Residents of Old Southwest Baltimore cannot take for granted the ability to grow old and stay healthy. With a neighborhood population of about 18,000 people, the life expectancy in certain areas is as low as 64 years—barely old enough to collect Social Security, and drastically short of Baltimore’s city-wide life expectancy of 71 years. Today, Bon Secours Hospital, which has a 130-year presence in the community, is a leader in efforts to address the neighborhood’s poor health outcomes by providing funding to support housing development and social programs meant to improve the community’s social determinants of health: non-medical, social, economic and environmental factors that affect health. Spurred by the hospital community benefits incentive in the tax code and the community health needs assessment requirement of the Affordable Care Act, nonprofit hospitals across the country are increasingly tackling local health challenges using approaches that are data-driven, interdisciplinary and informed by community input.
LIIF’s new report, “Partnering for Prevention,” investigates the ways that hospital community benefit spending is driving collaboration between the health care and community development fields. Drawing on LIIF’s commitment to provide capital for healthy families and communities, the report highlights best practices from the work of groups such as Dignity Health, Bon Secours Health System, Asian Americans for Equality and Mercy Loan Fund.
Nonprofit hospitals across the country are increasingly tackling local health challenges using approaches that are data-driven, interdisciplinary and informed by community input.
A strong and growing evidence base illustrates the importance of these collaborations and the link between poverty and poor health. For example, the Robert Wood Johnson Foundation has reported that, on average, college graduates at age 25 have life expectancies that are eight to nine years longer than those who have not completed high school, and two to four years longer than their counterparts who have attended some college but not received a degree.
Non-medical factors contribute considerably to these outcomes. According to the County Health Rankings and Roadmaps program, only 20 percent of the responsibility for overall health can be attributed to the clinical health care services a person receives. Other important factors include one’s environment, such as access to transportation and quality affordable housing; social and economic factors such as education, employment, and family support; and health behaviors including diet, exercise, and use of alcohol, drugs, and tobacco.
Only 20 percent of the responsibility for overall health can be attributed to the clinical health care services a person receives.
Within the community development field, organizations including LIIF have been working for decades to improve what are now recognized as social determinants of health, with a focus on the physical and social fabric of housing and neighborhoods. Key actors include nonprofit lenders, such as community development financial institutions (CDFIs), and developers of affordable housing such as community development corporations (CDCs).
LIIF’s new paper suggests five ways nonprofit hospitals and community development organizations can collaborate to improve the health of people living in low-income areas:
- Strategic Partnerships: Nonprofit hospitals could engage in strategic partnerships with community development corporations and CDFIs to inform their community health needs assessments and otherwise guide implementation of community benefit investments.
- Affordable Housing and Services: Community development corporations and nonprofit hospitals could collaborate to create and preserve affordable housing, along with other programs that draw on the partners’ respective strengths. Affordable housing is not only critical for individual well-being; housing development and renovation is an essential investment in the physical environment of a neighborhood.
- Homelessness Prevention: Hospitals could support legislation and fund programs to prevent, reverse and end homelessness, following the example of Boston Children’s Hospital.
- Real Estate Finance: CDFIs could seek, and nonprofit hospitals could provide, funding to support the origination of loans for affordable housing, health clinics and other health-related real estate investments—while additionally supporting research and documentation of best practices.
- Continued Alignment of Interdisciplinary Efforts: Beyond community benefit funding, future research should examine the potential for using additional funding sources, such as the Delivery System Reform Incentive Payment program, to align the work of the community development and health care fields.