A Measure of the Potential Impact of Hospital Community Health Activities on Population Health and Equity

Abstract

Hospitals can be significant contributors to investment in upstream community health programs. This article provides a scale that can be used not only by hospitals but by other health care and public health organizations to better align their community health strategies, investments, and partnerships with programming and policies that address the foundational causes of population health and equity within the communities they serve.

Nonprofit Hospital Community Benefit in the U.S.: A Scoping Review From 2010 to 2019

“…Pennel et al assessment of 2013 CHNA content and interviews with stakeholders led them to believe that non-profit hospital involvement in population health was unlikely (99). Along the same lines, after analyzing 23 organizations' CHIPs and finding that very few were addressing the structural causes of health inequity, Begun et al proposed a 5-point scale to help organizations focus on higher-impact, population health activities (41). But other articles, some from advocacy organizations, continue to suggest that nonprofit hospitals should take a larger role in population health improvement and to use community benefit as cornerstone of such work.…”

Overview of the Most Commonly Identified Public Health Needs and Strategies in a Nationally Representative Sample of Nonprofit Hospitals

“…Early findings from the literature on hospitals suggest that these organizations often favor community benefit investments that are in line with their role as clinical service providers (e.g., access to health care services and health promotion related to acute and chronic diseases such as cardiovascular disease, diabetes, or infectious disease) over investments not as closely aligned with traditional health care services, such as behavioral health, prevention, and nonmedical social determinants of health. A growing literature on this subject suggests that hospital-led programs to address mental health, substance use, or upstream social determinants of health such as food access, quality housing, and structural racism are less commonly adopted by nonprofit hospitals (Begun et al, 2018; Rozier et al, 2018). These findings are important but have mostly relied on small samples of hospitals, as the reports are time-consuming to analyze; or have focused on hospital programs enacted soon after the ACA was implemented.…”

Addressing Health Equity in Public Health Practice: Frameworks, Promising Strategies, and Measurement Considerations

“…Examples of social determinants of equity include community-engaged decision making, government and organizational policies, and efforts to eliminate root causes of socioeconomic differences). Higher values on the scale indicate the potential for greater impact (9). The National Quality Forum (NQF) provided another example of steps needed for health equity measurement in their development of a road map to achieve health equity in health care (4).…”