Written by Randy Oostra, CEO of ProMedica (a member of the Healthcare Anchor Network) with the support of The Democracy Collaborative's David Zuckerman and Katie Parker, this report offers an in-depth look at how the Toledo, Ohio based health system aligned its institutional operations and clinical practice to better tackle the social determinants of health. From an innovative hospital-owned grocery store in a food desert to investments in preserving affordable housing, this exploration of ProMedica's decade-long journey to understand how their resources as a healthcare anchor could be used for the wellbeing of the communities they serve is a useful guide for hospitals and health systems embarking on similar shifts.
Democracy Collaborative Reports and Publications
Our new report, Higher Education's Anchor Mission, examines how an ongoing—and expanding—effort to track the impact of colleges and universities on the financial and social well-being of their surrounding neighborhoods is helping these anchor institutions align their resources to build stronger community partnerships and create more inclusive local economies.
with support from Chicago Anchors for a Strong Economy (CASE), the Civic Consulting Alliance, and The Democracy Collaborative
Anchor institutions can play a key role in helping the low-income communities they serve by better aligning their institutional resources—like hiring, purchasing, investment, and volunteer base—with the needs of those of communities. The recommendations in this “playbook,” drawn from research carried out to help Rush University Medical Center (RUMC) align around its Anchor Mission, are being published to help other hospitals and health systems accelerate their own efforts to drive institutional alignment with community needs.
Impact investing and employee ownership: Making employee-owned enterprises part of the income inequality solution
With income inequality in the United States at record high levels, employee ownership is increasingly being lauded as a potential solution to spreading wealth more broadly. Most recently, research from the National Center for Employee Ownership released in May shows that employee owners have a household net worth that is 92 percent higher than non-employee owners. They also make 33 percent higher wages, and are far less likely to be laid off.
But employee ownership requires new investment in order to get to scale. A new report by Mary Ann Beyster, president and trustee of the Foundation for Enterprise Development (FED), published by the Fifty by Fifty initiative of The Democracy Collaborative, examines the investing landscape for potential opportunities in employee ownership. The report, Impact Investing and Employee Ownership, reports on the results from six months of research showing that the opportunities for impact investors to support employee ownership are limited, but that an investing infrastructure is beginning to emerge across asset classes.
In The Next System Project’s first policy brief, Democracy Collaborative Fellow Ellen Brown, founder and president emeritus of the Public Banking Institute, explores what’s wrong with President Trump’s approach to infrastructure. By focusing on private investment and public-private partnerships (PPPs) to come up with the capital to invest in repairing and upgrading our infrastructure, his plan will accelerate (partial) privatization of public assets and impose huge costs upon local residents, to be repaid through local taxes and extractive and regressive user fees like tolls.
Drawing on the historical precedents of both Lincoln’s investments in railroad infrastructure and FDR’s financing strategies for the New Deal, Brown shows how public strategies for investing in infrastructure make far more sense than what Trump is likely to put on the table. She estimates that an approach grounded in the use of public depository banks, either at the federal level or spread across a state-by-state network, could cut the $1.18 Trillion financing costs associated with a $1 Trillion investment in infrastructure in the Trump plan, once the returns demanded by private investors are factored in, to a mere $200 Billion. Not only would such public banks be able to lend money for infrastructure projects at a far lower rate, the interest earned on such loans would return to the public coffers.
Brown also identifies an even bolder approach that could bring the costs of investment in infrastructure down to zero. By embracing its power to create money for the public good using an innovative “qualitative easing” approach to inject new money into the real economy, the federal government could directly cover the costs of the pressing upgrades and repairs to our nation’s roads, bridges, dams, water supplies, electrical grid, and transit lines without the need to borrow any money at all.
The inability of traditional politics and policies to address fundamental U.S. challenges has generated an increasing number of thoughtful proposals that suggest new possibilities. Individual thinkers have begun to set out – sometimes in considerable detail – alternatives that emphasize fundamental change in our system of politics and economics.
We at the Next System Project want to help dispel the wrongheaded idea that “there is no alternative.” To that end, we have been gathering some of the most interesting and important proposals for political-economic alternatives – in effect, descriptions of new systems. Some are more detailed than others, but each seeks to envision something very different from today’s political economy.
We are in a time of deepening systemic crisis. Throughout the world, we see staggering levels of economic inequality, unchecked extractive behavior by corporate-dominated industries, overt attacks on civil rights, massive and ongoing violence against women and people of color, deteriorating democracy, heightened militarization, endless wars, rapidly advancing climate change—and the list goes on.
Unfortunately, the system that has produced this crisis isn’t “broken.” In fact, the mounting challenges we face are to a large degree its natural byproducts and intended outcomes. Therefore, we cannot simply wait for the system to correct itself, or hope that by working at the margins for piecemeal reforms we will alter its fundamental outcomes. Instead we must think deeply about what we want to replace the current system with, and then work to establish the new institutions, practices, and customs required to make this vision a reality.
In December 2016, leaders from 40 health systems gathered in Washington, DC to explore the potential to more fully harness their economic power to inclusively and sustainably benefit the long-term well-being of American communities. Together, they discussed best practices and strategies to advance the Anchor Mission of healthcare.
At the conclusion of the convening, the Healthcare Anchor Network was formed to support health systems collaborating nationally to accelerate learning and local implementation of economic inclusion strategies.
This report summarizes the events of that convening and next steps, inviting your hospital or health system to join the Network and help advance the Anchor Mission of healthcare in your institution, in your community, and nationally.
Across the country, healthcare institutions are recognizing that they can creatively leverage their supply chains to address the upstream economic and environmental conditions that have the greatest impact on the health of local residents. In doing so, they can create family-supporting local jobs and build community wealth. This toolkit on local and diverse purchasing showcases examples of how hospitals and health systems are reevaluating their roles as their community’s largest purchasers, understanding that a thriving local economy is fundamental to a healthy community.
The sourcing of goods, services, and food that your hospital or health system does every day, when aligned with your mission, can help build local wealth in the communities you serve. By supporting diverse and locally owned vendors and helping to incubate new community enterprises to fill supply chain gaps, hospital and health systems like yours can leverage existing resources to drive local economic growth and build a culture of health in their communities. This toolkit can help you get started
Nationally, health systems have an estimated $400 billion in investment assets. Redirecting even a small portion of these resources to place-based investments would shift billions of dollars toward addressing economic and environmental disparities in local communities. It would allow institutions to more effectively improve community health and well-being, even as they continue to earn a healthy rate of return. This toolkit outlines a range of strategies for how health systems are using their investment assets to help address the resource gaps that keep communities from achieving better health and well-being.
As we learn more about what families and children need to lead healthy lives, it is clear that adverse social, economic, and environmental factors, coupled with racial disparities, prevent communities from building a culture of health. The good news is that hospitals and health systems are recognizing that they have significant, untapped assets at their disposal to help address these challenges: their investment portfolios. Through place-based investing, institutions can leverage these resources to improve their communities’ overall health and well-being. This toolkit will help you get started.
Broad-based ownership models bring substantial benefits to communities and workers, particularly those of low and moderate income. These models are poised for substantial growth as tools for solving the massive problem of economic inequality. In an economy where wages have been stagnant for decades—and a disturbing 40 percent of jobs are now part-time, temporary, or contingent—public interest in models fostering broad-based ownership has grown substantially.
Every day, we learn more about how patients’ health outcomes are tied not only to the healthcare they receive but also to the conditions in the communities where they live. Social and economic inequities, amplified by race, often emerge as the leading factors explaining differences in health outcomes and life expectancies.
Through local and inclusive hiring, health systems can invest in an ecosystem of success that lifts up local residents; helps create career pathways for low-income, minority, and hard-to-employ populations; and begins to transform neighborhoods. In the process, health systems can develop a more efficient workforce pipeline, meet sustainability and inclusion goals, and ultimately improve the health of their communities. Establishing a local and inclusive hiring strategy is an important first step towards rethinking your health system’s role in the community. This toolkit can help you get started.
There's a movement afoot to build a more equitable, democratic economy in the United States. It's a movement led by community-based activists who, each in their own way, are building new institutions to support social and economic justice, rooted in community-controlled land and enterprises. This movement has a name: it's called community wealth building.
On June 13 and 14, 2016 in Washington, DC, many of the nation’s leading experts in employee ownership, sustainable business and finance, community and economic development, and philanthropy came together in a Learning + Design session. Co-hosts for the meeting were Marjorie Kelly and Jessica Bonanno of The Democracy Collaborative and Camille Kerr of Democracy at Work Institute. The purpose of the session was to discuss how to achieve unprecedented scale of employee ownership by focusing on achieving an audacious goal: 50 million U.S. employee-owners by 2050. This report summarizes and expands upon the June meeting:
Cities are increasingly turning to their “anchor” institutions as drivers of economic development, harnessing the power of these major economic players to benefit the neighborhoods where they are rooted. This is especially true for cities that are struggling with widespread poverty and disinvestment. Urban anchors— typically hospitals and universities—have sometimes isolated themselves from the poor and struggling neighborhoods that surround them. But this is changing. Since the late 1990s, as population, jobs, and investment have migrated outward, these “rooted in place” institutions are becoming a key to the long, hard work of revitalization. In Cleveland, the Greater University Circle Initiative is a unique, multi-stakeholder initiative with a ten-year track record. What is the “secret sauce” that keeps this effort together?
Rochester’s Market Driven Community Cooperatives Corporation: A Feasibility Analysis & Implementation Plan
The City of Rochester's Office of Innovation, under the leadership of Mayor Lovely Warren, has been coordinating a project to develop worker-owned cooperative businesses as part of a comprehensive wealth building strategy for Rochester, New York.
In 2015 the City engaged The Democracy Collaborative, a group with extensive expertise from similar work in Cleveland Ohio in connection with the Evergreen Cooperatives and the Greater University Circle Initiative. The Democracy Collaborative completed a study in February 2016 that documented incredible potential for the project, a high degree of community support including local Anchor Institution buy-in, as well as several potential business niches for future worker-owned businesses. The report also includes an implementation plan to move the project forward in two additional phases, the first of which was approved to proceed by the Rochester City Council on March 22nd, 2016.
As cities wrestle with the growing challenge of wealth inequality, more and more leaders are looking to broad-based ownership models as tools to create jobs and build community wealth. These models are highly effective, with a positive impact for low- and moderate-income individuals and communities. This report looks at six such models—ESOPs, Worker Cooperatives, CDFIs, Social Enterprises, Municipal Ownership, and Emerging Hybrids—with examples of best practices, and explores how these models can be used in community economic development.
Healthcare’s role in creating healthy communities through increasing access to quality care, research, and grantmaking is being complemented by a higher impact approach; hospitals and integrated health systems are increasingly stepping outside of their walls to address the social, economic, and environmental conditions that contribute to poor health outcomes, shortened lives, and higher costs in the first place.
How do low-income communities learn to advance economically and build wealth? Low-income communities and communities of color, in challenging structural economic and social inequality, have historically grappled with tensions inherent to development. Who participates in, directs, and ultimately owns the economic-development process? In creating and sustaining new, inclusive economic institutions, how do community members cultivate and pass on skills, commitment and knowledge—especially among those who have long faced barriers to education and employment?