As the fourth wave of COVID-19 infections surges across the country, U.S. hospitals once again find themselves working to keep their communities healthy on multiple fronts. They are taking care of the patients filling emergency rooms and ICUs. They are supporting public health messaging about vaccines and masks. And they are continuing to address the social determinants of health which shape the places people live and, by extension, their health. Hospitals seeking to make long-term improvements in the social determinants are increasingly turning to community investment, which has the potential to drive dramatic advancements in community health and health equity.
The first waves of the pandemic most deeply harmed disinvested communities of color, many of them immigrant, whose low-paid essential workers kept critical sectors like supermarkets, nursing homes, and deliveries going as most of the country stayed home. Residents of these communities know that they need quality affordable housing, family-wage jobs, a healthy environment, more transportation options, and food security to be able to live healthy lives. These needs were acute before the pandemic, caused too many unnecessary deaths during the pandemic, and will still be there when the pandemic ends. Community investment helps meet those needs.
The over-arching goal of community investment is to shift the way capital flows into communities. Community investment improves the social, economic, and environmental conditions in disinvested communities while producing some economic return for investors. When done well, community investment brings resources into communities to meet resident priorities while creating long-term mechanisms, such as revolving loan funds, that enable community members to achieve their long-term aspirations.
Hospitals and health systems often act as anchor institutions with strong motivations to improve community health as well as substantive assets—including investment capital, purchasing and hiring power, real estate, expertise, and relationships—to put toward that goal. We’ve already seen some leading hospitals and health care systems add investment to their toolbox of strategies for structurally shifting conditions in their communities.
Take Nationwide Children’s Hospital (NCH) in Columbus, Ohio: In 2008, NCH launched Healthy Neighborhoods Healthy Families (HNHF), an initiative to improve community health outcomes by addressing affordable housing, education, health and wellness, community enrichment, and economic development. HNHF has been investing in housing in Columbus’s South Side neighborhood, where it has transformed over 350 vacant and abandoned properties into quality affordable homes.
In 2019, HNHF extended its efforts to another neighborhood, Linden, where it is engaged in a planning process with neighborhood residents to identify their housing needs and the best ways to meet them. Rather than put that process on hold as Nationwide managed the pandemic, they instead redoubled their efforts, recognizing how the economic downturn was affecting housing stability. In the last year alone, Nationwide has continued to engage virtually with neighborhood residents, recruited new investors, initiated home repair programs for homeowners and rental properties, secured land for new affordable homes, and created new financial vehicles to preserve and develop affordable housing. Their persistence will ensure that South Side and Linden residents not only have more housing options but see long-term change in the resources available to their communities.
At the system level, CommonSpirit Health has built a portfolio of over $100 million in community investments across its footprint. In one local example of its work, in San Bernardino, California, where CommonSpirit has two hospitals, it has partnered with the city and local developers to produce and preserve affordable homes. In addition to investing its own resources in a large, multi-family rental development, CommonSpirit helped secure a $20 million investment from the State of California. Since the pandemic, it has approved investments in two homeownership efforts led by local nonprofit developers.
As the examples above suggest, hospitals that pursue community investment do not have to do it alone—and, in fact, are most successful when they collaborate closely with community members from the start. Investing in Community Health: A Toolkit for Hospitals, a resource prepared by the Center for Community Investment and the Catholic Health Association, lays out a set of six steps to guide hospitals setting out on this important work:
- Lay the groundwork: Assess institutional understanding of social determinants and educate your hospital community about them, convene a cross-department team to support the work, and engage your board and senior leaders.
- Choose your focus: Working with the community, identify the most pressing health needs, their root causes, and the people they most affect. Reviewing the hospital’s community health needs assessment and implementation strategy is a good place to start this search. Use the information you gather to determine your investment priority.
- Find partners: Reach out to community members and local community investment stakeholders to find out what they are doing to address community health needs and how you might get involved.
- Identify investable opportunities: With your cross-department team, determine your institutional investment priorities, including what resources are available to allocate for investment. Working with community members and your community investment partners, figure out which deals and projects in your communities could make best use of your investment.
- Create a strategy: Set a general goal with specific targets for impact, develop criteria for prioritizing investment opportunities and making decisions about which to pursue, identify partners, select your initial investments, and take action. Continue to involve community partners in the process to build community trust and get buy-in for selected projects.
- Enhance the local community investment system: Assess the policies and regulations, available funding, skills and capacities of local actors, and institutional relationships that undergird community investment in your communities (we call this the enabling environment). Look for opportunities to improve the system through advocacy and policy change to support greater investment, engaging community members who have been overlooked or excluded, and/or finding new roles for your hospital to play.
The Center for Community Investment and the Health Anchor Network offer additional information, examples, and resources about hospital community investment, which promises to be one of the most important things hospitals can do for their communities, today as the pandemic rages, and in the future when we hope it is long gone, and with it the conditions that made it so difficult for so many.