacy organizations have
attempted to provide underserved communities with markets that supply fresh foods and
vegetables or healthy food programs. But, despite these various attempts to combat the obesity
29
epidemic through these initiatives, health disparities experienced by the Hispanic population
continue to exist and predominantly Hispanic communities in the County’s regions are getting
worse. As communicators, there needs to be change in strategy to look at the issue at hand from a
different perspective – a different lens. Health is not solely based on what a person consumes or
what exercises he practices, it is based on his environment, community and accessibility to carry
on with a healthy lifestyle.

30
Chapter Five: Determinants of Health
What Determines Health?
“However important individual genetic susceptibilities to disease may be, the common cause of
the ill health that affects populations are environmental: they come and go far more quickly
than the slow pace of genetic change because they reflect the changes in the way we live.”
- Richard Wilkinson and Michael Marmot
54

Findings from researchers like Sir Michael Marmot have helped agencies like the World
Health Organization and subsequently, the Pan American Health Organization, bolster good
health by not relying solely on medical intervention. Through his research, Marmot found that
broader social, economic and political circumstances influence a person’s quality of life.
55

Factors like education level, employment, income level and distribution, housing, childhood
development, food security and nutrition, race, gender, and stress can factor into person’s risk for
chronic illness and life expectancy.
56

Figure 11. Social Determinants of Health Diagram

54
Carles Muntaner, Virginia Gunn, and Deb Finn Mahabir. 2015. Social Determinants of Health Oxford
University Press. doi:10.1093/obo/9780199756797-
0150. http://oxfordbibliographiesonline.com/view/document/obo-9780199756797/obo-
9780199756797-0150.xml.
55
Ibid.
56
Ibid.
31
For example, transportation policy can drastically affect a person’s health and well-being
despite it not being a part of ongoing messaging to prevent obesity. Healthy transportation can be
achieved by less driving and more walking and cycling. If transportation policy improved, fewer
people would continue with sedentary lifestyles that rely on cars and instead choose modes of
active transportation like cycling, walking or public transportation. By incorporating activity into
their everyday commutes, a person could protect themselves against chronic illnesses such as
obesity and diabetes. Furthermore, families who live in low social and economic circumstances
are more susceptible to suffering from poor health throughout their life.
57
Having poor education,
insecure employment and poor living conditions can influence the amount of stress a person lives
with and the degree to which it affects their health. The longer a person lives under stressful
economic and social circumstances, the less likely they are to grow old peacefully and healthy.
58

Figure 12: Portion of Children Living in Poor Households (50% the National Average)
Figure 12 shows the United States as the country with the highest percentage of children
living 50% below the Federal Poverty Line (FPL). As mentioned above, the longer a person lives
under stressful, poor conditions affects how healthily they’re able to live the rest of their lives.

57
Ibid.
58
Ibid.
32
More than 25% of American children are living under poor conditions which unsurprisingly
correlates with the increasing numbers of American children becoming obese, overweight and
diabetic. Similarly, Los Angeles County shows connections between increasing rates of obesity
and the number of Hispanics living below the poverty line throughout multiple SPAs.
A framework proposed by Black and Mccinko for understanding how neighborhoods
influence health and obesity supports an approach that tackles the determinants of health at three
different levels.
59
The first level consists of social, historical and political factors, such as public
policies, distribution of resources and the racial and ethnic composition of the community.
60
At
the second level, neighborhood features shape the health behaviors individuals form, including
access to affordable, fresh food, health services, and sports facilities, environmental features such
as open, green spaces, and availability of sidewalks; and the cohesiveness of the community,
which determines levels of social support and trust.
61
Lastly, the third level focuses on the
individual. This includes the individual’s genetic makeup, socioeconomic status, culture, and
ethnicity, along with other features like gender and age.
62
Together, all three levels influence
how an individual or family will live. This framework helps dictate an individual’s commitment
to pursuing a healthier lifestyle by eating healthy or exercising regularly, what factors most
likely influence their decision and the power of that influence.
63

59
Black, J. L. and Macinko, J. (2008), Neighborhoods and obesity. Nutrition Reviews, 66: 2-20.
doi:10.1111/j.1753-4887.2007.00001.x
60
Ibid.
61
Ibid.
62
Ibid.
63
Ibid.
33
Los Angeles County Department of Public Health -- Key Indicators of Health
The Key Indicators of Health report produced by LACDPH focuses on the social
determinants as defined previously to determine the overall health of the County. The indicators
help make connections between different features of regional environments and health outcomes.
Through these reports, the County can pinpoint where the greatest disparities lie and what
populations are most greatly affected year after year. As mentioned previously, SPA 3, SPA 4,
SPA 6 and SPA 7 contain the largest Hispanic populations and most of these regions show
worsening health conditions.
The report focuses on multiple areas such as social determinants, physical determinants,
parenting practices, health status, health care access, preventative services, health behaviors and
finally, compares them to health outcomes. There is a significant disparity in access to health
care for Hispanics. Compared to all minorities in the County, Hispanics have the highest
difficulty of receiving healthcare at 47%.
64
Furthermore, in 2015, 43% of Hispanics were not
medically insured. Lack of access to health care impacts a person’s quality of life and life
expectancy. Although immigrants are less likely to have health care access, those that do face
cultural and linguistic barriers that can further negatively affect the quality of care and
confidence in the healthcare system.

Communication is Key
While the issues discussed in this chapter are policy-based, there is an opportunity for
communicators to analyze current methods and practices in public health and policy planning to
determine the most efficient way to motivate people and influence behavior change – the goal for

64
Community Health Assessment 2015, Report.
34
any communications plan. Considering the multi-factoral framework that was discussed, it seems
communicators focus on the individual’s responsibility to eat healthy and exercise without
addressing ALL the factors influencing the unhealthy choices being made. Additionally, an
individual’s behavior is not solely determined by their will; it is shaped by the support systems in
place and whether they exist in a conducive environment likely to help them succeed. An
individual’s intention to pursue a healthier lifestyle consisting of eating clean and exercising
regularly is formed by a few things: 1) a person’s knowledge and attitudes; 2) their current
beliefs and practices; 3) whether a person believes the task is plausible depending on the level of
difficulty; and, 4) accepting whether these behavioral changes will impact their health as
promoted.
65

Current health campaign messaging and efforts focus on two issues - improving a
person’s knowledge and attitude towards preventing obesity through healthy eating and exercise
and accepting the value of these changes and their impact on health and well-being. However,
they fail in addressing the other factors, making it difficult to truly carry out sustained lifestyle
changes. It is in this area in which communication professionals can make a difference by
addressing the challenges faced by the Hispanic population. Without public policies that correct
the availability of open park spaces, proximity to clean, fresh food, minimize access to fast and
processed food, and improve transportation or the availability of jobs within an individual’s
community, achieving a healthy lifestyle will always be a daunting challenge. This is not to
assume that all Hispanic communities in the County are affected by the same issues. SPA 7 may
have issues with drinking water, while SPA 6 has issues with air pollution. It is in the best
interest of the strategic communications practitioner to research the issues associated with the
different areas of the County to form the best campaign rather than solely focusing on the

65
Ibid.
35
audience’s demographic details. Like creating diverse and relatable campaigns within the
Hispanic population, there is a need for strategically diverse communication campaigns to tackle
the priority issues presented in different regions.
Obesity prevention and nutrition education advocacy groups focus on the availability of
the affordable, fresh food, but as was seen in the Let’s Move campaign, this solution is not
always the most effective. There are many factors why a person or family does not visit their
newly opened market featuring fresh food. As part of a strategy, communications professionals
should incorporate a place-making approach to the campaign. Place-making allows members of
the community to have input into what initiatives they would like to pursue to create a healthy,
supportive environment for the community to prosper. Engaging the multiple stakeholders like
organizations, groups and community leaders helps develop a message that resonates with target
audiences and builds credibility for a communications campaign.
66
Additionally, including the
targeted audience in the process of developing policies, resources, and/or amenities intended to
support healthier lifestyles, creates a sense of ownership and stewardship and crafted messages
and messengers therefore are more likely to reflect what a community actually wants.
It is essential for the communications professional to assume the role of the person in the middle,
relaying the wants of the Hispanic community and incorporating them into the needs to create
the most effective campaign and healthy environment. If met with reluctance, it is important to
build a relationship with community leaders and create a source for relaying messages of a
campaign.

66
Nilsen, P. "The Theory of Community Based Health and Safety Programs: A Critical
Examination." Injury Prevention12, no. 3 (2006): 140-45. doi:10.1136/ip.2005.011239.
36
Chapter Six: The California Endowment – Building Healthy Communities Initiative
“That simple message of reliance on individual responsibility over government is repeated
with discipline and regularity across a wide range of issues. However, it’s fair to say that there
is no equivalent meta-narrative regularly employed on the side of prevention and shared
responsibility.” – Daniel Zingale, Senior Vice President, The California Endowment
67

Individual responsibility is the driver to achieving a healthy lifestyle in current health
messaging practices. At times, agencies and organizations acknowledge the issues surrounding
the availability of fresh food and open spaces that impede individuals from achieving a healthy
lifestyle, but there is no clear call to action on how to change them from an organizing or
communal standpoint. Furthermore, much messaging revolves around medical solutions to
obesity and diabetes. Such efforts are focused on equipping the individual with the correct health
knowledge to affect behaviors. Similarly, chronic diseases and infections are correlated to an
individual’s genetics. (Figure 13) Both items can be addressed by improving access to health
care but research shows this medical model only influences 30% of health outcomes.
68

67
A New Power Grid: Building Healthy Communities at Year 5. Report. Los Angeles, CA: California
Endowment, 2016.
68
"Building Healthy Communities." California Endowment. http://www.calendow.org/building-healthy-
communities/
37

Figure 13: Medical vs. Socio-Ecological Factors
In Northern California, the Bay Area Regional Health Inequities Initiatives (BARHII)
created The Framework for Health Equity focusing on how health disparities can be prevented
by addressing socio-ecological factors such as race, class, neighborhood and workplace.
69

Through various funding sources, BARHII developed this framework, which was later adapted
by the California Department of Public Health and The California Endowment (TCE),
California’s largest health foundation.
70

Building Healthy Communities
TCE’s mission aims to increase access to affordable health care to underserved
individuals and promote improvements to the health status of Californians by focusing on factors

69
Ibid.
70
"BARHII Bay Area Regional Health Inequities Initiative – History." BARHII Bay Area Regional
Health Inequities Initiative. http://barhii.org/about-us/history/.
38
outside of medically-based solutions.
71
By changing policies and narratives through various
initiatives, TCE works on improving the health of communities by repairing environments where
people live, work and play. Subsequently, the foundation launched a 10-year, $1 billion-funded
initiative – Building Healthy Communities – focusing on finding solutions to issues preventing
underserved communities and communities of color from achieving healthy lifestyles.
The California Endowment selected 14 places throughout the state for its Building
Healthy Communities initiative and used criteria focusing on social determinants of health data
to determine which sites best displayed an opportunity to improve and create a healthy
environment.
72
TCE devoted nine months to analyzing these sites by studying the outcomes of
poor health, health data, key stakeholders and history of grant-making. After completing the
initial process, the foundation created “hubs” in each of the locations to guide the community on
distinct paths towards achieving a healthy environment.
73
Among these hubs throughout
California, three are in Los Angeles County in the communities of Boyle Heights, Long Beach
and South Los Angeles. Other Southern California hubs near the County are based in Santa Ana
(Orange County), the Eastern Coachella Valley (Riverside County) and City Heights (San Diego
County).
74

The Building Healthy Communities initiative focuses on engaging young people in these
communities to create a healthy, inclusive and resilient environments by changing institutions,
policies and systems.
75
TCE formed each hub similarly by choosing one organization as the “hub

71
"Our Story." California Endowment. Accessed February 28, 2018. http://www.calendow.org/our-story/.
72
"14 Places." California Endowment. Accessed January 28, 2018. http://www.calendow.org/places/.
73
Ibid.
74
Ibid.
75
Ratner, Bonnie, and Connie Chan Robison. Forging Structures, Systems and Policies That Work in
Communities. Publication. Center for Collaborative Planning, Public Health Institute.
39
facilitator” tasked with creating steering committees, workgroups and structures.
76
Additionally,
each hub developed an implementation plan on achieving the same 10 outcomes outlined by the
Building Healthy Communities Initiative, relying on strategies targeting changes in health,
human services, education and community environment.
77
While each hub created its own
strategies, plans needed to entrust deeply on the Building Healthy Initiatives framework to
approach the goal of improving the community’s health holistically.

How to Change Health – The TCE Way
Although each of the 14 hubs are geographically distinct, the focus lies on creating a
strategy based on the BARHII framework. Therefore, while a city like South Los Angeles is a
very different place than Merced (Central Valley), the adapted strategy tackles the same issues
presented in each community – significant health disparities in low-income neighborhoods.
78
To
improve health status, healthy environments need to be created and for healthy environments to
thrive, stakeholders need to feel safe in all aspects. According to BHC’s Theory of Change, for
health status changes to occur, a strategy should aim for three goals: power building, policy and
systems change, and improved opportunity environment. (Figure 14)

76
Ibid.
77
Ibid
78
A New Power Grid, 2016.
40

Figure 14: Building Healthy Communities’ Theory of Change
Power building, or capacity building, is accomplished by focusing on drivers of change
developed through people power; youth leadership, development and organizing; enhanced
collaboration and policy innovation; leveraging partnerships and resources; and changing the
narrative. (emphasis author’s)
79
Some communities have focused on one of these more than
others, but essentially, all drivers of change were engaged. By empowering people in the
community, residents design solutions for their own needs and transform into true advocates of
the community while building relationships to help strengthen the community’s overall power.
Moreover, investing in youth leadership development helps continue the community’s health in
the long-run. While it is imperative to foster and maintain leadership and organize with youth
who show interest in enacting change in their communities, strategies should also devote
attention to engaging youth who are societally disconnected and may be more susceptible to

79
Prevention Institute Advancement Project. Community Safety: A Building Block for Healthy
Communities. Report. January 2015.
https://www.preventioninstitute.org/sites/default/files/publications/BHC Community Safety for web.pdf.

41
violent, unsafe environments. These drivers of change will help support changes in policy and
systems through BHC’s existing campaigns while building awareness and education within the
community about the issues affecting a healthy lifestyle.
“Health Happens Here” is BHC’s overarching goal and message but three different
campaigns indicate the focal areas of expected changes to policies and systems: “Health Happens
in Schools,” “Health Happens in Neighborhoods,” and “Health Happens with Prevention.” These
three campaigns are intended to address where health is created and present the greatest impact
on a person’s lifespan by creating support systems and policies in favor of healthy lifestyles.
“Health Happens in Schools” aims to address school climate, school wellness and
comprehensive supports.
80
“Health Happens in Neighborhoods” focuses on food environment
and food systems; land use planning and anti-displacement; community and economic
development; environmental health and justice; systems that restore and heal; and, healthy youth
opportunities.
81
Lastly, “Health Happens with Prevention” tackles public health, health in homes
and health care services.
82

In achieving environmental change by increasing opportunity, it is hoped communities
will create long-lasting resources and partnerships in place to facilitate continued access to health
and well-being. As part of the last step in achieving positive change in community health status,
the Building Healthy Communities initiative hopes to accomplish the following goals:
1. “All children have health coverage;
2. Families have improved access to a ‘health home’ that supports healthy behaviors;
3. Health and family-focused human services shift resources toward prevention;

80
Ibid
81
Ibid
82
Ibid
42
4. Residents live in communities with health-promoting land use, transportation and
community;
5. Children and families are safe from violence in their homes and neighborhoods;
6. Communities support healthy youth development;
7. Neighborhood and school environments support improved health and healthy behaviors;
8. Community health improvements are linked to economic development;
9. Health gaps for boys and young men of color are narrowed;
10. California has a shared vision of community health.”
83

To achieve these outcomes, the 14 hubs throughout the state are charged with engaging
and empowering the communities they serve to change the policies and environments that
influence health. The initiative’s distinguishing factor in addressing health lies in changing the
narrative by stepping away from placing responsibility solely on the individual and turning
towards a communal, shared responsibility solution. While maintaining communication
encouraging healthy foods and active lifestyle recommendations, the initiative also advocates for
changes to the policies and resources in place, empowering youth and adult community members
to amplify their voices to shape the conversation on the needs and wants of the communities
surrounding the BHC hubs. By changing the narrative, BHC validates the concerns and struggles
of individuals who are continuously told to eat healthy and exercises but cannot. The
circumstances preventing a given community’s residents from improving its health status are
acknowledged when issues like access to open spaces, air pollution, community safety, food
deserts and unconducive school environments are addressed. Campaigns like Health for All
acknowledge that health happens outside the home; it happens in schools, in the community, at

83
The California Endowment. Building Healthy Communities: Ten Outcomes for Community Health. Los
Angeles, CA: California Endowment.
43
work and in health services. Health disparities need more than a single solution because so many
factors contribute to an individual’s overall health status of an individual and his ability to make
behavioral changes to pursue a healthier lifestyle.

In the Hub
South Los Angeles, Boyle Heights and Long Beach are multi-cultural communities but
they all have one thing in common, they’re primarily Hispanic communities dealing with
growing health disparities. While Long Beach resides within SPA 8 (also known as the South
Bay), the region holds a 40% Latino majority with a median household income of $50,000, well
below the White median household income of $86,000 and overall SPA median income of
$67,000.
84
Furthermore, Boyle Heights’s Latino community is ingrained into the region’s history
while the Latino population in South Los Angeles is due to a newly emerging shift. The South
LA area once held an 80% African-American majority but is now two-thirds Latino.
85
Although
there has been a drastic change within South LA’s community, community leaders and
organizers are not representative of the shifting demographic which calls for a focus to empower
new voices.
86

Although they are in different regions of the County, each BHC hub engages in different
advocacy initiatives to address the issues that affect the communities’ health the most while
continuously tying back to the initiative’s overarching campaigns.

84
Supplement to Community Health Assessment, Service Planning Area 8: South Bay. Report. Los
Angeles: County of Los Angeles Department of Public Health, 2014.
85
Gersema, Emily. "Takeaways from the Transformation of South Los Angeles." USC News. December
07, 2016. Accessed November 28, 2018. https://news.usc.edu/112088/lessons-from-the-transformation-
of-south-los-angeles/.
86
Ibid.
44
Boyle Heights – Health Happens Here
Despite initial challenges like gaining the trust of other community organizations, BHC
Boyle Heights found success in forming the necessary committees, workgroups and structures to
carry out the three separate campaigns. Key stakeholders and organizers took part in each arm of
the campaign and formed a collective coalition of over 45 groups. By uniting the multiple
stakeholders in each of these organizations, the campaign utilized and armed existing
constituents and advocates to carry out the campaign’s message to a larger group while fostering
new leaders. BHC used the members of the community as the best messengers to spread
information and education while activating their personal networks. Most importantly, new
messengers were local youth who called for changes in their various environments to create a
community supportive of their success.
BHC Boyle Heights has actively supported other complementary campaigns aimed at
changing school environments and increasing health care access for all. This includes the
#SchoolsNotPrisons campaign promoting a free music and art tour throughout California
advocating for state funding to prioritize schools over prisons. The rationale: for a community to
create healthy environments, its residents must feel safe to use available resources.
TCE partnered with musicians and artists like Common and La Santa Cecilia to promote
the event using platforms such as videos, social media and traditional media relations, while
BHC hub communities used grassroots organizing and social media to spark change locally.
BHC Boyle Heights participated in video tactics; in the video #SNP Los Angeles, local leaders
discuss the need to help youth succeed in school settings by changing how they are disciplined,
using the voices of real people and translated into Spanish almost seamlessly by using English
45
and Spanish interchangeably, in subtitles and text. Lastly, the video connects how changing
funding from prisons to schools will improve the health of youths.

Figure 15: #SNP Los Angeles
In addition to using real people from the community in the video, BHC Boyle Heights
implemented a local campaign - #InvestInYouth. Through this movement, BHC Boyle Heights
amplifies youth voices and stories to promote the need to invest in youth and include them in the
conversation, with the goal of empowering the community to make positive changes in their
neighborhood and schools, including the implementation of policies conducive to healthy school
environments within the Los Angeles Unified School District (LAUSD).
BHC Boyle Heights also engaged in strategies directly intended to change school health
policies, such as pressuring schools to remove sugary foods from school menus, and identifying
student health ambassadors and implementing the Fresh Prep Initiative and the Smarter
Lunchroom Movement at Roosevelt High School with the intention to engage students by
teaching cooking classes and informational sessions healthy food options versus processed
foods.
87

87
Ibid.
46

Figure 16: #IAmPossible – BHC Boyle Heights
Engaging youth as the primary messengers in the community secures the future of the
community by creating a path towards success in a region that traditionally has been
underserved. Through efforts like BHC Boyle Heights, Hispanic youth in LA County are now
encouraged to participate and advocate for what they want, thus providing the opportunity to
change the narrative of their neighborhood. Allowing them to create their own messages and use
their own voices and opinions, also provides opportunities to change how surrounding
communities perceive them. (Figure 16) Instead of feeling like they are viewed as an unengaged,
dumb, gang-affiliated group because of the color of their skin or neighborhood, local youth in
this hub are rising to show they can accomplish more if given the resources other affluent
communities regularly receive.
88
With proper systems in place, healthy environments in schools,
neighborhoods and homes should help lead to success and healthier lives. Lastly, youth cannot
become what they cannot see. Youth in poor Hispanic communities are surrounded by dire
circumstances, like limited access to open spaces, lack of healthy, affordable foods and
disadvantageous schools -- similar or worse to the conditions their parents experienced.
Furthermore, it’s likely these environments affected the health of their relatives and friends –

88
BHC Boyle Heights. "SYI2015 Health Happens in Neighborhoods HD." YouTube. December 16,
2015. Accessed 2018. https://youtu.be/TTkzTmtu0PY.
Video
47
creating a community plagued with obesity and other chronic illnesses. By developing a
community of youth wanting to see changes in their communities, BHC is helping them create a
vision of a future they can aim to achieve.
Building Healthy Communities tackles policies and systems impeding underserved
communities from achieving healthy lifestyles, and TCE’s #Health4All campaign works in
harmony to promote preventative health programs within the hubs and surrounding communities.

Hispanic communities suffering from high rates of obesity, overweightness and diabetes
are expected to eat healthy and exercise regularly despite their environments. When they fail to
do so, they can feel a sense of blame or judgment because of the inability to follow through. A
recent study reported that lower-income parents tended to honor their children’s requests for junk
food to nourish them emotionally because they were not able to oblige other requests a more
affluent family could afford.
89
However, if parents in underserved neighborhoods had the access
to clean, affordable food, the time to prepare healthy food and the support systems to provide for
the needs of their children, then eating healthier and making healthy choices for the benefit of the
family could be a priority and possibly attainable.

89
Fielding-Singh, Priya. "Why Do Poor Americans Eat so Unhealthfully? Because Junk Food Is
the Only Indulgence They Can Afford." Los Angeles Times. February 07, 2018. Accessed 2018.
http://www.latimes.com/opinion/op-ed/la-oe-singh-food-deserts-nutritional-disparities-
20180207-story.html.
48
Chapter Seven: Is the long-term investment worth it?
Investing in communities by providing community-based organizations with grant
funding and resources is a step in making systemic changes within underserved Latino
communities. In addition to TCE’s investment, multiple foundations and health organizations
like the City of Hope work with local stakeholder groups to address health disparities. The City
of Hope, a cancer treatment hospital and research center located in the city of Duarte within LA
County’s SPA 3, serves the immediate area and five surrounding counties.
90
As mandated by the
state, the City of Hope carries out a regular Community Health Needs Assessment and develops
an implementation plan to address the priority issues in the surrounding community to inform the
hospital’s community benefit. Prior to 2016, the hospital focused on increasing awareness about
cancer screenings to improve preventative treatment and minimize cancer cases, but through
community focus groups and dialogue Community Benefit Manager Nancy Clifton-Hawkins
found the community’s priorities were much different than the hospital’s. “They said, ‘first we
want access to care – because if we can reduce the cultural and linguistic barriers and poverty
barriers like that to health, then people will get into care. The second part is addressing healthy
living and chronic diseases that increase your risk for cancer and diabetes and then focus on
mental health. Then we’ll look at cancer awareness and prevention,’” said Clifton-Hawkins.
91

Working with the surrounding communities and stakeholders demonstrates the
importance of incorporating insights from the community into a strategic plan designed to
change health outcomes. If hospital organizations and foundations dictated what areas are
priorities, these organizations could risk the chance of failing before beginning to implement a
plan because the priorities do not align.

90
"City of Hope: Cancer Treatment & Cancer Research | City of Hope Comprehensive Cancer Center."
Home. Accessed 2018. https://www.cityofhope.org/homepage.
91
"Nancy Clifton-Hawkins." Interview by author. December 5, 2017.
49
Like TCE, the City of Hope funds local organizations through its Healthy Living Grant
Program to address the causes that create barriers to good health and works with them to process
the needs assessment data to design programs capable of making a difference in their
communities. With foundations and organizations taking a lead in place-based work, the question
becomes – what is the need for public relations agencies and communications experts to take on
a similar approach, particularly with such a high investment through multiple resources such as
time, personnel and money.

Great on Paper, but Reality is Different
Norma Rodriguez, an account director working with TCE through Imprenta, a public
relations agency specializing in Asian-Pacific American and Latino demographics, supports
three Building Healthy Communities hubs -- Boyle Heights, Santa Ana, and Coachella Valley --
with strategic communications implementation, media relations and crisis management. While
the foundation’s framework is unique by allowing each hub to dictate what issues it should
prioritize, she recognizes the limitations to this approach. “Building Healthy Communities is
doing something interesting. On paper, it has this mission and certain approach to their work. But
I found that there’s a little bit of a disconnect of what happens on the ground versus what they
propose to do. The execution part is very difficult.”
92
Rodriguez cited a few roadblocks in
developing strategic messaging to key audiences in these communities such as linguistic barriers,
community knowledge and self-imposed limitations by the foundation to minimize legal risks.
For example, when developing a campaign to increase Vote-by-Mail registrations within
the Hispanic community of the Coachella Valley, a BHC hub, Rodriguez noted a major

92
"Norma Rodriguez." Interview by author. February 8, 2018.
50
challenge was designing effective messaging without crossing the foundation’s comfort in using
“politically charged” words which in this case referenced voting. BHC Coachella Valley
recognized the difficulties eligible voters faced during elections because of polling locations,
work commitments, transportation challenges and family priorities. Therefore, the hub wanted to
encourage people to vote-by-mail and register by mail. Without directly telling key audiences
about the value of voting, Rodriguez’ team needed to create a public awareness and information
campaign about voting-by-mail but by distilling messaging down, she felt no real change would
come of it because of the difficulty to motivate people with only half the message.
93
“To
develop messaging that resonates with someone that’s a potential voter, you have to tell them to
go vote. You have to be clear, it has to be in language, and you have to be aspirational.”
Like the Coachella Valley hub, the South Los Angeles hub faced issues with developing
messaging and a clear call-to-action for the People’s Plan, a campaign designed to organize
community members to advocate for their needs to be addressed in the revised City of Los
Angeles Community Plan. The communities of South Los Angeles have seen a drastic
demographic change as stated earlier; the once- predominately black and African-American
community is now 76% Hispanic.
94
The campaign’s strategy included forming a coalition within
the area to develop recommendations the city could integrate to address the needs and issues
facing the community in coming years, including gentrification. Some of the strengths of the
campaign included developing messaging and communicating about the potential threats to the
community by demonstrating proposed scenarios if the revised Los Angeles Community Plan did
not plan for displacement but lacked impact in turning newly educated stakeholders to act.

93
Ibid.
94
"Los Angeles County (South Central) -- LA City (South Central/Watts)." Census Reporter. Accessed
2018. https://censusreporter.org/profiles/79500US0603751-los-angeles-county-south-central-la-city-
south-centralwatts-puma-ca/.
51
Because of the foundation’s official IRS 501(c)3 nonprofit status, there is a clear line it cannot
cross – any call-to-action directly affecting policy is a legal violation, which thus creates self-
imposed limitations on communications. Despite messaging limitations, the People’s Plan
successfully developed effective communication with the communities of South Los Angeles
with the help of the coalition. Additionally, the coalition collected petition signatures supporting
the coalition’s recommendations for the City Council. Furthermore, the collateral developed for
the campaign resonated with the communities to effectively portray the different scenarios that
could play out without any action. (Figure 17, Figure 18)

Figure 17: We Demand the People’s Plan (English)
52

Figure 18: ABC’s of the People’s Plan (Spanish)
Rodriguez’ team offered the necessary resources to carry the foundation’s campaign
forward. While TCE provides funding resources and program guidance to the individual hubs,
implementation of the work would not be successful without the guidance of public relations
agencies or communications professionals like Rodriguez and Imprenta Communications Group
who describe themselves as experts in crafting messages to communities of color and equipped
with the knowledge of navigate the limitations of nonprofit. Additionally, while Rodriguez
works on certain communication aspects for Building Healthy Communities, TCE contracts with
other public relations firms like Rally and the Rios Company to work on social media content
and advertising – creating a network to support changes tackling health in Latino communities.
53
Without the long-term commitment and network of firms, coalitions, community leaders, and the
foundation – the Building Healthy Communities initiative does not hold the same impact
throughout the state. Firms help the hubs create, guide, and disseminate the content and
information created locally and assist in garnering media attention and coverage to truly create a
focus on the needed changes and bringing the issues hitting these communities back into the
spotlight and on the radar of policy makers – creating a policy window.
95
Furthermore, the long-
term investment helps in developing a relationship with the communities and understanding what
goes on outside a person’s life as a patient. What are the root causes that create roadblocks to
carry out a healthy lifestyle?

Niche Market Only
Firms like Imprenta Communications Group that specialize in creating campaigns
targeting Latinos and communities of color are certainly a useful resource for foundations and
clients to contract for campaigns targeting multi-cultural demographics. However, while niche
firms like these exist, there is a greater need to diversify staff across the public relations field
considering the ethnic makeup of the PR industry in the United States is 87.8% white. The PR
industry acknowledges the need to become more diverse and inclusive to avoid creating tone-
deaf campaigns like the Pepsi ad featuring Kendall Jenner or Dove’s ad showing a
transformation of a black woman into a “cleaner” white woman, but escalated efforts to diversify
staff across the industry do not always signify a consensus in diversifying race and ethnicity.
96
In
a survey conducted by the Harvard Business Review, the researcher found diversity and

95
Kingdon, John W. "Why Some Issues Rise and Other Are Negated." In Agendas, Alternatives, and
Public Policies, 157-63. Second ed. New York, NY: Addison-Wesley, 2003.
96
Chitkara, Angela. "PR Agencies Need to Be More Diverse and Inclusive. Here's How to Start." Harvard
Business Review. April 12, 2018. Accessed 2018. https://hbr.org/2018/04/pr-agencies-need-to-be-more-
diverse-and-inclusive-heres-how-to-start.
54
inclusion tactics meant different things across the industry, ranging from gender equality to
LGBTQ inclusion.
Because organizations and clients are requesting a track record of successful
communication strategies to diverse communities, PR agencies are quickly reacting by hiring
diverse staff when possible but fail in retaining their talents because of various reasons, including
inclusion. To combat issues of diversity and inclusion, the report suggests creating pipelines for
diverse talent by broadening recruitment access. Secondly, by conducting internal training to
help employees acknowledge their bias towards diverse hires. Other suggestions include tracking
the rate of turnover and adding the need for diversity and inclusion to an organization’s core
values. While these suggestions are necessary to improve the PR industry in relation to its lack of
diversity, there are still ways to improve its effectiveness.
Rodriguez consulted on a communications campaign on behalf of the Los Angeles
Community College District targeting Deferred Action for Childhood Arrivals (DACA) students
and families in the Los Angeles region. The intention of the campaign was to stress the
importance of having students stay in school despite the uncertainty of their DACA status and
issues revolving immigration raids. When approached with the project, Rodriguez noticed the
materials that had been produced by the previous consultants showed disconnection and tone-
deafness by using sterile stock-images and ineffective messaging. Because of her personal
knowledge of the community and what DACA families were feeling, she could suggest changes
to key messaging that resonated with target audiences. “Parents care about education, but right
now, parents care mostly that they might have to leave their kid behind if they get deported,”
said Rodriguez. With these insights, Rodriguez suggested the key message to parents should be
about support and protection and for students - it should be that of defiance and perseverance.
55
Adding diversity by hiring more PR professionals who are people of color to the PR
industry could certainly bring different viewpoints and lenses to communications. Clients and
larger firms should not really on niche PR firms to do campaigns targeting multi-cultural
communities on any subject. With the changing demographic of the nation, the PR industry –
particularly industry leaders – should look to include diversity and furthermore, local talent into
their workforce. What Rodriguez provided was not just cultural competence and linguistic
comprehension, she understood the community challenges to achieving higher-education, and in
other cases healthy living.
What long-term investments like the Building Healthy Communities initiative provide is
the capacity to make an impact on minimizing the health disparities Hispanic communities face
but they also build a pathway to cultivating leaders in policy-making and communications who
can use their insights and knowledge to create successful campaigns for these communities and
demographic. Furthermore, while foundations and non-profit organizations are implementing
successful campaigns addressing underserved communities, there is still room for improvement
in messaging found in traditional media. Without the limitations of nonprofit status, PR agencies
and private-sector organizations have an opportunity to take place-based campaigns a step
further.

56
Chapter Eight: Recommendations
Investing in robust communications plans that tackle the multiple determinants of health
to minimize health disparities in Latino communities throughout Los Angeles County is not a
risk, but a strategic move health communicators should implement.
There are a handful of reasons why communicators should choose to engage in a long-
term relationship within communities to tackle the most prominent chronic illnesses affecting
Latinos. These include:
• Chronic illnesses like diabetes, obesity and mental health are not exclusive to these
demographics but are influenced by the environment and situations found in these
communities. For Hispanic communities in Los Angeles County, policies have
historically excluded community members’ input and priorities and there is now an
opportunity to shape future policies with the recommendations of the people directly
affected by them.
o Categorizing a population solely on their race and ethnicity is not an efficient
way to develop a communications strategy or plan. There are vast behavioral
and cultural value differences between older Latino adults, second-generation
Hispanics and foreign-born children that influence what sources of
information they trust when seeking a solution to their health issues.
• The solution to tackling health disparities must be more than an adjustment to one’s diet
and exercise regimen. Without the proper systems in place, whether it’s resources,
amenities or influencers, Hispanics cannot succeed in improving their health status if
they merely carry out the recommendations provided to them.
57
• Robust strategies targeting multiple factors affecting health can result in myriad
benefits.
o Creating relationships with existing stakeholders builds the legitimacy of a
campaign but developing new narratives and nurturing new leaders within
youth sets a more sustainable pathway for future communicators.
• Factors affecting a community or individual’s health change over time. While at one
point, the priority was to increase education and awareness around healthy diets and
exercise, health communicators should look to step into a second stage of addressing
health by shifting away from a single lens solution to a holistic approach.

Here are a few recommendations to enhance communications targeting Hispanics and
increase their changes of being effective and successful.
1. Diversity and Inclusion
Encouraging more diversity within the professional ranks of the PR industry is not
necessarily a new priority, but it is a critical one. Many PR leaders cited the need
to diversify their staff to provide meaningful insights to the accounts they were
working on with targeted audiences.
97
However, the industry should not stop at
merely hiring diverse staff but also work to improve inclusion to prevent turnover.
Furthermore, in addition to recruiting more diverse talent into the industry,

97
Kim, Soon Mee. "Seven Diversity & Inclusion Strategies for 2018." The Holmes Report.
January 18, 2018. https://www.holmesreport.com/agency-playbook/sponsored/article/seven-
diversity-inclusion-strategies-for-2018.
58
agencies should create pathways to support their aspirations for C-Suite positions;
this would further to strengthen an organization’s leadership.
98

2. Create Culturally Competent Materials
Creating collateral materials should not stop at simply translating messaging from
English to Spanish. The same principles practiced in creating English content on
social media, television and print should be implemented for Spanish language
content and collateral which includes cultural competency. Furthermore, while
Google’s translation capabilities improve day-by-day, it does not account for the
significant cultural and community differences throughout Los Angeles County.
Similar to applying relevant language that takes colloquialisms into consideration,
creative content should be representative of the targeted audiences. In a nutshell,
direct literal translations and stock imagery may not work. Los Angeles County is
a diverse region and creating images representing the community can relate to
may be as easy as collaborating with community stakeholders on content creation.
3. Hire Locally
Investing in diversifying personnel helps with creating more culturally-competent
messages and strategies, but investing in local talent provides an additional
opportunity to build on existing foundations of relationships, knowledge and
community familiarity.
4. Dedicate Funding
Without the 10-year, $10 billion investment of The California Endowment, the
efforts of the Building Healthy Communities initiative wouldn’t be as impactful,
but more importantly, it wouldn’t be adequately evaluated. Some critics have

98
Chitkara, 2018.
59
complained about the initiative’s local control and participation, but TCE’s long-
term investment allows them to actively find solutions to tackle those issues and
adapt. While the initiative’s grant cycle is not over, the work carried out by each
individual hub has made significant impact – whether elevating the voices of the
historically ignored or creating new youth leaders who acknowledge the impact
their community has on their health. Furthermore, the initiative’s been successful
in its efforts in emphasizing the need to listen to these voices because health is a
right, not a luxury restricted to only a select few.
5. Simple Messaging vs. Robust Campaigns
Campaigns to encourage healthy diets and regular exercise successfully relayed
the importance of these habits to live a healthier life. However, the same energy
and resources that have been applied to repeatedly emphasize an individual’s
responsibility to following healthy habits should be replicated into creating robust
campaigns that tackle the surrounding community-based issues and challenges
that are preventing Hispanics in underserved communities from adopting these
behaviors. Without addressing the crippling systems currently in place, any
individual in one of these communities will find it extremely challenging to make
behavioral changes to improve his health. Allowing the community to voice what
changes they prioritize will help in developing a pathway to a healthy life.
6. New Narratives
At a pivotal time where representation and inclusion is sorely needed in media
portrayals of the Hispanic community, nurturing and highlighting the narratives of
Latino voices brings an opportunity to partner with local leaders to create
60
messages and content that resonates with these communities. For decades, these
communities have been approached by outside institutions telling them how to
live a healthier life and placing an added responsibility without accounting for any
of accompanying emotional, physical, cultural and environmental barriers. By
developing and fostering local voices of the community, there is an opportunity to
create influencers and messengers a community can relate to and follow.

Conclusion
While addressing food deserts and the personal responsibilities of the Hispanic
community as a solution to end chronic rates of diabetes, obesity and overweightness can help
tackle these issues, as communicators we must learn to step back and realize we need to do more.
Research and data continue to indicate that members of the Hispanic population are continuously
affected by obesity and overweightness, leading to graver illnesses like diabetes, cancer and
heart failure.
When developing a strategic communications campaign, practitioners must analyze the
internal strengths and weaknesses and external opportunities and threats of a potential campaign
and in this stage, a community’s environmental limitations should not be viewed as a weakness
but as an opportunity to involve the community and nurture a path towards shared participation
in desired outcomes. In conversations with industry experts and community members, the
importance of eating healthy and exercising regularly was a message that was received
consistently, and depending on the audience, transmitted through appropriate platforms. But in
these same conversations, acknowledging the ability to carry out these recommendations and
61
create behavioral changes are likely to be successful if the appropriate changes to adjust the
support systems are also in place.

62
Bibliography
"#SchoolsNotPrisons – Let's Build Schools Not Prisons." #SchoolsNotPrisons. Accessed
December 21, 2018. http://schoolsnotprisons.vote/.

"14 Places." California Endowment. Accessed January 28, 2018.
http://www.calendow.org/places/.

A New Power Grid: Building Healthy Communities at Year 5. Report. Los Angeles, CA:
California Endowment, 2016.

"BARHII Bay Area Regional Health Inequities Initiative – History." BARHII Bay Area
Regional Health Inequities Initiative. http://barhii.org/about-us/history/.

BHC Boyle Heights. "SYI2015 Health Happens in Neighborhoods HD." YouTube. December
16, 2015. Accessed 2018. https://youtu.be/TTkzTmtu0PY.
Video
Boone-Heinonen, Janne, P. Gordon-Larsen, J. M. Shikany, and B. M. Popkin. "Fast Food
Restaurants and Food Stores." Archives of Internal Medicine171, no. 13 (2011): 1162-
170. doi:10.1001/archinternmed.2011.283.

"Building Healthy Communities." California Endowment. http://www.calendow.org/building-
healthy-communities/.

The California Endowment. Building Healthy Communities: Ten Outcomes for Community
Health. Los Angeles, CA: California Endowment.

"Champions for Change Program." CDPH Public Portal. February 27, 2018.
https://www.cdph.ca.gov/Programs/CCDPHP/DCDIC/NEOPB/Pages/ChampionsforChan
geProgram.aspx.

"Childhood Obesity Trends in LA County, Children's Data Network USC." Achieving Healthy
Weight Early in Life. https://insight.livestories.com/s/childhood-obesity-trends-in-la-
county-childrens-data-network-usc/56183373a750b32489d54cdd/.

Chitkara, Angela. "PR Agencies Need to Be More Diverse and Inclusive. Here's How to Start."
Harvard Business Review. April 12, 2018. Accessed 2018. https://hbr.org/2018/04/pr-
agencies-need-to-be-more-diverse-and-inclusive-heres-how-to-start.

"City of Hope: Cancer Treatment & Cancer Research | City of Hope Comprehensive Cancer
Center." Home. Accessed 2018. https://www.cityofhope.org/homepage.

Clayman, Marla L., Jennifer A. Manganello, K. Viswanath, Bradford W. Hesse, and Neeraj K.
Arora. "Providing Health Messages to Hispanics/Latinos: Understanding the Importance
63
of Language, Trust in Health Information Sources, and Media Use." Journal of Health
Communication15, no. Sup3 (2010): 252-63. doi:10.1080/10810730.2010.522697.

Community Health Assessment 2015. Report. County of Los Angeles Department of Public
Health. 112-17. Accessed November 2017. http://www.bhclongbeach.org/wp-
content/uploads/2012/06/LACDPHCommunityHealthAssessment2015Final.pdf.

Cummins, Steven, and Sally Macintyre. ""Food Deserts" -- Evidence and Assumption in Health
Policy Making." British Medical Journal325, no. 7361 (2002): 436-38.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123946/#.

Los Angeles County Department of Public Health. "Diabetes Continues to Increase in Los
Angeles County." News release, 2015. Desire Health Magazine Inc.
http://dhmi.org/lacdph-diabetes/.

"Division of Nutrition, Physical Activity, and Obesity." Centers for Disease Control and
Prevention. December 11, 2017. Accessed January 28, 2018.
https://www.cdc.gov/nccdphp/dnpao/state-local-programs/reach/index.htm.

"El DOC Responde." Univision 34 Los Angeles. May 1, 2016.
https://www.facebook.com/Univision34/videos/10154793172103528/.

Estimates of Diabetes and Its Burden in the United States. Report. National Diabetes Statistics
Report. Centers for Disease Control and Prevention, 2017.
https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf.

Fielding-Singh, Priya. "Why Do Poor Americans Eat so Unhealthfully? Because Junk Food Is
the Only Indulgence They Can Afford." Los Angeles Times. February 07, 2018.
Accessed 2018. http://www.latimes.com/opinion/op-ed/la-oe-singh-food-deserts-
nutritional-disparities-20180207-story.html.

Flores, Antonio. "How the U.S. Hispanic Population Is Changing." Pew Research Center.
September 18, 2017. http://www.pewresearch.org/fact-tank/2017/09/18/how-the-u-s-
hispanic-population-is-changing/.

Gersema, Emily. "Takeaways from the Transformation of South Los Angeles." USC News.
December 07, 2016. Accessed November 28, 2018. https://news.usc.edu/112088/lessons-
from-the-transformation-of-south-los-angeles/.

Gilligan, Heather Tirado. "Getting Fresh Fruits and Vegetables Into Poor Neighborhoods Doesn't
Make Poor People Healthier." Slate Magazine. February 10, 2014.
http://www.slate.com/articles/life/food/2014/02/food_deserts_and_fresh_food_access_are
n_t_the_problem_poverty_not_obesity.html.

64
Gutierrez, Carlos. "Health Disparities among Hispanics: Diabetes." Univision Communications
Inc. July 12, 2017. https://corporate.univision.com/blog/healthcare/2016/07/26/health-
disparities-among-hispanics-time-to-close-the-gap/.

"Health Happens in Schools Workgroup Meeting." BHC Boyle Heights. Accessed January 18,
2018. http://boyleheightsbhc.org/schools/.

Johnson, Steven Ross. "Gauging the Public Health Value of @MichelleObama's @Let's Move
Campaign." Modern Healthcare. August 23, 2016.
http://www.modernhealthcare.com/article/20160823/NEWS/160829986.

Key Indicators of Health by Service Planning Area.Report. January 2017.
http://www.publichealth.lacounty.gov/ha/docs/2015LACHS/KeyIndicator/PH-
KIH_2017-sec UPDATED.pdf.

Kim, Soon Mee. "Seven Diversity & Inclusion Strategies for 2018." The Holmes Report. January
18, 2018. https://www.holmesreport.com/agency-playbook/sponsored/article/seven-
diversity-inclusion-strategies-for-2018.

Kingdon, John W. "Why Some Issues Rise and Other Are Negated." In Agendas, Alternatives,
and Public Policies, 157-63. Second ed. New York, NY: Addison-Wesley, 2003.

Krogstad, Jens Manuel. "Key Facts about How the U.S. Hispanic Population Is Changing." Pew
Research Center. September 08, 2016. http://www.pewresearch.org/fact-
tank/2016/09/08/key-facts-about-how-the-u-s-hispanic-population-is-changing/.

LaVeist, Thomas Alexis., and Lydia A. Isaac. Race, Ethnicity, and Health: A Public Health
Reader. Jossey-Bass, 2013.

Lopez, Mark Hugo, and Anna Brown. Mapping the Latino Population, By State, County and
City. Report. Pew Research Center, 2013.
http://cssr.berkeley.edu/cwscmsreports/LatinoPracticeAdvisory/DATA_State_National/
Mapping_the_Latino_Population.pdf

"Los Angeles County (South Central) -- LA City (South Central/Watts)." Census Reporter.
Accessed 2018. https://censusreporter.org/profiles/79500US0603751-los-angeles-county-
south-central-la-city-south-centralwatts-puma-ca/.

"Nancy Clifton-Hawkins." Interview by author. December 5, 2017.

"Norma Rodriguez." Interview by author. February 8, 2018.

Nilsen, P. "The Theory of Community Based Health and Safety Programs: A Critical
Examination." Injury Prevention12, no. 3 (2006): 140-45. doi:10.1136/ip.2005.011239.

65
"Our Story." California Endowment. Accessed February 28, 2018. http://www.calendow.org/our-
story/.

Panzar, Javier. "It's Official: Latinos Now Outnumber Whites in California." Los Angeles Times.
July 08, 2015. http://www.latimes.com/local/california/la-me-census-latinos-20150708-
story.html.

Passel, Jeffrey S., and D’Vera Cohn. "U.S. Population Projections: 2005-2050." Pew Research
Center's Social & Demographic Trends Project. February 11, 2008.
http://www.pewsocialtrends.org/2008/02/11/us-population-projections-2005-2050/.

Passel, Jeffrey S., D’Vera Cohn, and Mark Hugo Lopez. "Hispanics Account for More than Half
of Nation's Growth in Past Decade." Pew Research Center's Hispanic Trends Project.
March 24, 2011. http://www.pewhispanic.org/2011/03/24/hispanics-account-for-more-
than-half-of-nations-growth-in-past-decade/.

Prevention Institute Advancement Project. Community Safety: A Building Block for Healthy
Communities. Report. January 2015.
https://www.preventioninstitute.org/sites/default/files/publications/BHC Community
Safety for web.pdf.

Ratner, Bonnie, and Connie Chan Robison. Forging Structures, Systems and Policies That Work
in Communities. Publication. Center for Collaborative Planning, Public Health Institute.

"Renowned Cardiologist Dr. Juan José Rivera Joins Univision News as Chief Medical
Correspondent." Univision. February 12, 2013.
https://corporate.univision.com/corporate/press/press-releases/2013/02/12/renowned-
cardiologist-dr-juan-jose-rivera-joins-univision-news-as-chief-medical-correspondent/.

Rivera, Dr. Juan. "El Ejercicio Ideal Para Cada Edad." Univision. January 22, 2016.
https://www.univision.com/noticias/salud/consulta-con-dr-juan-el-ejercicio-ideal-para-
cada-edad-video.

Simon, Paul, MD, MPH. "Obesity and Park Equity in Los Angeles County." Lecture.
https://envhealthcenters.usc.edu/wp-content/uploads/2017/05/Paul-Simon-_P1.pdf.

Solving the Problem of Childhood Obesity Within a Generation. Report. White House Task
Force on Childhood Obesity Report to the President. Executive Office of the President of
the United States, 2010. May 2010.
https://letsmove.obamawhitehouse.archives.gov/sites/letsmove.gov/files/TaskForce_on_
Childhood_Obesity_May2010_FullReport.pdf.

Supplement to Community Health Assessment, Service Planning Area 6: South. Report. Los
Angeles, CA: County of Los Angeles Department of Public Health, 2014.
http://www.publichealth.lacounty.gov/plan/docs/SPA6Supplement.pdf.

66
Supplement to Community Health Assessment, Service Planning Area 7: East. Report. Los
Angeles, CA: County of Los Angeles Department of Public Health, 2014.
http://www.publichealth.lacounty.gov/plan/docs/SPA7Supplement.pdf.

Supplement to Community Health Assessment, Service Planning Area 8: South Bay. Report. Los
Angeles: County of Los Angeles Department of Public Health, 2014.

Vega, W. A., M. A. Rodriguez, and E. Gruskin. "Health Disparities in the Latino
Population." Epidemiologic Reviews31, no. 1 (2009): 99-112.
doi:10.1093/epirev/mxp008.

67
Appendix A: Industry Interviews
Industry Interview: Norma Rodriguez, Account Director, Imprenta Communications Group

Norma Rodriguez is an account director with Imprenta Communications Group and serves on the
executive board of the Hispanic Public Relations Association (HPRA-LA) as treasurer.

Rodriguez works with clients such as the Annenberg Foundation, The California Endowment
and Planned Parenthood.

Interview Questions and Answers
Can you describe what Building Healthy Communities is?
BHC is a really good case study and the work that they’re doing. So BHC is a 10 year $10
Billion initiative. So, the California Endowment has invested nearly 10 billion directly into low-
income, underserved, often rural communities throughout the state of California.

The rural communities are more to the north of us, in the Central Valley as well. Their structure
is to divide up those communities, 14 throughout the state, and then equip these hubs with
resources. So, there’s a program manager that oversees the work. There’s a communications
person – that’s where we come in to play. Up until now, they’ve had this model where they let
the hubs do whatever they want in terms of campaigns that they undertake. So, for BHC, their
definition of health is pretty broad. They see health implications in all sorts of social issues –
gentrification and displacement, obviously, food, access to healthcare, education, youth
empowerment, immigration – all of these are issues that they see as related. So, when they say
building healthy communities, they don’t just mean healthcare. So, because it’s so broad –
different communities, different hubs, the 14

– they kind of chose their own fights to fight. So,
for example, in Boyle Heights or Santa Ana there’s a big anti-displacement and gentrification
fight. Also in South LA but not in Coachella. They have different issues – access to water and
pipes and roads and voter engagement – so there’s no gentrification campaign in Coachella per
se. But all of these various efforts are under this big umbrella.

So, I think for us, a challenge has been communicating in culturally relevant ways. Developing
messaging, working directly with the people on the ground through our Vietnamese campaigns
and saying what are you trying to communicate and how do we do it in a way that’s going to
catch people’s attention that doesn’t feel cookie cutter, doesn’t feel tone deaf.

How do you engage them, how do you activate? There’s a disconnect between creating and
implementing. What can the agency do better to fix that?
I think BHC is doing something interesting. So, on paper, BHC has this mission and a certain
approach to their work. But I found, especially in Coachella, that there’s a little bit of disconnect
of what happens on the ground versus what they propose to do and I think to do. I think you have
68
a written way to move forward, but the execution part is very difficult. So, you can have a great
plan on paper thinking it’s going to play out a certain way and then it doesn’t. To give you an
example of that – Coachella, they have a voter education vote-by-mail campaign. And voter
engagement, civic engagement, that’s all part of building a healthy community. So TCE is a part
of that because they believe that being civically engaged is important. But we ran into problems
when we were developing messaging to encourage people to educate themselves on the vote-by-
mail option. So, one thing that, especially in rural communities, is a challenge is that even if
you’re interested in voting, a lot of times polling places are few and far between and the fact that
people have to go between the hours of 8 and 8, you know, if you’re not nearby, you don’t have
access to a car, you work late, you have kids at home – it’s difficult to go vote. So, they wanted
to do outreach to encourage people to vote-by-mail and register by mail. So, we ran into a lot of
road blocks in trying to figure out what words to use that were not “politically charged” words,
and I understand BHC’s position which is they can’t be political, they can’t be an advocacy
group but at the same time, we’re talking about people to register to vote, or not even register – it
was a public awareness information campaign. We’re not even telling them to go register, we’re
telling them “Go Vote by Mail” and they were all nervous about it. So, I think when you distill
your messaging down and you cookie cutter it, you just take the teeth out of it and there’s no real
change because you’re not really going to motivate anyone to go vote if you say we need to build
stronger communities.

It’s not that they were restrictions. I think there was wiggle room but it comes down to how
comfortable they are with risk and you know, straddling that line a little bit – there was nothing
inflammatory, there was no politician that was called out, there was not a specific election that
we were pointing to – it was just vote-by-mail, vote, vote, vote. But the word vote to them is a
call-to-action and so they’re restricted. What I’m saying about that is that if you want to develop
messaging that resonates with someone that’s a potential voter, you have to tell them to go vote –
you’re not going to use euphemisms or like dog whistle words to get them to think “Oh maybe
they want me to go register to vote.” No, you have to be clear, it has to be in language, you have
to be aspirational, so at least for voting that was one challenge that we kind of struggled through.
Same thing with People’s Plan.

People’s Plan is a gentrification plan in the South LA Hub, we were trying to get people to sign a
petition to put pressure on city council to develop fair and inclusive zoning plans because they
were updating their community plans and messaging was also very challenging there. We did a
good job in communicating in language but calls to action and kind of painting the picture of this
alternative scenario for people, like “This is where we’re at but this possible.” Those are direct
calls to action because you want to motivate people to be active in their community, well those
who can. Undocumented people are not going to stick their necks out and risk everything. But
those of us who can, we should. But that’s very BHC specific, those kinds of limits on
messaging. In my opinion, I think they’re mostly self-imposed limits because I think there’s
69
more wiggle room than they’re willing to play with but any private foundation 501c3 – you’re
restricted legally.

What is the line?
I think the default position is that you can’t. You’re not endorsing a specific candidate; can you
do a call to action. Yes, but you can’t do a call-to-action that can directly affect policy. So,
you’re not saying, tell Eric Garcetti to vote no on measure A, you can say “Tell Eric Garcetti to
support fare housing.” But BHC doesn’t tolerate that. They’re not comfortable with doing that
kind of maneuvering. So, for me, that’s frustrating because it’s limiting but they’re nervous
about it because they run into legal problems.

What’s your main demographic for these campaigns? Is it older Latinos or millennials?
It’s a little bit harder to mobilize the older generation. I’ve noticed that older adults rely on
their kids to know what’s going on, for example to go out to vote?
I think depending on who your audience is, you need to reach those audiences through
communication modes that they’re using. For example, with Zika – we know we’re trying to
reach older populations that go back and forth, either for work or leisure or for business. A lot of
these people are older, lower education, low resources, rural communities and so the chances of
them being active in social media – if they’re an older person, are slim to none. So for messaging
for parents of families, we’re relying heavily on TV and consulates because we know that these
people will go to the Mexican consulate and say “Hey, I’m going to TJ and I’m going to do this
and this” and they get updates on health or even when they’re in waiting rooms, the consulates
often have TVs rolling with public health messages and updates and so our Zika messaging for
parents of families and older people is primarily through consulates, community events, where
we know they may go, so tabling at events, and TV and radio PSAs
For younger people we do digital media, social media and all that.

Do you think the consulate offices are as effective here in LA County compared to San
Diego?
Yes, absolutely. Consulate offices are getting majorly involved. Every consulate has a program
called Ventanillas de Salud and they’re basically mobile units that drive out to rural areas,
although LA has a Ventanillas de Salud too. And they do free health screenings and they do
diabetes and blood pressure screenings, preventative care and in that same opportunity where
you have that captive audience, they’re there for care, we’re also working with them to push that
Zika messaging and that’s a consulate program and they’re a very good resource for this
campaign. Communicating not only in language and tone that is relevant to your audience but
also what means of communication they use is very important.

What do you believe health communications or public health communicators are doing
right in their outreach and health education efforts?
70
So, I think that they’re not doing it right for the most part. I think a lot the messaging is tone
deaf, it doesn’t really speak to the community that they’re trying to reach and I think in large part
that is because people of color are not as an integral part of the field which is why large scale
campaigns like Zika and other big public health efforts contract with firms like Imprenta, of
which there aren’t that many, that hyper focus on ethnic communities using ethnic media and
developing kind of individualized messaging for different age groups, different ethnic groups.
Just to give you an example, while this is not necessarily health related but it had to do with
outreach and PR, for LACCD we’re doing an outreach campaign for DACA recipients and you
know, they contracted Imprenta because we were able to develop messaging in ways that
somebody that is not from the community wouldn’t understand. I saw the very preliminary ads
that they built and it was very white looking. Really airbrushed people, clearly, they were using
stock images and very sterile language, sterile look, and it almost look like an ad for any other
thing. And so, they brought us in and we did messaging for parents. And for parents knowing, I
have family members who are DACA recipients, for those families they’re in crisis right now.
There is fear that their families are going to get torn apart. So, when you’re talking to a parent,
don’t say your kid needs to continue their education right now. Parents care about education but
parents care mostly that they might have to leave their kid behind if they get deported. So, from a
parents’ perspective, talk to them about their kid being safe at a community college where they
will be supported and looked after in the event that they do have to separate. So, don’t way, your
kid has to finish what they started because they know that but that’s not at the top of the list
anymore – you’re in survival mode. So, the messaging that you deliver to get students to build
that trust and their families has to resonate. And so, they switched it around, those ads are
running right now and they’re getting a good response. But for families we’re doing radio, one or
two Facebook, not a lot of social media and print ads in La Opinion and Hoy because that’s how
we know they’re going to receive their information. And for students, DACA students are very
brave, they’re super educated, they’re familiar with the language and culture and it’s not a fear
message, it’s a defiant message like don’t let this stop you from what you started, you know,
don’t let this distract you, don’t let this deter you. We’re here to support you, we’re here to
protect you and so the messaging there has a more defiant tone. One of the hashtags is
#LACCDFamilia #LACCDConfianza. And so, that kind of special messaging to speak to certain
group is so critical. You saw the stuff they created before, it’s like, that’s not going to give
anyone a peace of mind or inspire them to continue attending school. So, I think for the most
part, that kind of sensitivity and cultural, acknowledging the differences in culture and ethnicities
is not that prevalent. So, I think there’s a long way to go. I think there’s a lot of opportunities to
continue to do that, not just in health campaigns but overall.

Diversity is an issue and I think agencies are trying to diversify their staff. But according to
some reports, the Latinos comprise at least half of the population by 2030. Should public
relations agencies continue to treat this demographic as a niche demographic?
71
In that regard, Latinos are already the majority in California. By definition, we are not the
minority anymore, we are the majority. But our numbers bely where we are in terms of real
power. We might have the numbers but we don’t have the power. So, a lot of things have to
change, it’s complicated and a big thing to think about, but just think about PR, getting more
Latinos into the field of PR is kind of a no brainer. Obviously, there has be to more of us in the
field. But I think you’re right, big companies like Ogilvy that are really big players in the
industry do understand that they lack certain cultural sensitivity and that messaging is not a one
size fits all, the types of outreach you do is not one size fits all, modes of communication as well.
So, you have to be nimble, you have to be really sensitive to who you’re talking to and that as to
do with women, ethnicity, age group, where you live, all of those things matter.

What do you believe to be the greatest obstacles in creating behavior change regarding
adopting a healthier lifestyle within the Hispanic communities of Los Angeles County?
In terms of health, I think there are certain spheres of influence. Having trusted health officials
deliver messaging, having well known people deliver messaging – like the Zika campaign is
going to look for a Spanish language influencer that everyone knows and everyone loves – like
Piolin even though he doesn’t have his show anymore – somebody like that, to deliver the
message and it will carry a lot more weight in the messaging for the Latino population. So,
they’re in the process of finding who that might be.

But I think in terms of behavior change, who the messenger is, what the message is and then
having policies back up what you’re trying to achieve. So, you’re talking about food deserts, you
have to make sure that your planning and your zoning accounts for supermarkets not just liquor
stores and fast food places. Um, but that cities and communities are doing concrete things that
attract supermarkets, and attract banks and attract small businesses that generate economic
development in a community and those things tend to have a ripple effect where the quality of
life overall will improve and usually that also means how you feed yourself. And so, behavior
change, there are all kinds of things that come into play but behavior change is ultimately a
personal decision that you make and you’re going to make that choice – whether you’re going to
a Jack in the Box drive thru or you’re going to to to the market, park your car and pick fresh
foods and vegetables but it’s not that simple either. If you have a big family and you can feed six
kids with seven dollars and it’s a full meal and they’re going to have a full belly – whereas at the
supermarket, seven dollars is not going to buy you anything. It’ll buy you a bag of beans and
some vegetables. Maybe not even vegetables because vegetables are expensive. So, it’s hard –
behavior change, personal decisions, personal accountability – all of those things are real but at
the same time, you have to be realistic about what you’re asking people to do. Some parents
might not see anything wrong with fast food and that might be like an issue about education but
sometimes, even if you want to you can’t.

72
Some people don’t really go to the doctor for preventative care. If they go, they’re there because
they’re already sick and you have to go. And that’s how people end up in the emergency room or
their neighborhood urgent care to see what you can get for free. So, it’s complicated, behavior
change is not just one thing – it’s not one PR campaign, it’s about access, it’s about education,
it’s about personal accountability – I mean all of these are related.

Anything you’d like to add –
Bringing it back to BHC, they’re experts at finding opportunities for communities to mobilize.
So, one thing, they’re a nimble organization despite how big they are, how funded they are. They
have touched on campaigns ranging from youth imprisonment, discipline policies in schools,
immigration, sanctuary cities, water – name the issue and they have a hand it in some way. And
they employ social media like mad – they use influencers like Common, he’s done concerts left
and right for BHC – they use influencers, they use social media, they use billboards, they use
radio, you know, full page ads in newspapers – they’re very savvy because they have the money
to do so. They use every medium available and to just pump these hubs with resources so they
can produce their own content and push things out. So, in terms of outreach, there’s lot of
different ways to get there and be sensitive to who and where you’re talking to people, they do it
really, really well.

What is your role with BHC?
Imprenta is on contract with BHC to do pitching, media releases, press advisories. We do high
level strategic planning around communication. So, what is your goal, who your audience is,
who your media targets are going to be and community events or third party validators like
elected officials who can come in and vouch for you and then so we will develop holistic
communications plans and help in the execution of that as well. As well as rapid responders, like
crisis management day of or next day, we’re in charge of that. We put on press conferences and
other firms like Rally, they deal with developing social media content and there’s also the Rios
company and they do advertising. They do ads and billboards. They have a pretty good array of
firms working to support – it’s like a little network.
73
Industry Interview: Maggie Clifton-Hawkins, MPH, MCHES – Community Benefit Manager,
City of Hope

Maggie Clifton-Hawkins, MPH, MCHES is the manager for the Department of Community
Benefit for the City of Hope. She works closely with the Marketing and Communications
Department and develops the hospital’s Community Health Needs Assessment and
Implementation and Strategic Plan.

Interview Questions and Answers

On policy and health -
Help us to shape those into bites that could be delivered to the policy makers so they can make
decisions regarding health.

If you don’t have public policy then you can’t appropriately address the needs of those without a
voice and so that’s what public policy exists for. It’s not for those who can stand up and advocate
for themselves, it’s for those can’t.

It’s an important part to specialize in because people get too busy about that portion of it and
then people leave and aren’t there to support the advocacy effort of our community. And so,
unfortunately, not a lot of it has been sustainable or if it has, it’s gone into the law books and
then times change and communities change and needs change and then there’s no one there who
can adequately plan out that portion of it. And then people grow up and their interest change and
so you have to build up the foundation of those advocates who are there in the long run but also
nurture the ones that are coming up.

On the community benefit report – how are you using the information gathered in the
report to address some of the issues?
The 2016 Community Health Needs Assessment, just so you know every single non-profit
hospital in the United States needs to develop it right. So, what we did was had an open forum
and invited the community members to come in and hear about it but what happens with that
particular report – you saw the larger one, attached to that is a separate report which is the
implementation strategy – that is what we do with the information we get from the needs
assessment. And I’m just finishing up the Spanish translation of it that will go out to our Spanish
speaking community members and organizations too. But, the idea is that you take those results
and you bring them to your community stakeholders and that’s what I did. And so, we had a
discussion – it’s usually my community benefit advisory council which is about 20-25
community representatives that represent particular pinpoints in the community so they could
represent the LGBTQ community, they can represent the school districts, they can represent the
elderly, you know, all these different organizations. And then I present them with all the high-
74
level findings and then I say, “Can you help me prioritize these?” because it’s not up to the
hospital to determine it because it’s not up to the hospital. If it were up to the hospital, then the
hospital would focus on what it wants to but the point of the Needs Assessment and the
subsequent implantation strategy is to take all of those focus group results and all of the high-
level data, distill it in a way that’s understandable to your stakeholders and ask them to say
what’s really important and then prioritize it. So, we got together and just sitting with the group,
it was just a year ago, and just sitting with them – they said, “You know what? Let’s combine
heart disease and all the diseases together and keep our healthy living component of it.” And
what they did for the first time ever was to prioritize mental health, which didn’t come up before
and now when you look at all the other hospitals around here, now they are all prioritizing
mental health as well. And so, they said, first we want access to care – because if we can reduce
the cultural and linguistic barriers and poverty barriers like that to health, then people will get
into care. The second part is addressing healthy living and all of those chronic diseases that
increase your risk for cancer and diabetes and um and then focus on mental health. And then they
said, we’ll look at cancer awareness and prevention. And I looked at them and said well why did
you put cancer prevention and awareness last? I had to ask – but it all demonstrates that as a
cancer institute we don’t dictate what it is that happens and they said “Nancy, if we address
access to care and help increase behaviors that reduce risk factors and the mental health issues
that get in the way of people able to make behaviors and sustain those behaviors then ultimately
we’ll see a reduction in cancer. Which is true – the research backs that up in different ways. And
so, that’s what happens or I hope that answers your question in relation to what we do with the
data and how we get the community to know what’s going on. Just to rephrase it – “We get it, we
present it, the community helps us prioritize it, I write the strategic plan, the community
members ratify it and then that moves us forward and so October 1
st
was the first day were we
first started to address four new priority areas and before we had five priority areas which were
pretty much dictate by you know, powers that be here because it was right after I started at City
of Hope and I kind of had an idea, and now they’re allowing us to work with our community
members to make those sort of things happen. And so, the next step is – you read the community
benefit report…

…. When you read the report, if you noticed, each section had an instruction on how to use the
section and that’s because I’ve read a lot needs assessments. Like I said, I’ve been doing this
since 2005 and none of them really tell the community how to use this data report and so my
thought was, we’re going to create this report, darn it, we’re going to teach them how to use the
data so they can use it in their own organizations and enhance their capacity to use local data to
apply for grants and things like that. That’s why it’s very instructive and explains how you can
connect the different sections, you know together.

The community benefit report
75
The community benefit report, what that is, is each nonprofit hospital has to do a needs
assessment, then they have to write an implementation strategy or a strategic plan to show what
it is that you’re going to do. The report every year is like our, our commitment to the community
to demonstrate to them what we’ve been doing to address those things in the implementation
strategy that we’re currently responsible for. So, this one here, and the one I’m getting ready to
write right now is dictated by 2013 Community Health Needs Assessment. So, after this year
though, next year in October, when I start collecting data, it will be based on the 2016
community Health Needs Assessment. So, as you can see, it’s sort of like in three phases because
a lot of people… what happens is that the hospitals don’t have the staff to do it nor the public
health expertise to kind of pull it together. A lot of times, Community Benefit is put inside the
marketing department, which ironically, I’m inside the marketing department but I’m actually a
department myself but they’re often truly run by the marketing department so they think that
what they do in the community is going to increase the bottom line of the hospital. That’s not
what is supposed to happen in community benefit, you’re supposed to put the vulnerable first and
make sure you address those needs first. So, what the report does is it forces the hospital to
describe what it is that they’ve done. Moneywise – their investment, but more importantly, and
it’s been strengthened over the last years, is how are you measuring your outcome. How are you
measuring whether or not what you’re doing is actually making an impact in the lives of the
people that you’re serving and that pushes it away from a marketing effort. So instead of saying
“Oh, well we increased our patient population,” it’s more “How did you prevent people from
coming here to begin with?” Did you increase the number of people who went in and got
screenings, which by the way that reminds me – as a cancer hospital, we’re not like all the other
nonprofit hospitals that are out there that do have to focus on obesity, or poverty or homelessness
in things like that because we’re a special hospital, we can focus on cancer and things around
cancer. However, you know where I’m going with this slip, the majority of risk factors are
preventable risk factors which have to do with community health in anyway – obesity, you
know, the reduction of diabetes, you know, an increase in physical activity, and you know, all of
those other things.

A lot of the groups that we did the focus groups with asked – are going to go back and share the
data with them and I haven’t had a chance to go out and do that but it’s going to happen. This
late winter, early spring, through health consortium of the San Gabriel Valley, I’m pulling
together all of the nonprofit hospitals and we’re going to be sharing the data from the
Community Needs Health Assessments with the organizations that participate in this particular
group with the intent of sharing the data and showing how they can enhance their organizations
but these reports were written over three years and there’s so many more dynamic websites and
places like that where you can get data and it’s more relevant and up-to-date and so it’s also
going to be about teaching people how to utilize up to the moment data as well so they can make
decisions. Some of the things that we’ve done to kind of get around it like with Day One and
Bike SGV, when we funded them, that category I told you about “Healthy Living,” I’m one
76
department and one person, right? And so, I can’t get out and run programs in the community
and it doesn’t make sense for me to do something. I live in Orange County, I may work here
every day, and I’m getting to know the organization but I’m not a member of this community
long-term, right? And it makes sense to work with organizations that devote their lives and their
staff to the communities their working in. So, the healthy living grants are a way for us to get
into the community focused on those priority areas, but mostly on the healthy living, on a long-
term basis, a one-year grant period, it’s only a $5,000 but they get technical assistance from me.
Which means, I look at their evaluations, I strengthen their capacity to report on what they’re
doing, to get them to think differently about what it is that they’re reporting on. Now some of
them are rogue and they’ll do what they want to do and anything they want to do, right, but they
just won’t get funded again. But, if they do it the right way, for example, one organization – I
need to connect with how we’re doing in impacting healthy living in a community, and
sometimes they’re just doing process, which is fine, you survey 200 people this year, that’s great.
But you spend a lot of time in the effort of surveying 200 people – Well how did you change
their lives and how did your organization change and my favorite example is the Pasadena
Unified School District. We funded them a few years ago and we funded them again – this year
they took a year off - so the idea is…

…So, what happened with Pasadena Education District in their Sharing Health Start program,
They were trying to do these mini-cooking classes and we did these new Farmers Markets but
what they didn’t realize, when I looked at their data and they actually reduced the number of
families that didn’t go without food at the end of the month. Small number but because they were
teaching people how to utilize fresh foods and vegetables in their cooking and using the Market
Map program and things like that, then less families went hungry at the end of the month. That is
significant. And so, I take more of an intimate approach a lot of the times through the healthy
living grants to actually show people how to use their data and dive into it and make a difference.

But this is great because there’s a link in for you, too. The buck doesn’t, the buck will often stop
at the hospital’s website. All they’re mandated to do is make it available to the community by
posting it on their website. The folks here, I’m trying to get everyone in this institution to use my
reports, right. I would love everyone from all over the San Gabriel Valley to use my reports.
Wouldn’t it be great if the local health reporter, or someone like that came through and said,
“Hey, here’s the Community Needs Health Assessment as promoted by the City of Hope and
nonprofit hospitals and this is where you get the data if you wanted to.” But I don’t have the
person power to go do that with everyone but by making one train the trainer with all the other
hospitals and all these other organizations, they’ll be going out and doing it but they don’t get
nearly as excited as I do. You know, because they want to cure cancer right, and so another data
report… blah. But it would be nice in the end, I mean, I use to teach at the University of Phoenix
and I would tell my students, if you need a needs report or you need a data go to any nonprofit
hospital where you live. They are obligated to provide that data and then we provide links to
77
other organizations where people can go to and get more information but that’s the missing link
because people aren’t as interested. Data is boring, right, and so why would you want to know all
of this stuff when we’re moving on and we can get it from someplace else which is reports from
UCLA right, we’ve got the LA Health Dashboard where we can get data from. We can go to the
Community Commons that sponsor the Kansas State University and get data from there. We can
go to the CDC wonder any time we want. And so, what is the exercise in doing this and how
does it actually help the community by doing these reports and the only thing I can tell you is
that it’s my dream to do a whole workshop after this stuff. I mean, at least we’re doing the one
with the group in getting people to understand how to use it that way. Because otherwise, I mean
these reports cost hospitals in excess of 25 thousand dollars for us to create these reports. That’s
a minimum. Some hospitals spend upwards of $100,000 and that is ridiculous. But are you
spending that much money if no one is using the data other than yourself. It should be a part of
the lifeblood of an organization.

We have an opportunity to make a difference here. They didn’t start charging patients until the
80s, you know, when HMOs came around and things like that. We do have that benevolent
structure and the need to do good.

How do we get people to become healthy if they don’t have easy access to clean food and
regular exercise?
Well the tough part really lies in the sustainability component. You teach a class and think you
did a good job and you’re done, right. Those are the one and one things. I can’t stand those. But
there are organizations out there that are culturally competent, you know, speak the proper
language of the diverse communities we come around here. I mean our service area is the entire
San Gabriel Valley and the other four counties that sort of surround us. I’ve got projects that
we’ve funded way out in the Antelope Valley and into the South Bay and Long Beach, right, and
we’re going to be looking at other ones going out to Palm Desert, Riverside, you know that neck
of the woods. Where we live, it’s very diverse. You have so many different languages just right
here in the area but the way we address it, to get specific to your questions, is through those
organizations. You know, I can’t get out there and do it. I don’t have enough time and energy
and effort for people to do it which again is leaning on the benevolence of our local
organizations and kind of working with them. To state another great example is the work that I
just did with FAME (First African American Methodist Church) in Pasadena and they’re a leader
in the black community and we know the black community is dying more, men and women,
from preventable causes, a lot of it has to do with health inequity and social disparities, poverty,
crime and all of those other issues that kind of just, and especially around cultural aspects of
working in the African American community as well. So, I created a partnership with them last
year to do this huge prostate awareness campaign. It culminated into a film festival and health
fair at their church where we screen fourteen men for prostate cancer and we found out that one
didn’t have access to healthcare. He was black and Latino and he needed help and so we were
78
able to do it and connect him with ChapCare so that he could have a source of care. And 14 isn’t
a big number, but we’re going for big numbers here, we’re going for the number of people and
significant lives we can impact and change because those 14 men went and got screened and saw
how easy it was to be done. We’ve changed 14 men’s lives who will go out and speak to other
men and speak to men older and younger than them to make a difference. And so, how do we get
out there and address those issues, it’s not me, it’s just by being a leader and providing support.
A lot of them don’t have support and it’s about providing sources to help them make a difference
in the lives of the people they serve.

What do you look at to evaluate engagement within your grants?
Well one is to look at how many people show up to the events right. And then we ask them have
you received care because we like to follow up and things like that with them. I’m not in there
every single time and people often forget about evaluation because it’s not the easiest thing to
do. So again, I can create the tools and teach them how to utilize it in the community. In fact, last
March, I held trainings with the black churches. You have to stay with them, you have to stay
present, you have to still work with them and build the trust because you build trust equity and
social capital and you build those sorts of things. That is the cornerstone of sustainability
programs in behavior change in those areas.

Last remarks on improving communications.
I think in hospitals, it’s to get them interested in the other stories. Not so much about the acute
issues because a lot of people are interested in what’s going on right now, but there is a whole
bunch of life that goes on outside of that person’s life as a patient and even before they get here.
And so, as hospitals we need to become more interested in those things that influence people
from getting access to care or once they get care, why are they not compliant. Sometimes it’s
because they can’t afford the medications, maybe they can’t afford transportation to get to their
appointments. We need to get interested in stories about that so a great example is, I was able to
feed a story to Josh, and we’re different here right, a friend of mine works with the very
vulnerable patients here and she’s a patient coordinator of sort. The part that’s really cool is that
she told me that she was able to get a grant to get this family a car.

79
Appendix B: Target Audience 1:1 Interview Guide
Interviewee(s): Date:
Interviewer: Start Time:
Location: End Time:
Ethnicity: Age:
Language: Gender:
Generation: Insured?

Interview Guide

1. How would you describe your current health? (Do you exercise often? How often do you eat
out or eat healthy?)

2. Where do you receive information about health topics? (health news, health crisis, health
issues, preventative care)

a. How often do you receive health information? (daily, weekly, monthly)

3. Where do you search for health-related questions or more information on health? (Websites,
Nurses, Doctor’s Office)

4. What makes these sources trustworthy? Why do you prefer them over other sources?

5. What is the most recent health news/information you came across?

6. Do you know of any health programs in your city? (Free workout classes, nutrition education
classes, Flu-Vaccinations)

a. If yes, how did you hear about these programs?
b. If yes, have you ever attended any?

7. On a scale from 1 -5 (1 = not important and 5 = very important), how important is having a
healthy lifestyle?

a. What are the reasons you care/not care about maintaining your health?

8. On a scale from 1 -5 (1 = very unlikely and 5 = very likely), how likely are you to follow
through with a workout regimen your doctor recommends?

9. On a scale from 1 -5 (1 = very unlikely and 5 = very likely), how likely are you to follow
through with a healthy meal schedule your doctor recommends?

10. Overall, how do you feel about health communications? Do you understand the information
presented through materials? Is it relatable?

11. Is there anything you’d like to add that I haven’t asked about?
80

Interviewee(s): Date:
Interviewer: Start Time:
Location: End Time:
Ethnicity: Age:
Language: Gender:
Generation: Insured?

Interview Guide (Spanish)

1. ¿Cómo describirías tu salud? (¿Hace ejerció con frecuencia? ¿Come saludable o come
comida rápida?)

2. ¿Dónde recibe información sobre temas de salud? (noticias de salud, crisis de salud,
problemas de salud, cuidado preventiva)

a. ¿Con qué frecuencia recibe información de salud? (Diario, semanal, mensual)

3. ¿Donde busca preguntas relacionadas con la salud o más información sobre la salud?
(Páginas de Web, enfermeras, doctor, miembros de la familia)

4. ¿Que hace que estos sitios o personas sean confiables? ¿Por qué los prefieres sobre otros?

5. ¿Cuál es la información o noticia de salud más reciente que encontraste?

6. ¿Conoce algún programa de salud en su ciudad? (clases de entrenamiento gratuitas, clases de
educación nutricional, vacunas contra la gripe)

a. ¿Como se enteró de estos programas?
b. ¿Alguna vez ha asistido?

7. ¿En una escala de 1 - 5 (1 = no importante y 5 = muy importante) que tan importante es tener
un estilo de vida saludable?

a. Cuáles son las razones por las cuales le importa/no le importa mantener su salud?

8. ¿En una escala de 1 a 5 (1 = muy improbable y 5 = muy probable), Que probabilidades hay
de seguir con un régimen de ejercicios recomendado por su médico?

9. ¿En una escala de 1 a 5 (1 = muy improbable y 5 = muy probable), qué probabilidades hay de
cumplir con un régimen de comidas saludables que recomiende su médico?

10. En general, ¿cómo te sientes acerca de las comunicaciones sobre la salud? ¿Comprendes la
información presentada a través de los materiales? ¿Es adecuado?

11. ¿Hay algo que quiere agregar que no le haya preguntado?

81
Appendix C: Target Audience Key Findings
Participant Breakdown
• Eight Interviews
• Four men, four women; all first- or second-generation Hispanics
• All were of Mexican descent
• Ages ranged from 29 – 63
• Language: All spoke Spanish, only eight spoke English as well. Half the participants
preferred speaking in Spanish despite being proficient in English.
• Residence: All participants live within LA County
• Insured: All participants had a medical insurance provider.

Health

Although some respondents battled serious health issues such as diabetes or strokes at some time
in their life or currently, all participants felt comfortable with their current health status and felt
in control of any health issues. While one or two respondents mentioned they were overweight,
they cited specific action steps in attaining their desired weight such as eating healthy and
exercising regularly.

Additionally, while respondents acknowledged the importance of eating healthy and a desire to
consistently eat well and exercise frequently, they indicated circumstances or environments
leading to make unhealthy choices.

Important Quotes

“I feel like I have very good health for my age because I don’t take any medications. I try to eat
fresh foods and bring my lunch to work. Sometimes I try to exercise but I just don’t have the
time for it.”

“I would say my current health is average – I am overweight but I still exercise. I run often and
that makes me feel in shape. I work at a hospital to I eat healthy there, but once I’m at home I
definitely eat unhealthy.”

“After my stroke, I have more consistent routine of eating healthy and exercising. I would say I
exercise pretty often about five to six days a week. I don’t eat out much either.”

Communication

Because respondents ranged in age, their informational sources did as well. A correlation
between their dependence on speaking Spanish and using traditional media for health news was
evident. Multiple respondents referenced Univision 34 Los Angeles as a primary source of health
news but did not tune into the program intentionally for health. Respondents comfortable
speaking English stated they received passive health information through social media and
magazines.

82
When looking for specific information on health-related issues or suggestions, most respondents
used internet searches to find relevant answers. One respondent relied on family members to find
information regarding health because of their inexperience using a computer.

Important Quotes

“When I have a question about something related to health I usually do a search on Google and
pick the first item that comes up. Other than that, I sometimes receive health information from
the news on channel 34 or magazines that come in the mail.”

“I get my health news from Facebook or MSN.com’s highlighted news. If it looks newsworthy
then I’ll read it but that’s occasionally.”

“If I’m looking for health news or information then I do a Google search and look at the
difference sources that come up before clicking on something.”

“If something is bothering me and I want to find a remedy or something to do at home then I’ll
ask my daughter to call the doctor or look up something on the internet.”

Trusted Messengers

Since most participants referenced the health segment on Univision 34’s local news, Dr. Juan
Carlos is a trusted messenger for primarily Spanish-speaking Los Angeles residents.
Respondents comfortable speaking English and using the internet relied on internet websites or
social media accounts like Men’s Health.

All participants cited their doctor as a trusted source messenger.

Important Quotes

“I see health messages on social media pretty daily because I follow the Men’s Health page. I
like it because it shows me different exercises and profiles people that are actual living proof of
doing the exercises and following the food recipes. It’s just relatable.”

“I think I find an article trustworthy if it has a doctor giving an opinion about something or their
work is published.”

Supportive Environments

All respondents were asked if they were aware of any programs offered to assist them in
following a healthy lifestyle and responses varied. Some respondents were aware of the services
provided at their local community or senior center, while others didn’t know of any - even if they
followed their city on social media. One respondent wasn’t aware of special services provided by
the city or insurance but had access to the gym and felt safe walking around his neighborhood to
reach his daily exercise goal.

83
Additionally, respondents noted that while they intended to eat healthy because it would benefit
their health, unhealthy food at home or lack of time caused them to break these patterns.

Abstract (if available)

Linked assets

University of Southern California Dissertations and Theses

Conceptually similar

PDF

Public relations implications for regulation of health blogs

PDF

Preventing type 2 diabetes among Hispanic Americans: opportunities for optimizing mobile phone technology

PDF

Multicultural campaigns: outdated approaches to reaching the modern U.S. Hispanic consumer

PDF

Reversing the transition away from traditional foods and culture: health care communications for a multicultural audience

PDF

Doing the hard work: including diversity and inclusion in your public relations tool kit to build stakeholder relationships

PDF

Comparing breast cancer awareness campaigns through four different ethnicities

PDF

Saving public relations: tackling the underrepresentation of Latino professionals in U.S. communications industry

PDF

The influencer break-down: a history, categorization, and analysis of success for health & wellness influencers

PDF

Generation Z: social media, influencers and brand loyalty in entertainment

PDF

Why we follow influencers: the role of Asian female fashionistas in Los Angeles

PDF

Exploring perceptions of facilitators that encourage breast cancer screening behavior among latina women in Los Angeles County

PDF

Getting genetically modified animals to market: the Mount Everest of public relations issues

PDF

60 years of magic: an in-depth look at Disneyland’s use of public relations strategies

PDF

The comic book superhero: his amazing journey to connect and communicate with society

PDF

The women’s rights movement of today: how social media is fueling the resurgence of feminism

PDF

The changing landscape of higher education: experiential learning in public relations for the millennial generation

PDF

Does the commercialization of street art signal the gentrification of graffiti? A focus on the street art and graffiti in Los Angeles

PDF

Infant and maternal health care in Nepal

PDF

An inconvenient truth about the public relations industry and greenwashing

PDF

Experiential public relations: the importance of strategic messaging, understanding target audiences, and analysis of successfully curated brand-consumer interactions

Asset Metadata

Creator Medina Diaz, Anais (author)

Core Title Simple communication solutions for complex health issues: needed changes to improve health communications targeting Los Angeles County Hispanics

School Annenberg School for Communication

Degree Master of Arts

Degree Program Strategic Public Relations

Publication Date 10/18/2018

Defense Date 10/18/2018

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag communications,community engagement,health communications,OAI-PMH Harvest,Public Relations

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Floto, Jennifer (committee chair), Jackson, Laura Min (committee member), Kozinets, Robert (committee member)

Creator Email anais.medina6@gmail.com,anaismed@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-86239

Unique identifier UC11675316

Identifier etd-MedinaDiaz-6891.pdf (filename),usctheses-c89-86239 (legacy record id)

Legacy Identifier etd-MedinaDiaz-6891.pdf

Dmrecord 86239

Document Type Thesis

Format application/pdf (imt)

Rights Medina Diaz, Anais

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA