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Community Wealth and Community Health: Hospitals and The Anchor Mission

A massive shift is taking place across the nation: hospitals have increasingly become the economic engines of their communities. With annual purchasing of half a trillion dollars and billions in their investment portfolios, hospitals are a powerful economic force that, if employed strategically, could have a major positive impact on community health and well-being. As a result, a growing number of hospitals are engaging in community economic development, recognizing the importance of environmental hazards, poverty, unemployment, and other social factors in determining health outcomes and the vibrancy of their communities.

In moving further upstream to address socioeconomic factors, these innovative hospitals have  advanced beyond their traditional practice of simply providing acute care, acknowledging that today this historical core competency is insufficient if they are to accomplish their nonprofit and public missions of “health promotion.”

Some hospitals, like Bon Secours Health System, have explored affordable housing to reduce homelessness and inadequate housing conditions. Others, like Dignity Health, have recognized that utilizing a portion of their endowment for community lending can send powerful and positive ripple effects through the communities they serve. University Hospitals in Northeast Ohio has prioritized localizing its nearly $1 billion in annual procurement, “discovering that hospitals can help heal entire cities through economic development,” as its CEO Tom Zenty noted. Leveraging previously untapped institutional resources, Kaiser Permanente has adopted a philosophy called “Total Health,” understanding the environmental, community and economic factors that impact health outcomes, and has begun to fully realign their organization to achieve this vision.

Another critical factor driving these shifts is an often overlooked provision of the Affordable Care Act, which requires every nonprofit hospital to complete a Community Health Needs Assessment in their community every three years. This is a strategic new opportunity to shift the conversation: a health system must for the first time engage its local community on its health—not healthcare—problems and explain how the hospital intends to address them. Often, when so engaged, communities identify joblessness, poverty, affordable housing, and clean and safe streets—and not just the presence or absence of disease—as major factors affecting the health of their community.

In many communities, anchor institutions like hospitals remain on the sidelines in the face of pressing economic and health challenges. But across the country, more and more healthcare institutions are shifting their historically inward gaze away from a circumscribed and incomplete vision of health promotion and outwards toward the total well-being of the communities they serve — a positive trend that will hopefully continue to grow.

Case Study: Bon Secours Health System (Baltimore, MD)

Southwest Baltimore’s primary anchor institution has adopted an approach to community and economic development that focuses on revitalizing neighborhoods and rehabilitating housing, providing family and women’s services, offering youth employment and workforce development, and expanding financial services.

Case Study: Mayo Clinic (Rochester, MN)

The center of this $8.5 billion health system is spurring local revitalization of the surrounding region and Downtown Rochester, consciously targeting local and diverse suppliers, and pioneering an anchor-led community land trust that has created 875 units of permanently affordable housing.

Case Study: Gundersen Lutheran Health System (La Crosse, WI)

This three-state rural health system is breaking new ground by using its anchor power to help sustain its communities and the environment, from helping start an innovative multistakeholder food cooperative to implementing extensive renewable energy initiatives.

Case Study: Henry Ford Health System (Detroit, MI)

From place-based revitalization to business incubation, the Henry Ford system is working hard to help the hard-hit communities of Detroit.

Case Study: University Hospitals (Cleveland, OH)

This Cleveland hospital's Vision 2010 initiative helped put economic inclusion and local procurement at the center of a $1.2 billion expansion plan.

Case Study: Cleveland Clinic (Cleveland, OH)

From local procurement to comprehensive community partnerships, the Cleveland Clinic is embracing the anchor mission.

More updates

Hospitals Building Healthier Communities: Investing Outside Institutional Walls

This webinar, organized by the Association for Community Health Improvement and the American Hospital Association, outlined opportunities for hospitals to promote health through economic development and community investment. The discussion used the findings of The Anchor Dashboard as a starting point to show how hospitals can broaden their impact on their surrounding communities.

Hospitals As Anchor Institutions: Linking Community Health and Wealth

This post originally appeared on the Commons Health Care Network blog.

Since the passage of the Affordable Care Act, discussions of healthcare policy in national politics and the mainstream media have overwhelmingly focused on the law’s impact on health insurance rather than public health. For example, the 2 percent of the population that will be affected by the individual mandate provision have received an inordinate level of attention. But a separate ACA provision should receive at least as much attention and energy, as it will have a significantly greater impact on the country, and open up new possibilities for how health systems and communities can work together to target pressing economic and health challenges.

Community Benefit and Anchor Institutions: Linkages and Opportunities

This webinar, organized by Community Catalyst and the Democracy Collaborative, explored how community benefit requirements, especially in the wake of new Affordable Care Act (ACA) regulations governing Community Health Needs Assessments (CHNA), can provide a powerful and effective framework to drive transformative community economic development.  

Read more about Community Benefit and Anchor Institutions: Linkages and Opportunities ...

Exchanging Ideas for a Just Economy

Conference focuses on strategies to ensure fair and equal access to capital

Last week, the National Community Reinvestment Coalition (NCRC) hosted its annual conference in Washington DC. Entitled “A Just Economy: Ideas, Action, Impact,” the conference brought together nearly 800 community-based practitioners and policymakers to discuss responsible community investment and share strategies to ensure equal access to credit, capital, housing, jobs, and banking services. Read more about Exchanging Ideas for a Just Economy ...

Key Community Benefit Terms

Across the country, nonprofit hospitals are beginning to comply with a new federal requirement that they partner with community and public health representatives to identify and develop strategies for addressing community health needs. This requirement, found in the Affordable Care Act, builds on the best practices of leading hospitals and hospital systems that already strategically invest resources and build partnerships with community groups and public health leaders to improve community health. This one-page provides definitions for important terms to know.

How Nonprofit Hospital Wealth Can Build Assets for Low-Income Communities

David Zuckerman
The Ladder

Study after study tell us that socioeconomic factors contribute more greatly to overall health than lack of access to healthcare. And few statistics are more powerful than the fact the zip code you live in is a better determinant of your life expectancy than your genetic code. When eight-and-a-half miles can result in a difference in life expectancy of more than 20 years, the local hospital’s quality of care is not at fault. Instead, the culprit is the lack of community wealth in the poorest neighborhoods.

The Affordable Care Act: Implications for Community Development

Steve Dubb
Rooflines

Even if you have not tuned out of the long-running debate about the future of health care in the United States, you can be forgiven if you’ve never heard of a “community health needs assessment” – which is also often referred to by the even more wonky initials CHNA.

Unlike putative “death panels” and insurance mandates, which consumed countless hours of media time, section 9007 of the Affordable Care Act, buried on pages 737–739 of the 906-page law and given the boring, bureaucratic title of “additional requirements for charitable hospitals,” was pretty much ignored.

But boring does not mean unimportant!