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Melissa Marshall, Chief Medical Officer, California Primary Care Association
Health care and community organizations have a direct stake in state policy. Medi-Cal funding, the regulations that govern how programs operate, and conditions like housing costs that shape patients’ and clients’ health are all influenced by decisions in state agencies. That means choosing to stay on the sidelines in Sacramento can have significant implications.
But for organizations that haven’t incorporated advocacy into their regular work, the scale of the challenge can be intimidating. In 2025 alone, more than 2,350 bills were introduced in the California Legislature. Even the California Primary Care Association (CPCA) couldn’t take a position on all of them. No organization could.
The immense scale of California policymaking was the backdrop for a talk by Melissa Marshall, CPCA’s chief medical officer, at a recent California Improvement Network (CIN) partner meeting. Advocacy is a broader undertaking than most people assume, she said. It includes taking positions on legislation, shaping regulations, engaging in ballot initiatives, serving on stakeholder committees, submitting official comments, building coalitions, and simply telling the story of what an organization does well. Each of these advocacy tactics is a real lever, and each competes for every organization’s limited staff time.
The question isn’t simply whether community groups should advocate more. It’s identifying where an organization’s influence comes from, whether that is policy expertise, community trust, relationship building, technical knowledge, or something else. Once those factors are considered, they can help organizations understand when they should lead, when they should engage in partnership, and when they should follow.
Permission Not to Take On Everything
A state official at a CIN partner organization, who spoke candidly on the understanding that he or she would not be named, told the CIN audience that the group built a framework for deciding whether to lead, partner, or follow on a given issue. “We track several bills internally and get that information out to staff and our stakeholders,” the official explained. First, the team categorizes bills that should be supported, opposed, or watched before deciding how deeply to engage. “Sometimes it’s better to follow a true champion rather than think that you’re the lead yourself,” the official said. That framework gave the organization “permission not to take on everything.”
Marshall explored that theme from a different angle. “We’re stronger when we’re together,” she said. “The more we can collectively join forces, create economies of talent and resources, the more effective it will be.” Collective effort only works if organizations are clear about what functions they’re equipped to perform, Marshall said, rather than everyone advocating on everything. The choice of leading, partnering, or following turns that into a practical decision: Focus your capacity on where your organization has something distinctive to contribute, and support others when they are better positioned to lead.
Different Organizations, Different Strengths
Where an organization lands is less a matter of ambition than an honest assessment of its capabilities. At the CIN meeting, one representative of a state agency described running her own version of the same triage process, separating bills her agency engages with from ones it simply watches. The difference is that her approach is set by statute. Her agency can’t stake out formal positions on legislation. It can only provide technical assistance. Still, she said, her team does its best to have opinions.
An official from Latino Health Access is working from a different starting point. The source of his organization’s strength is years of trusted relationships within immigrant communities, and so that’s where it takes leadership. “Any door is an excuse for us to start a conversation,” he said. Latino Health Access uses service interactions around housing, health, and immigration as openings to talk with families about why their rent eats up 30% of their income, or why voting matters beyond the act of casting a ballot. “It’s not just that people have the right to vote, but why they have to vote, and how policy impacts their family,” he said.
Those candid conversations only work if people trust the person trying to persuade them. That trust is under strain right now for families navigating fear of deportation or immigration over-enforcement. Protecting that trust is part of the advocacy itself, and it sets the pace at which the organization can lead.
Advocacy Isn’t About Doing More
These examples point to a broader way of thinking about advocacy. Organizations have different sources of influence: policy and technical expertise, formal authority, trusted community relationships, convening power, or the ability to tell stories that others need to hear. Understanding what your organization uniquely brings can help determine where it should lead, where partnership could extend its influence, and where someone else is better positioned.
But what an organization or individual is positioned to do isn’t determined by influence alone. Another attendee, a public health leader who immigrated to the U.S. two decades ago, added another dimension: risk. She described the limits on how she can advocate professionally and the personal risks she weighs when deciding whether to speak out. Marshall acknowledged that organizations and individuals can bear different levels of risk, adding another dimension to decisions about when and how to engage in advocacy.
Effective advocacy doesn’t necessarily mean doing more. It means being clearer about where your organization’s influence comes from and intentional about how you use it. On any given issue, that may mean leading. It may mean bringing your expertise or relationships to a partnership. Sometimes it may mean recognizing that someone else is better positioned to lead and putting your weight behind them.
Questions for Your Organization
- Where is your organization already doing advocacy work without calling it that? Consider regulatory comments, stakeholder committees, public education, and storytelling.
- For the issues central to your mission, name honestly whether your organization is positioned to lead, partner, or follow. Notice if the instinct to say, “We should be doing more,” is getting in the way of that assessment.
- Who are the “true champions” already working on the issues you care about? What would it look like to actively support their efforts rather than building your own?
The California Improvement Network is a project of the California Health Care Foundation and is managed by Healthforce Center at UCSF.
