Hospitals need a community investment approach to improve health

If you deliver healthcare, you know that children who live in disinvested neighborhoods too often land in emergency departments with conditions like asthma, uncontrolled diabetes and bacterial pneumonia that could be effectively prevented with better access to routine medical care, as well as other factors that influence health, like safe and affordable housing and healthier foods. As the COVID-19 pandemic has revealed, these barriers to health disproportionately impact people of color and those with low incomes.

As a pediatrician at the nation’s largest health philanthropy and the CEO of one of the country’s largest pediatric research hospitals, we see how much neighborhoods matter to children’s health. In fact, neighborhoods matter to everyone’s health.

Because most of what affects our health happens outside of hospitals and clinics, institutions like Nationwide Children’s can do much more to eliminate inequities that keep communities from thriving and children from being healthy. This will require hospital leaders to think differently about their mission and adopt a community investment approach that takes a more expansive view of health and what it takes to produce it.

There is a perception that health institutions are solely motivated by economic drivers and will invest only in projects that meet narrowly defined targets for return on investment. But we’re seeing a growing number of healthcare organizations embracing their mission to remove deep-rooted barriers to health through their role as anchor institutions. They’re recognizing their unique capacity to invest in communities to improve health, creating affordable housing, developing workforce programs, and supporting local small businesses. But this work can’t advance without support from the C-suite and the boardroom.

Nationwide Children’s is part of a cohort of not-for-profit healthcare pioneers from safety-net hospitals to academic medical centers to health plans that have been identifying best practices to guide other institutions that are interested in investing upstream to improve health. The Robert Wood Johnson Foundation is supporting this work so it can expand.

The leaders of these institutions see the mutual benefits that accrue when they partner with neighborhoods to do this work. Investing in conditions that provide better opportunities for healthy lives allows them to strengthen community relationships and meet their obligations to residents who live there. It also allows hospitals to build reputation and market position by leveraging their skills, power and assets to promote value of care over volume of services.

Investing upstream also offers those who run healthcare institutions an opportunity to build and strengthen trust in the community and truly collaborate with residents, faith leaders, not-for-profits, and philanthropies to improve neighborhood conditions that influence health; all while meeting their mission to keep people healthy.

Hospitals are often among the most stable financial institutions in a community. They have resources and infrastructure. Hospitals own or can invest in land and get capital to flow. Health systems can make loans directly to affordable housing developers or partner with community development financial institutions. Hospitals also know how to leverage public and private funding sources to subsidize housing and promote home ownership and use their land for grocery stores and other amenities.

Their involvement also can unlock investments by others. In a partnership with a faith-based community development organization, Nationwide Children’s Healthy Neighborhoods Healthy Families has leveraged nearly $50 million to the South Side of Columbus. It has guaranteed loans and its investments have been multiplied many times over with the help of the city, the United Way of Central Ohio and others, resulting in nearly 450 high-quality, affordable homes.

Nationwide Children’s is now working with residents of another Columbus neighborhood. It has engaged the municipal land bank to make use of vacant land to build high-quality affordable housing. Our success is tied to our close collaboration with residents, churches and community organizations, working hand-in-hand.

Health systems can use their influence, too. The average life expectancy for a person without stable housing is about 27 years less than a housed person. Kaiser Permanente has advocated to preserve 17,000 affordable homes along a new light-rail system that offers residents of Prince Georges County, Maryland, access to opportunities that influence health.

The Affordable Care Act requires hospitals to do a community health needs assessment to identify the root causes of health problems; many hospital leaders are taking steps to improve health in their backyards.

But they need to go further. If we want a nation where everyone has the opportunity for a healthy life, more hospital leaders must start questioning not whether to invest but how much and where, and then work as full partners to create equitable and healthy communities.