How Cities Can Support & Finance a Culture of Health

What does it take to ensure cities are healthier places to live, learn, work and play? A strategy that engages the right stakeholders.

This post was co-authored by Kevin Barnett, Colby Dailey and Sue Pechilio Polis.

When leaders in local government, community development, and the health care system came together to develop a plan for rehabilitating a historic building – the Swift Factory in North Hartford, Connecticut – they viewed the building as a potential hub for community health.

Community Solutions partnered with the city, state, Saint Francis Hospital, and others to engage the community in dialogues about their health needs and concerns. Using resident feedback as a guide, they began the process of designing a building that will serve as a neighborhood hub for job creation, food production and health promotion. “We have the opportunity to reinvigorate one of the poorest communities in Connecticut,” said Rick Brush, CEO of Wellville and Director at Community Solutions. “Support from the city and state government was critical to bring together the collective vision, resources and innovative financing needed for success.”

Now more than ever – given tight budgets and fiscal constraints in cities – it’s critical for leaders and stakeholders to work together. Community anchor institutions such as hospitals are often one of the largest employers in communities and are essential partners in community health improvement efforts. Likewise, community development financial institutions (CDFI’s) also play a key role in financing strategies to improve neighborhoods and ensure better access in vulnerable communities to health improving resources, services and supports.

Here are two specific strategies cities can use to engage with these stakeholders:

Engaging Hospitals as Partners

The following strategies can help city leaders expand the depth and breadth of their existing relationships with hospitals to build healthier communities.

1. Review Hospital Community Health Needs Assessments (CHNA’s). Give attention to how hospitals define their geographic communities (required by the IRS) and the degree to which their geographic parameters are inclusive of census tracts where poverty and associated health disparities are concentrated. In their analysis of population health dynamics, do they identify disparities by race and ethnicity only, or do they identify the communities where these populations are concentrated? An excellent public access tool to assist in the identification of these census tracts, hospital locations and other relevant factors is the Vulnerable Populations Footprint (VPF) tool.
2. Compare CHNAs to Other Assessments. Review other assessments conducted by a variety of organizations (e.g., local public health agencies, United Ways, Community Action Agencies, Federally Qualified Health Centers) to identify opportunities for alignment of priorities and programs.
3. Review Hospital Implementation Strategies (IS). Determine whether the programs outlined in the IS indicate a focus in communities where disparities are concentrated, or are they framed as “serving the community at large,” with broad dispersion of limited resources at the city, county or other broad geographic parameters. This provides an invaluable entry point for dialogue and analysis into ways in which resources of multiple organizations and entities may be better aligned and focused in order to produce a measurable impact.
4. Focus on the Social Determinants of Health. Develop a matrix of priorities across organizations to identify potential alignment with city efforts to address various social determinants of health, including land use, affordable housing, food systems, transportation, planning with a focus on links to jobs, and livable wages.
5. Build a Shared Sense of Ownership for Health. In an environment of increased transparency and public scrutiny, it is important to communicate an ethic of shared ownership for health in the engagement of hospital leaders. Communicate an interest in coming together to solve complex problems and optimally leverage the limited resources of diverse stakeholders including nonprofits, community development financial institutions (CDFI’s), city agencies, etc. Hospital leaders need to understand that the city and other stakeholders will be partners in the allocation of resources, including the development of public policies that offer the potential to scale and sustain positive outcomes.
6. Build Capital to Support Community and Economic Development Projects. City leaders can set the tone for hospitals to consider investments in community infrastructure through tax incentives, loans, assistance with the permitting process, and informing development to ensure it meets the concerns of residents.

Engaging Community Development Financial Institutions

As city leaders look for ways to spur and leverage resources to ensure improvements in neighborhoods to promote improved health and safety, another key partner are Community Development sector actors, including Community Development Finance Institutions (CDFI’s) that bring investment capital and Community Development Corporations (CDC) that bring deep knowledge of a community needs and assets. The Community Development sector is in the leveraging business and can often help stretch limited resources through innovative financing including tax credits (e.g. new market tax credits), investment products (e.g. Healthy Futures Fund), and low-interest loans. As city leaders and staff consider outreach to local CDFI’s and CDCs, some good initial steps include:

• Scanning existing models of city and CDFI or CDC partnerships through an exploration of recent case studies. Examples include:
  • Rolling Hills CDFI Partnership 
  • East Bay Asian Local Development Corporation CDC partnership
• Engaging a local CDC or CDFI to explore where their investments in social determinants of health might intersect with city efforts to improve health disparities. Build Healthy Places Network’s Partner Finder is a good place to start.

Mayors, city leaders, hospitals and CDFIs can leverage and bolster each other’s efforts. By engaging with one another, identifying common ground, and collaborating across sectors, they can join forces to advance health equity and opportunity, creating communities where all people can live rewarding and healthy lives.

About the authors:

Kevin Barnett, DrPH, MCP is a senior investigator with the Public Health Institute. Kevin has conducted applied research and fieldwork on two distinct but related issues: the charitable obligations of nonprofit hospitals and the diversity of the health professions workforce. Email him at kevinpb@pacbell.net.

Colby Dailey is the Managing Director of the Build Healthy Places Network and has worked for over a decade spearheading local, national, and global initiatives while cultivating and guiding cross-sector collaborations for collective measurable impact. Email her at cdailey@buildhealthyplaces.org.

Sue Pechilio Polis is responsible for directing the health and wellness portfolio for the National League of Cities (NLC) as part of the Institute for Youth, Education and Families. Email her at polis@nlc.org.