Community voices leading to community benefit

The Raices Cooperative Farm

Community voices leading to community benefit

Providence Hood River Hospital - Oregon
Rural hospital set apart by how community’s voice shapes priorities, partnerships, and investments including a food security council, produce prescription program, and teaching farm.
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  • Significant resources were dedicated to gathering primary data on food needs in the community. Surveys were mailed to over a thousand households and more than 600 surveys were hand-administered. 
  • The results of this survey revealed one in three persons in the region were experiencing food insecurity.
  • Three innovative food-access programs are supported by the hospital’s community benefit investments:
    • Veggie Rx
    • Gorge Food Security Coalition
    • The Raices Cooperative Farm
  • In 2016, the region was awarded the Robert Wood Johnson Culture of Health Prize. 

ŸHospital Name: Providence Hood River HospitalŸ
Hospital Type: Private, nonprofit, critical access
Hospital Size: Small (25 beds) Ÿ
Geographic area: RuralŸ
System/Network: Providence St. Joseph HealthŸ
Network coverage: California, Oregon, Washington, Montana, Alaska, Texas, New Mexico


Black/African American: 3.2%
American Indian: 1.5%
Asian Pacific Islander: 7.2%
Hispanic: 12.6%
White: 77.4%


Community health needs assessment region:

  • Columbia Gorge region
    • 5 counties in central north Oregon
    • 2 counties in southwest WashingtonŸ

Population: 84,23411

Health indicators

Obesity: 2 out of 3 are obese or overweight
Diabetes: 1 in 2 have chronic health conditions. 14% have diabetes.
Food insecurity: 1 in 3 experience food insecurity
Poverty: 1 in 4 experience financial instability

Providence Hood River Memorial Hospital is nestled in the foothills of the Columbia River Gorge that divides Oregon and Washington state. In the past decade, the Gorge, an agricultural, rural region, has experienced significant population growth that has shifted the demographics of its residents. Hood River City, where Providence Hood River is located, was historically a largely white, rural town. Today, 31 percent of Hood River City residents identify as Latino and seven percent of the population are migrant workers. Although these changes are more marked in Hood River City, similar changes are taking place across the county and the Gorge region. 

The Providence Gorge service area covers a large geographic region that spans seven counties where social, health, and economic indicators change drastically from county to the next. Hood River County (Hood River City is the county seat), which is one of Oregon’s prime destinations for outdoor enthusiasts, is ranked second overall for health factors in the state. Yet Wasco County, a neighbor to the east, ranks 25th among Oregon’s 36 counties for health outcomes and 18th for health factors.2 

The region faces particular challenges with social, health, and economic disparities that are heavily concentrated among lower-income households, including those identifying as Latino. 

Hood River regional map


In Hood River, 1 in 3 households worry about running out of food and 1 in 5 people have had to go without

- 2016 Columbia Gorge Community Health Assessment

Community health needs and assessment: Priorities and process

  • Food and diet-related disease priorities  
    • 2013 CHNA - Food insecurity
    • 2016 CHNA - Food insecurity and healthy eating3
  • Participation from food-based organizations in CHNA process 
    • Meals on Wheels, Next Door Inc., FISH Food Bank, Gorge Grown Food Network
  • How/why did food issues emerge as a priority?  
    • A region-wide survey, both mailed and hand-administered, was conducted for the 2013 and 2016 CHNA. The survey consistently found high rates of food insecurity and was key in how food emerged as a CHNA priority area.
  • Key community Indicators
    • One in three persons in the region experience food insecurity. Those with lower incomes are almost 10 times more likely to go without food than those with higher incomes. 
      One-third (36%) of Hispanic or Latino respondents experienced food insecurity in the past year
      Nearly two-thirds (65.2%) of Native Americans reported experiencing food insecurity

Full assessment: 2016 Columbia Gorge Community Health Assessment

Assessing health needs—and how to meet them

Community health needs assessment process

In 2013, Providence Hood River Memorial Hospital took a lead role in developing the Columbia Gorge Health Council’s Regional Community Health Assessment. This regional effort brought together 14 partners including hospitals, public health departments, coordinated care organizations, and community organizations to conduct a collaborative assessment for a region that spans seven counties in Oregon and Washington. This rigorous, collaborative process was the catalyst for community discussions on health that have shaped Providence Hood River’s priorities, partnerships, and investments in the region. 

In Oregon, Medicaid is organized into 16 Coordinated Care Organizations (CCOs) responsible for managing the needs —  as well as federal dollars — for low-income patients. Unique to Oregon,  is a statutory requirement that all CCOs must have a Community Advisory Committee (CAC) made up of at least 51 percent representation from Medicaid consumers. The advisory committees ensure that the community’s voice is reflected in health care policy and decisions and are responsible for approving a community needs assessment. 

In the Columbia Gorge, the CAC includes representation from food-based community organizations such as Gorge Grown Food Network. These food organizations play a critical role in the Regional Community Health Assessment, including developing survey questions for the community survey, assisting with survey administration, and providing input on the Community Health Improvement Plan (CHIP). 

Perhaps the most remarkable feature of Providence Hood River’s CHNA process is the significant resources dedicated to gathering primary data. To get a more granular look at the health needs of the community for the 2013 CHNA, the Columbia Gorge Regional Health Council launched a Community Health Survey that asked residents 72 questions ranging from health care access to transportation to food access. 

CG Council survey image
Snapshot of the 2016 Columbia Gorge Community Health Assessment compares data collection results from 2013 and 2016 food surveys.

The results of this survey revealed a particularly troubling trend: one in three persons in Hood River were experiencing food insecurity. 

In response to the alarming rates of food insecurity, this issue was prioritized in the Community Health Improvement Plan. As a step in that plan, a region-wide food survey was launched in 2013 and repeated in 2016 with the aim of further investigating food access and insecurity. The food survey included questions such as “did you skip a meal?” and “what makes it difficult to access food?” In both 2013 and 2016, surveys were mailed to over a thousand households and, in an effort to increase response rates from non-English-speaking, elderly and/or low-income households, over 600 surveys were hand-administered. In separate, but parallel data collection, Women, Infants, and Children (WIC) Food and Nutrition Service offices found regional trends showing high body mass index (BMI), high hunger, and poor nutrition among children. 

This data not only helped researchers understand the demographics of hunger in the community, but also how much it would cost to meaningfully impact and eventually solve food insecurity. 


“It would cost approximately $10 million per year to augment each hungry person’s access to fresh fruits and vegetables by $1 per day. In that same population, there's about $800 million dollars worth of health care being consumed.”

- Mark Thomas, Director of Mission Integration and Spiritual Care for Providence Hood River

For Thomas, it makes economic sense to increase community resources to address healthy food access since the dollars needed to meet the community’s food needs is far lower—only about one percent of the current amount spent on health care for patients facing food insecurity. 

The CHNA process prompted action from community leaders and community-based organizations with Providence Hood River leading many of these efforts.  

Providence Oregon’s community benefit activities are organized under the Community Health Division, a 13-person department across eight regional hospitals. Among the network’s hospitals, Providence Hood River is a leader in community benefit, outspending its network hospitals on community health improvement investments as a percentage of operating expenses. 

“We're often held up as an example of what community benefit is supposed to look like when it’s really running on all cylinders,” said Thomas. 

From Gorge Grown on Vimeo.

Investing in solutions

Implementation strategy

In response to the region-wide CHNA findings, Providence Hood River has made significant investments of staff time, in-kind resources, and grant funding to programs working to address food insecurity. In 2015, Providence Hood River provided leadership and seed funding to form the Gorge Food Security Coalition. Another key investment has been PHR’s partnership with Gorge Grown’s Veggie Rx, a program that provides vouchers for fresh fruits and vegetables to persons experiencing food insecurity.

Project spotlights

VeggieRx participant
Veggie Rx has helped over 10,000 food insecure residents in the Columbia Gorge region access fresh fruits and vegetables. The program has over 30 farmers markets and grocery store sites where participants can redeem vouchers for up to $30 worth of fresh produce. (Gorge Grown Food Network)

Ongoing work

Providence Hood River participated in the recently completed 2017 Columbia Gorge Community Health Improvement Plan.  Healthy food access, obesity, and food insecurity continue to be important issues for the area. Providence Hood River also continues to support regional projects that support healthy food access for its most vulnerable community members. These include the following new and developing projects:

  • Oregon Food Bank expansion - The Oregon Food Bank, which represents a statewide regional network of food banks and pantries, opened its newest warehouse site in December 2017 to serve the Columbia Gorge region. The warehouse will distribute food to regional pantries, which previously relied on deliveries coming from Portland, Oregon. Deliveries were frequently delayed or unable to reach the area in severe weather.  Providence Hood River provided $35,000 in funding to support the opening of new pantry sites, which will receive food distributions from the warehouse and expand healthy food access for communities facing food insecurity. 
  • Promoting healthy behaviors - Providence Hood River provided support for Pasos Para la Familia, a chronic disease prevention program that teaches nutrition education, exercise, and stress management to families and is offered in Spanish. They also provided support for Youth Fit for Life, a new afterschool physical activity program at Mid-Valley Elementary School in Hood River City. 

In recognition of the significant efforts to address health disparities and hunger, the Gorge community received the 2016 Robert Wood Johnson Culture of Health Prize. A key supporter and champion for much of the work happening in the region is Providence Hood River Memorial Hospital. 

From their efforts to survey hard-to-reach populations to their funding for numerous healthy food and food security initiatives, Providence Hood River has made significant investments and commitments to listen to and respond to the needs of their community's most vulnerable populations. 

"A fundamental commitment that we aspire that the people whose needs we're trying to understand and address need to have a stronger voice in the whole community health needs assessment process, including in how they're asked, what they're asked. We've taken that very, very seriously.”

- Mark Thomas, Director of Mission Integration and Spiritual Care for Providence Hood River
End Notes
  1. This population refers to the region covered by the Columbia Gorge Region as defined by the Columbia Gorge Health Council in the 2016 Community Health Assessment
  2. Hood River County, Oregon. Community Health Rankings and Roadmap. Available at  
  3. Information from the 2013 Columbia Gorge Community Health Assessment and 2014 Community Health Improvement Plan.  

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