Hospital community benefit: Investment in community health improvement
Nonprofit hospitals are required to maintain community benefit programs to maintain their tax-exempt status. The principal form of this public benefit historically has been—and continues to be—the provision of free or reduced-cost care to patients unable to pay for health care services. However, recent changes to community benefit regulations have encouraged hospitals to become more involved in community health promotion and disease prevention.
The Affordable Care Act established additional community benefit requirements for tax-exempt hospitals — including conducting community health needs assessments (CHNAs) and developing implementation strategies to address priority needs.
Inspired by this growing commitment to respond to community health needs, Health Care Without Harm’s Healthy Food in Health Care program carried out a national research project to support hospital community benefit professionals and community partners in developing initiatives that promote healthy food access and healthier food environments. The project was supported by a grant from the Robert Wood Johnson Foundation.
Health Care Without Harm’s national community benefit research included a survey, in-depth interviews, and case studies. Key study questions included:
- How are assessments of the community food environment, food access, food behaviors, and diet-related health conditions included in CHNAs?
- Which food-related organizations and community groups are collaborating in the CHNA process and in implementation strategies?
- What is the national landscape of community benefit initiatives to address healthy food access and diet-related health conditions?
- How are these programs being evaluated?
- What are facilitators and obstacles to community benefit investment in initiatives to improve community food environments, including initiatives with food system sustainability objectives?
Community benefit programming to improve healthy food access and reduce risk of diet-related disease: A national survey of hospitals and a forthcoming comprehensive research report discuss our national research findings, which informed the resources, recommendations, and examples presented in the Delivering community benefit: Healthy food playbook.
Our representative national survey found that obesity was identified as a health need in 71 percent of respondents’ CHNAs, while food insecurity or healthy food access was identified as a health need in 13 percent of CHNAs.
Another key finding was that the majority of community benefit interventions to prevent or treat obesity and diet-related health conditions centered around nutrition education and exercise promotion — and that fewer interventions focused on increasing access to healthy foods.
Alongside providing diet and nutrition education, more can be done to address healthy food access in our communities. Health professionals may educate overweight or diabetic community members to eat five servings of vegetables and fruits each day, but if there are no places to buy affordable fresh produce in the neighborhood or families are struggling with food insecurity, then it will be difficult to adhere to the recommendations.
Making access to healthy foods both convenient and affordable in our communities is an effective way to impact the social and environmental determinants that are the primary drivers of health or illness.
The goal of the "Delivering community benefit: Healthy food playbook"
The goal of the playbook is to support and inspire hospital community benefit professionals and community partners in developing initiatives to promote healthy food access and healthier food environments. The playbook presents information and tools to address food- and diet-related community health needs at several steps in the community health engagement process
If a facility has identified obesity, food access, or diet-related chronic health conditions among the priority health needs in its CHNA, then initiatives to promote healthy food access and increased consumption of fruits and vegetables (which are often combined with diet and nutrition education) can be important components of an implementation strategy to address these needs.
Additionally, hospitals can extend the reach of their contribution to health by collaborating with community partners to build strong, local economies and vibrant, resilient communities.
Investing community benefit and other resources in local and sustainable food initiatives and enterprises can be a pillar of a community development framework that addresses multiple social determinants of health by supporting economic growth, workforce development, access to healthy and affordable food, social cohesion, and personal well-being.
The playbook resources discuss numerous ways hospitals can provide community benefit support to initiatives that promote access to healthy foods, healthier food environments, and healthy eating. Our guidance resources include opportunity briefs illustrating hospital participation in a set of impactful healthy food access programs in their communities. In many cases, these strategies also include support for local, sustainable food producers.
These types of initiatives were observed in our national research and are included among the evidence-supported community health improvement strategies identified by
We also feature case studies of hospitals demonstrating exemplary community engagement and work to address health disparities. The case studies were selected in order to capture regional variation, diverse community settings and hospital characteristics, and to showcase a variety of healthy food access program types.
While this project takes a broad look at how hospitals are assessing healthy food access, obesity, and diet-related health needs in their CHNAs and how facilities are addressing these needs in their implementation strategies, the playbook resources particularly highlight certain kinds of “win-win-win” opportunities that:
- Improve access to healthy, affordable food and at the same time
- support economic and workforce development in low-income or disadvantaged communities and
- strengthen local and sustainable food systems
The playbook seeks to promote promising practices that include local food producers and food enterprises as part of a multi-pronged effort to increase access to fresh, affordable, and sustainably produced food; promote health equity, and stimulate the local economy—particularly through creating well-paid jobs in low-income communities.
These “win-win-win” initiatives support local and sustainable food production while working to eliminate health disparities and empower and improve the lives of community residents.
Hospitals and community health
Community benefit is only one of many ways that hospitals and health systems invest in the health and well-being of their communities. As anchor institutions — large, nonprofit organizations that, once established, tend to remain rooted in place — hospitals are increasingly recognizing their “anchor mission” to harness their significant economic and other resources to address social and environmental determinants of health in the communities they serve. This can include:
- A commitment to local hiring and workforce development and employee wellness
- Purchasing local, sustainably produced, and/or non-toxic materials and products
- Investing in green buildings and green energy
- Improved waste management
- Directing grants and social investment funds to local and regional initiatives that will promote equitable economic development and healthy, vibrant communities
- Advocating for local, regional, and national policy, systems, and environmental change
Health Care Without Harm and Practice Greenhealth offer a variety of tools, educational opportunities, and services to support hospitals in advancing their healing mission as anchor institutions, particularly with respect to health care’s environmental footprint.