What our ‘anchor mission’ means for central Mass.

Leveraging economic power to address social determinants of health

EARLIER THIS YEAR, UMass Memorial Health, the largest health care system in central Massachusetts, welcomed Harrington Hospital in Southbridge into its family.  A merger of a community hospital into a large academic health system is not noteworthy these days. But this one might be different.  Prominent in the 37-page affiliation agreement is a unique provision that reshapes the role that Harrington will play in its community.  And it may just portend a very different post-pandemic future for hospitals in this country.

The provision commits UMass Memorial and Harrington to pursue an “anchor mission” – a strategy which is novel because it has little to do with the care that is provided inside the hospital walls. Instead, it focuses on the surrounding community. It is a conscious and strategic commitment to leverage the economic power of the organization to address social disadvantage and pervasive inequality.

It does so in three specific ways.  First, it uses the hospital’s investment power, by taking a portion of its long-term investments and redirecting those investments to local community projects in vulnerable areas.  We committed $4 million to this purpose in the Harrington deal.  Second, it leverages the hospital’s hiring power by specifically targeting individuals from low-income neighborhoods for employment opportunities at the hospital.  Finally, it uses its purchasing power to redirect purchases of supplies and services in a manner that helps to lift up local community businesses, particularly those owned by minorities and women.

UMass Memorial and Harrington are part of a small but growing national network of hospitals pursuing an anchor mission strategy.  This approach makes sense because the health care we provide in our hospitals – as good as it is – contributes only about 15 percent to what makes an individual healthy over her lifetime.  A far greater contributor – about three times as much – are factors called the social determinants of health.  These are things like income level, housing situation, education level, environmental factors, and access to healthy food and transportation.

UMass Memorial began this journey in 2017.  We looked outside our walls at these social factors to health and we saw a disturbing picture.  We learned that a baby born in a neighborhood on the west side of Worcester has a life expectancy of about 84 years, above the state and national averages.  If that same baby happened to live two miles to the South, in a neighborhood not far from the new Polar Park, home of the Worcester Red Sox, her life expectancy would drop to 73, a gap of 11 years.  Same city, same state, same country.  A mere two miles takes away 11 years of life.

Why? The answer lies in the different conditions of life in these two neighborhoods. In one, a quarter of households do not own a vehicle, almost one-third lack a high school degree, and over 60 percent are on Medicaid. In the other, virtually every household owns a vehicle, 95 percent of residents have a high school degree, and less than 10 percent are on Medicaid.

According to Michael Marmot, a professor of epidemiology and former president of the World Medical Association, it all has to do with a lack of empowerment.  People who have transportation challenges, live below the poverty level ,and otherwise have difficulty making ends meet lack basic control over their lives. This creates enormous stress, which “leads to greater risk of mental and physical illness.”  And shorter life.

Enter our anchor mission.  By targeting our investments, hiring, and purchasing practices, we can create more jobs, more and better housing, grow businesses, and stimulate development. This will give individuals greater control over their lives and lead to better health.

Our numbers so far are impressive.  This past year we hired 21 people from the most vulnerable neighborhoods of Worcester.  We have set a goal of 30 for this coming year.  We have invested over $3 million in six projects across central Massachusetts.  One project establishes an innovative “tiny home” village for the chronically homeless, whereby individuals can have their autonomy while also building community connections and support.  Another project creates an arts and affordable housing community in Fitchburg, right across from the art museum, where immigrants and others can nurture and display their unrealized artistic talents.  It turns out that art helps to revitalize communities.  And we have pledged to triple our purchases from minority and women-owned businesses over the next five years.

This work will do much for our community.  But it may do even more for us.  It has unleashed a torrent of interest among our employees to get involved to help.  Over 500 of our employees – the very same individuals who have worked around the clock to save the lives of COVID patients – have volunteered this past year to help support the community in many of these efforts.  Some have called this work the most meaningful of their career.

Meet the Author

Douglas S. Brown

Chief administrative officer, UMass Memorial Health
The COVID-19 pandemic has exposed, with great brutality, the woeful underfunding of our public health infrastructure. Over the past 18 months, hospitals in communities across America stepped in to fill that void. Hospitals cannot bear this responsibility alone. But we can build upon the community connections we developed during COVID and continue to lead. By pursuing an anchor mission, hospitals can inspire and engage other like-minded institutions, for-profit and non-profit alike, to use their resources for the greater good.  Doing so will improve the health of everyone.

Douglas S. Brown is chief administrative officer at UMass Memorial Health and a member of the board of the American Hospital Association.