During a recent webinar, David Zuckerman, president and founder of the Healthcare Anchor Network (HAN), gave several examples of ways that health systems are using their roles as large employers to make community investments and partner with other community groups to advocate for changes in policy on housing, transportation and food insecurity.
The health system members of HAN embrace their roles as catalysts for health, economic, and racial equity by leveraging their everyday operations, including hiring, purchasing, and investment for equitable, local economic impact and to build community wealth.
Founding members included Advocate Aurora Health, CommonSpirit Health, Henry Ford Health System, Kaiser Permanente, ProMedica, Providence St. Joseph Health, Rush University Medical Center, RWJBarnabas Health, Trinity Health, and UMass Memorial Health Care.
Zuckerman was speaking on a panel discussion put on by US News & World Report that touched on health systems’ roles as anchor institutions in their communities. Also engaged in the conversation was Kinneil Coltman, Atrium Health’s senior vice president and chief community & social impact officer.
“Our focus has been how to consistently change your institutional behaviors, but one of the things we learned early on was that there was also a need to help health systems be more effective advocates around a broader vision of health equity,” Zuckerman said. “We've been mobilizing our health system partners to be better allies and advocates around areas that are outside their traditional wheelhouse, such as federal housing policy, and more recently, workforce development. There's simply no achieving health equity without stable, healthy and affordable housing and pathways to dignified jobs with a family supporting wage. Healthcare is not the expert in the space, and we've partnered with leading voices in their respective sectors and formed advocacy efforts.”
There's a need to mobilize broader coalitions and help bring the voice of large economic engines, the largest employers in congressional members’ districts, alongside these other sectors that have been marginalized, Zuckerman stressed. “I think there's an opportunity to add the voice of health are in this broader way. On the local level, we are seeing health systems take a more active role and broader advocacy agendas for health equity.”
He gave two brief examples. Trinity Health worked in coalition with community partners to advocate for the Cares Act funds for rental and utility assistance in Idaho. “This isn't healthcare systems alone doing the work,” Zuckerman said. “It's really important that they brought their voice to a broad coalition to help create the enactment of the Idaho Fair Warning Act, which gives tenants notice before eviction.” In the other example, UMass Memorial Health in Worcester was part of a coalition to help allocate ARPA funding for housing, including the first affordable housing trust fund in the city of Worcester, Massachusetts. “I think that this is a really important shift that we're seeing around these organizations being involved in other areas of social determinants of health policy that are so critical to helping us achieve health equity in this country,” he said.
As the largest employer in North Carolina, Atrium Health is rethinking its social impact on the community. Coltman spoke about carrying lessons learned during the pandemic into the future.
Headquartered in Charlotte, Atrium is the largest nonprofit health system in the Southeast and serves patients in North Carolina, Georgia, South Carolina and Alabama. It has over 73,000 employees and $13 billion in annual operating revenue. In May 2022, Atrium announced it was planning to merge with Advocate Aurora Health.
Atrium had been building a lot of infrastructure around health equity for a long time, Coltman said, “so when COVID started to roll into our communities, we had seen some of the headlines pouring in from other parts of the country about the profound and dramatic disparities along racial and socio-economic lines related to COVID, and we did not want to see that happen.”
“We quickly formed a COVID Equity Task Force, and we started to detect some very small disparities in testing in our communities,” she added. “We stood up and deployed roving mobile units that were going out in a truly barrier-free model, so that we were bringing testing to church parking lots and community centers and places like that.”
By taking those more grass roots approaches with community partners, over three-fourths of the vaccinations that have happened with Atrium mobile units have been people of color, Coltman said. “More broadly, we set up mass vaccination events that were providing vaccinations to more than 150,000 individuals in rapid succession. We detected a lot of myths and misinformation and cultural mores that we needed to navigate in order to have the most effective outcomes,” she added. “Because of some of these efforts, working with other partners, we did not see the dramatic disparities in COVID deaths in our region that we saw in some other parts of the country. But that said, we don't want to grow complacent. There's still a lot of work to do around those disparities that were there before COVID — disparities in chronic diseases that we all see in our communities. But I do think we learned a lot, and shame on us if we don't carry those learnings into other parts of our work.”
She noted that historically, health systems’ lobbying and advocacy efforts have been more focused specifically on healthcare issues. “We haven't always shown up to the conversations around eviction prevention, food policies, and farm bills moving through our state legislatures. We have started to curate those policy positions from the community-based organizations that we partner with every day, and letting them guide us in terms of what we want to throw our weight behind,” she said. “We also have tried to create more rapid translation of what our providers see in the emergency department, and what our social workers see working with some of the most challenging social circumstances — how can we mobilize quickly on those things, so that they're translating into policy and advocacy work.”
Zuckerman said that health systems in the U.S. hold a lot of resources in reserve for building new buildings or for times when finances are bad. These resources are kind of a rainy-day fund that can be leveraged differently to support investments in community development, like affordable housing, or access to healthy foods, such as helping grocery stores relocate the communities. For instance, Bon Secours Mercy Health in Richmond, Virginia, used an investment as well as a grant to help create a community land trust, which is a structure to help create permanently affordable housing. “It is really a reframing. Instead of looking at everything in our communities as deficits, which I think healthcare has been known to do,” Zuckerman said, “it's saying, what are the assets that we can leverage sustainably over the long term to disrupt the the inequities that are present today?”
“Our hospitals, regardless of what state, tend to be the largest employers in their communities,” Coltman said. “How do we use that role as an employer to drive health and health equity in our communities? We've GIS-mapped all of our regions and markets along the CDC social vulnerability index. What we're saying is, can we find systematic ways to employ folks from those most socially vulnerable communities, and then, as an employer start to wrap around them in ways that support folks in climbing out of poverty?”