The California Wellness Foundation was created in 1992 as a result of the conversion of Health Net, one of the largest provider networks in the state, from nonprofit to for-profit status. Under the terms of the California Department of Corporations' conversion order, the foundation received the equivalent of the department's valuation of Health Net at the time — $300 million, plus 80 percent of the equity in the holding company formed as Health Net's parent. The subsequent merger of Health Net's parent company and QualMed increased TCWF's assets dramatically. The foundation, which operates independently of Health Net, currently has assets of approximately $1 billion.
Earlier this spring, Philanthropy News Digest spoke to Gary L. Yates, president and CEO of the foundation, about the foundation's grantmaking priorities and initiatives to increase the diversity of the healthcare professions in California.
In addition to serving as president and CEO of the California Wellness Foundation, Yates serves as a member of the foundation's board of directors. He is also assistant clinical professor of pediatrics at the University of Southern California School of Medicine, and is a licensed marriage and family therapist.
Yates joined the foundation staff in 1992 after more than twenty years of experience in education and public health. Immediately prior to his association with the California Wellness Foundation, he was associate director of the division of adolescent medicine at Childrens Hospital Los Angeles. Yates received his undergraduate degree in government from American University in Washington, D.C., and his master's degree in counseling psychology from the University of Northern Colorado. His primary area of interest and expertise is adolescent health, about which he has written and spoken extensively.
Yates is actively involved in the leadership of numerous philanthropic, civic, and community organizations and currently serves as vice chair of the board of Independent Sector. He previously served as vice chair of the board of the Council on Foundations and chair of the boards of Grantmakers in Health, the Foundation Consortium, and Southern California Grantmakers. In recognition of his civic leadership and work in the field of health and human services, Yates has received numerous awards and official commendations.
Philanthropy News Digest: Tell us about your background and what led you to the California Wellness Foundation?
Gary Yates: My background is in education and health care. Prior to coming to the foundation, I was the associate director of adolescent medicine at Children's Hospital in Los Angeles for ten years. I wouldn't say anything in particular led me to the foundation. It was new and, at the time, the largest health foundation in California, and when I was recruited to manage its first initiative, I felt I couldn't pass up the opportunity.
PND: What is the foundation's mission?
GY: Our mission is to improve the health of the people of California by making grants for disease prevention, health promotion, and wellness education.
PND: And the focus of your grantmaking?
GY: We have what we call a responsive grantmaking program. We have prioritized eight issues for funding, including mental health, healthy aging, women's health, teen pregnancy prevention, violence prevention, work and health, environmental health, and increasing the diversity of the healthcare workforce.
We also have what we call a special projects fund for issues and projects that don't fall under any of those eight priorities. Currently, the two major areas of focus within the fund are sustaining the healthcare safety net — especially with regards to community clinics and public hospitals here in California — and focusing on public policies that increase access to healthcare for the underserved. It's also important to note that while it is not explicitly stated in our mission, our articles of incorporation dictate that we focus on the state's underserved communities.
PND: What do you see as the greatest health-related issue or issues facing Californians today?
GY: Well, the eight I mentioned. But if you're asking me to boil it down to the most salient at this point in time, I would say there are two: The first is preserving the healthcare safety net for underserved Californians, which means, among other things, keeping community clinics and public hospitals not just open but viable. And the second has to do with the diversity of California's healthcare workforce. The future of the State of California will be driven, in many ways, by demographics. And looking ahead to 2020, three things really jump out at you. First, the population of the state, which already has thirty-three million residents, is growing fairly rapidly and will increase by another ten million people by 2020. Two, over that same period, the number of Californians age sixty-five or older will increase by 70 percent. And, three, the state's population will continue to become more diverse.
As you probably know, California is one of the few states that does not have an ethnic majority — currently, Caucasians comprise roughly 48 percent of the state's population and Latinos are about a third. According to most projections, however, that will shift in the next fifteen years, with Latinos comprising 43 percent of the state's population by 2020, Caucasians dropping to about 33 percent, and Asians comprising about 13 percent. So, changing demographics, the continued aging and increased diversity of the state's population, and adding another ten million people to that population are all major challenges for any health funder, including the California Wellness Foundation, as well as for public policy makers.
PND: Why is diversity within health-related professions such an important issue?
| ...A lot of families have their children acting as interpreters with their parents' healthcare providers, which is not a healthy situation at all.... |
GY: There are several reasons. There's a growing body of evidence that suggests that ethnic minority health practitioners are more likely to practice in underserved and low-income areas. Therefore, one way to increase access to health care for the underserved is to increase the number of ethnic minority physicians, nurses, and other healthcare workers. There's also the issue of language and cultural competence. One of every four people in the state is an immigrant. Most are here legally, but many, when they first arrive, do not speak English, or do not speak it very well. So you have a situation where a lot of families have their children acting as interpreters with their parents' healthcare providers, which is not a healthy situation at all.
Language and cultural competence, the willingness to practice in ethnically diverse communities — all of this suggests that having a more ethnically diverse healthcare workforce will translate into more access and better care for Californians. But, as a state, we're way behind. I'll give you an example. As I mentioned, Latinos comprise a third of the state's population today. But only 4 percent of the physicians and 4 percent of the nurses in the state are Latino. So we have a long way to go, especially when you factor in the changing demographics I mentioned.
PND: What are the major barriers to increasing the diversity of California's healthcare workforce?
GY: There are many. The fact that California no longer supports affirmative action is a major barrier, and that, in turn, means institutions of higher education in the state need to do a better job of reaching out to underserved communities. Then there's the whole issue of young people in underserved or minority communities thinking that a career in health care is beyond their reach, which is not so much a barrier as it is a paradigm that needs to be changed. We simply have to do a better job of teaching young people in underserved, low-income communities about careers in health and health care; we have to let them know that they can get the kind of education they need for those careers; and we have to help them pay for that education. Obviously, the educational costs of a medical or advanced degree in a health-related field is a major, major barrier for most low-income and minority kids. Many kids coming out of medical school these days start out hundreds of thousands of dollars in debt, and just contemplating that prospect is a major turnoff for young people who are thinking about a career as a health professional.
PND: Tell us about the foundation's Champions of Health Professions Diversity Award?
GY: That's a program we put together at the beginning of 2001 to recognize individuals who have done stellar work and taken a leadership role in trying to increase the diversity of the healthcare workforce. We select three individuals each year to receive the award and provide them with a one-time cash award of $25,000, no strings attached. We also honor them at a dinner in conjunction with our annual conference and do a good deal of publicity, including a mailing to elected officials, opinion leaders, and media outlets in the state, around these individuals as well as the issue of diversity itself. In other words, we use the award to help promote a policy agenda concerned with improving access to the health professions for minorities in California.
PND: Has the program been successful?
| ...When you tackle a really tough issue — and this is a tough issue — you need to stick with it over the long haul...at least a decade...in order to make a difference.... |
GY: It's been very effective, so far. I say "so far" because we've learned that when you tackle a really tough issue — and this is a tough issue — you need to stick with it over the long haul, and by that I mean at least a decade, in order to make a difference.
But, as we get ready to announce our fourth annual diversity champions, we can look around and say we've made some progress. For the first time in California history, the Senate Health and Human Services Committee has held hearings on the issue of diversifying healthcare professions in the state. In fact, Deborah Ortiz, the senator who chairs that committee, was a keynote presenter at our first diversity award dinner, where she met that year's award winners, and that was the catalyst, I think, for her to dig deeper into the issue. Granted, it's just a step, but it's a step in the right direction.
There's another aspect of this that's more subtle, but by publicizing the good work of the award winners in their local communities, we play a role, however small, in their being seen as role models by other young people in those communities. It provides young people in those communities with tangible proof that they can do something great if they set their minds to it.
PND: Can you tell us about the Welcome Back Centers?
GY: Welcome Back is a program funded by the foundation. We have a couple of grantees in the state that operate programs to help immigrants from other countries with healthcare degrees get the additional education and language skills they need to set up a practice in California.
| ...It's not just that we need more diversity in the healthcare professions; we need more healthcare practitioners period.... |
But let me back up a second. When you think about the changing demographic profile of the state, and when you look at trend analyses concerning job creation in California over the next twenty-five to fifty years, one of the things that jumps out at you is the projected need for healthcare workers and professionals. It's not just that we need more diversity in the healthcare professions; we need more healthcare practitioners period — and I'm not just talking about doctors and nurses. I'm talking about lab technicians, radiological personnel, physical therapists, you name it.
I mean, one community college here offers sixteen different degree programs in health-related fields. And that's another leverage point we can use to increase the diversity of health-related professions in the state. The community college system in California is excellent, and in many ways it's very affordable. You can get a certificate or degree in a health-related profession through the community college system, or you can do your preparatory work for medical school or an advanced nursing degree there. So using and promoting the community college system and trying to create more slots than are currently available in various health-related fields is a key component in increasing not only the number of healthcare professionals in the state, but also the ethnic diversity of those professions.
PND: Does the California Wellness Foundation collaborate with other foundations or partners to achieve its goals?
GY: Not in the way that people usually think of collaboration. Until last year, when it ended, we were involved in something called the Foundation Consortium with fifteen or so other foundations. And we do a good deal of co-funding with other health funders in the state. We, meaning the CEOs of about a dozen other health funders, also meet on a quarterly basis to share information about our programs, the kind of things were doing, and new directions we may be considering, so that the right hand knows what the left hand is doing, so to speak.
PND: Is there any other initiative you'd like to tell us about today?
GY: The one thing I haven't mentioned is the public ed campaign we're preparing around the issue of diversity in the healthcare workforce. It really has two distinct components. The first is to push the policy envelope and raise the visibility of the issue across the state. And the second is to develop a comprehensive Web site for young people where they can learn everything they ever wanted or needed to know about careers in health or healthcare — how much they pay, what type of education you need, what you need to do to get the appropriate certificates or licenses, career advancement opportunities, and so on. Nothing like that exists right now for Californians, and as we were researching how today's high school and college students gather career information, it became clear that the Internet is the first place they turn to for that kind of information.
So we hope that by gathering that information in one place, we can help to open a few doors for young people as well as increase interest in these kinds of educational tracks from underserved communities. That, in turn, would put pressure on Sacramento to put more funding into our community college system, and especially into programs related to health and healthcare employment. You know, we shouldn't have to recruit people from outside the state or country to fill those jobs. There are millions of Californians who need good jobs. So we think a public education campaign is the next logical step in pushing the issue to the forefront in California.
PND: Well, thanks for your time today, Mr. Yates.
GY: Thank you.
Kevin Kinsella, PND's deputy director, spoke with Gary Yates in April. For more information on the Newsmakers series, contact PND Editorial Director Mitch Nauffts at mfn@foundationcenter.org.
