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Going outside the hospital walls to improve health

Study after study demonstrates that poverty is a powerful driver of poor health. Many of America's leading hospitals exist in poor communities. Could these powerful institutions (in economic as well as medical terms) help overcome the deeper sources of failing health among the 46 million Americans living in poverty?

A little-known provision of Obamacare provides an unexpected opening.

Section 9007 of the Affordable Care Act requires every nonprofit hospital to complete a Community Health Needs Assessment every three years to engage the local community on its general health problems and explain how the hospital intends to address them.

This means that nonprofit hospitals are no longer permitted to treat only those within their walls. They must now reach out to the community, especially its underserved populations.

Hospitals are major economic engines. Nationally, nonprofit hospitals alone had reported revenues of more than $650 billion and assets of $875 billion as of August 2012. If employed strategically, this powerful force could have a major impact on the health and well-being of people in poverty across the nation.

Several far-sighted institutions already offer a glimpse of what this can mean. University Hospitals and Cleveland Clinic in Cleveland — two leaders in the field — have decided that reducing health disparities requires such community-based economic strategies as bringing down high rates of unemployment, improving educational achievement, fostering community safety and building stronger social service networks. In 2007, these two hospitals and other community partners embarked on a comprehensive program to build community wealth.

The effort included employing their massive purchasing power to help develop a network of green, local worker-owned cooperative businesses to supply the area's large nonprofits. Taxpayer funds supporting Cleveland's nonprofit hospitals now do double duty by helping to underpin a broader community-building agenda, creating jobs and companies that — unlike corporations that come and go — will remain rooted in the local economy.

Among the cooperatively owned businesses are an ecologically advanced, commercial-scale laundry capable of handling 10 million pounds of health-care linen a year; a solar company that installs panels for the city's largest nonprofit health, education, and municipal buildings; and the largest urban greenhouse in the United States, one capable of producing 3 million heads of lettuce and 300,000 pounds of herbs a year.

Each of these businesses also provides no-cost health insurance to employee-owners, improving health and building community at the same time. And more such efforts are in the planning stages. Hospitals and other "anchor institutions" spend $3 billion a year — not counting salaries and construction — in the 40,000-person urban Cleveland neighborhood where University Hospitals exists. (Hospitals in many other cities are considering strategies based on the Cleveland model, including Pittsburgh, Atlanta, and Washington, D.C.)

Indianapolis' Community Health Network suggests additional possibilities. In 1996, the hospital discovered that area residents judged that safe and clean streets were central to creating a healthy community. The hospital system completely refocused its community benefit program and over the past 15 years has developed a comprehensive program aimed not only at street cleanups and safety but at improving family economic and food security. Community Health Network has supported a community supported agriculture program, a new food cooperative, efforts to rehabilitate local housing, and a matched-savings account program to help residents build assets.

Baltimore's Bon Secours Health System provides still another powerful example. In the late 1990s, Bon Secours concluded that the leading community health priorities involved such nuts-and-bolts issues as getting rid of rats, cleaning up trash and providing affordable housing. Since then, Bon Secours, working in partnership with Southwest Baltimore residents, has developed more than 650 units of affordable housing and has cleaned up and converted more than 640 vacant lots into green spaces.

Pop culture lionizes the heroic doctor, saving patients through dramatic, last-minute surgery. This will always be a vital hospital role. But how many lives could be saved if hospitals were better at addressing the conditions that produce such health emergencies in the first place? The little-noticed Obamacare requirement may help us find out.

Gar Alperovitz, Lionel R. Bauman Professor of Political Economy at the University of Maryland and co-founder of the Democracy Collaborative, is the author of the forthcoming book "What Then Must We Do?" David Zuckerman (dave@democracycollaborative.org), a research associate at the Democracy Collaborative, is author of the report, "Hospitals Building Healthier Communities: Embracing the anchor mission."

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