Hospitals tackling health of their neighborhoods

Time to move from shared assessments to joint investments

BOSTON’S HOSPITALS are currently collaborating on an exciting new way to identify and address the social and economic challenges facing city residents, creating a potentially powerful way to improve health and promote equity. But in order to deliver on this promise, hospitals will need to stretch further, collaborate on investments, measure impact, and make themselves accountable to the community.

Residents of Boston are rightfully proud of our status as a healthcare and educational mecca. The status of our state and our city at the top of many “best of” rankings is something we should be proud of. However, our pride must be tempered by the reality that the benefits of good health have not accrued equally to all residents.

We are writing as members of the Alliance for Community Health Integration, a statewide coalition of more than 35 public health, consumer advocacy, social service, and community organizations.  We are working to build a stronger, more unified voice for communities and consumers to advance racial and economic justice through reforms in healthcare.

We all know that the city of Boston has vast health inequities across race and income, and between neighborhoods. Life expectancies for Back Bay residents are nearly 10 years longer than for Roxbury residents. And health outcomes are consistently worse for people of color than for their white counterparts. In just one troubling example, the diabetes mortality rate is 92 percent higher for black residents compared with white residents.

Boston’s leadership status in healthcare is undeniable. But data shows that healthcare is just one contributor to good health – and a relatively small one at that. Healthcare quality and access contributes only about 20 percent to health outcomes. Most of what drives health is social and economic factors – access to stable housing, exposure to violence, income, educational opportunities, access to healthy food, and more. It is these so-called “social determinants of health” that most impact health outcomes – and that drive the racial, income, and neighborhood inequities that plague our city.

While we have lots of data about the impact of social determinants on health outcomes, the profile of state and national health expenditures flies in the face of this knowledge, with 90 percent of national healthcare dollars spent on medical care.  Luckily, the healthcare world is slowly beginning to shift to a more preventative approach.  As part of this nascent transformation, we are heartened that Boston hospitals are piloting innovative approaches to improve the health of their neighborhoods, not just their patients.

We are thrilled that for the first time, Boston hospitals are working together to identify the most pressing health challenges facing the city. Nonprofit hospitals are required to conduct community health needs assessments under federal law. But in prior years, Boston hospitals – many of which serve the same neighborhoods that face the same challenges – conducted independent assessments, duplicating efforts and missing opportunities to maximize resources. Last fall, Boston hospitals teamed up with the city’s health centers, community organizations, and the Boston Public Health Commission to form the first city-wide collaborative to do this community health assessment and planning together.

The collaborative has just wrapped up the assessment phase of their work, which included extensive surveys, focus groups, and interviews with community residents and leaders. More than 100 people – residents, non-profits leaders, business owners, and others – attended a meeting at the end of May in Roxbury to begin prioritizing the most important issues.  Housing; a combined category of employment, income, and education; mental health; and substance use and overall access to services all rose to the top.  These are big, complex challenges that will require ambitious, multifaceted solutions.  Clearly, no single institution can solve these problems alone, but together Boston hospitals can make a meaningful impact. In order for Boston hospitals to move the needle on these big issues, three things are needed.

First, the hospitals must move beyond collaborative planning to shared investments, pooling resources to tackle common challenges. Acting alone just won’t cut it. And moving toward coordinated investments can also encourage other major institutions to invest needed resources, further expanding reach and impact.

Second, clear measures must be identified and tracked to assess the impact of these investments, including the impact on racial equity, over time. We won’t get it right immediately, but we can measure and adjust course along the way.

Third, there must be ongoing accountability to residents and leaders in Boston neighborhoods that bear the brunt of health inequities and social injustice.

There are many shared investment examples nationally – and some locally – to draw upon. Dignity Health, Bon Secours-Mercy, Children’s Hospital in Columbus, and the University of Pittsburgh Medical Center are all working with local coalition partners to develop a strategy to address housing in their communities.  Kaiser Permanente helped to establish the Thriving Communities Fund to make sizeable investments in affordable housing.  Locally, Boston Medical Center is investing $6.5 million in a diverse group of community partnerships over the next five years to help combat the housing crisis faced by so many of its patients.  Recently, Boston Medical Center, Boston Children’s Hospital, and Brigham and Women’s Hospital jointly launched the Innovative Stable Housing Initiative with a combined investment of $3 million dollars over three years.

Beyond financial investments, hospitals have huge power to impact the social and economic fabric of Boston neighborhoods by contracting with local firms to provide goods and services and focusing the power of their investment portfolios locally.  Additionally, many opportunities exist within each hospital to create new models of employment practices that address structural racism and economic inequity.

Whether it is a review of professional development and creation of significant pipelines for advancement, or hiring practices that include individuals with a CORI, there are internal opportunities to address some of these problems.  For example, Baltimore’s John Hopkins reviewed its hiring practices and has hired hundreds of formerly incarcerated residents, providing financial security to those employees.

We are truly excited and impressed by the comprehensive and ambitious process that Boston hospitals are engaged in. We are confident that, if done right, this process can result in improved health for Boston residents and a closing of health inequities across race, income, and neighborhood.

Meet the Author

Enid Eckstein

Advocate, Community engagement, development and healthcare transformation
Meet the Author

Elmer Freeman

Executive director, Center for Community Health Education Research
Meet the Author

Carlene Pavlos

Executive director, Massachusetts Public Health Association
We look forward to following this process closely in the coming months and years. And we stand ready to roll up our sleeves and work with our hospital partners in our shared goal of better health and health equity for all city residents. It is time to keep working, and investing, together.

Enid Eckstein is a community activist who works with the Massachusetts Communities Action Network. Elmer Freeman is the executive director of the Center for Community Health Education Research and Service. Carlene Pavlos is the executive director of the Massachusetts Public Health Association.