With the increased focus on broader determinants of health, health foundations are asked to think and act more expansively and creatively about how to support health. In many ways, public health is getting back to its roots in doing so: the idea that the basic building blocks of our neighborhoods and communities greatly influence our health. If we want healthy people, we must ensure that these fundamental community elements, such as housing, transportation, public recreation opportunities, job opportunities, and food, are engineered to encourage and support health. Not only are these critical investments in and of themselves, they impact health.
With this broader view of health come opportunities for new partnerships with other nonhealth sectors that are already experts and making investments in these areas. National partnerships have emerged to support and highlight these connections. The Robert Wood Johnson Foundation–Federal Reserve focus on community development and the American Public Health Association–American Planning Association focus on community planning and design are just two examples. Although not always recognized, community developers and planners are making investments that affect health. We just need to make sure that their efforts are constructive and support healthy communities and people.
At the local level, nonprofit hospitals are another sector to consider working with. Because of their tax status, nonprofit hospitals are required to provide “community benefits” to the communities in which they are located. The Affordable Care Act has further pushed nonprofit hospitals to think more broadly about health, as well as changed the uninsured landscape. Historically, nonprofit hospitals have fulfilled their community benefit requirements by providing services to the uninsured.
However, while hospitals are firmly engaged in taking care of patients within their walls, they can be missing from the broader discussions about creating healthy communities.
St. Luke’s Health Initiatives (SLHI), a Phoenix, Arizona–based health foundation that focuses on the root causes and broader issues that affect health, has been engaged in promoting healthy community policies and investments for more than a decade.
What we saw missing from our local conversation about healthy communities was a basic understanding of the nonprofit hospital community benefit requirements by those outside of the hospital sector. Some healthy community advocates had heard of the community benefit requirements but lacked an understanding of how those could impact their work or how to start a conversation with a hospital.
Acknowledging this information gap, SLHI developed Connecting the Dots: A Healthy Community Leader’s Guide to Understanding the Nonprofit Hospital Community Benefit Requirements. Our intent was to provide basic information about the community benefit requirement, its relevancy to building healthy communities, and how to begin a constructive conversation with a nonprofit hospital.
One example of how community benefit can be used to promote healthy communities is at the HonorHealth John C. Lincoln Medical Center, in Phoenix, Arizona. It focuses some of its community benefit work on partnering with a nonprofit community development corporation called Desert Mission Neighborhood Renewal. Desert Mission provides services such as homebuyer education, affordable housing development, and commercial redevelopment.
SLHI is also funding and supporting an outlet where these conversations with hospitals can be taken to another level. The Arizona Partnership for Healthy Communities was the inspiration for the Connecting the Dots report and can facilitate making those connections.
The partnership evolved from a 2014 Federal Reserve Bank of San Francisco healthy communities conference in Arizona. The partnership is comprised of healthy community advocates from around Arizona—including people working for hospitals, banks, and insurers and in the areas of public health, transportation, and affordable housing—who are striving to build the basis for health in lower-income communities.
The partnership focuses on the “3 Cs” that comprise the biggest barriers to building healthy communities: capital, capacity, and connections. The hospital community benefit requirements have the potential to address each of these challenges.
Like others, SLHI sees the opportunity in the expanded and changing community benefit landscape. For us, it is an opportunity to unite in building healthy communities.
This blog post is very loosely adapted from the author’s upcoming article in Planning magazine’s November 2015 issue.
“More Community Benefits Mean Healthier Communities,” by C.J. Eisenbarth Hager, Planning magazine, November 2015 (forthcoming, subscription only).
What Others Are Saying:
Build Healthy Places Network, Resources page.
Build Healthy Places Network, “Why Place Matters to Health,” Pulse newsletter, July 31.