Like many health systems around the country, University Hospitals in Cleveland is in an urban area that's seen years of economic disinvestment and whose residents are poor and unhealthy.
“This is not an anomaly," said Steven Standley, chief administrative officer for University Hospitals.
While major academic centers in urban areas have grown in both prestige and revenue over time, the surrounding neighborhoods in many instances have not fared as well. The result has led to hospitals becoming major economic engines within the communities they serve, with some serving as the largest employer after other industries leave.
Many health systems have attempted to address the effects of poverty within their surrounding communities by employing initiatives focused on alleviating the social determinants that lead to poor health outcomes. Efforts have included health screenings, food drives and programs aimed at preventing poor eating habits, smoking and gun violence.
But a new initiative launched Tuesday aims to go beyond such community benefit programs to give hospitals incentives to use their hiring, purchasing and investing power as a means of revitalizing underserved communities to improve the health of their residents.
“Our focus is really on how can hospitals as a large economic employer really be drivers for more inclusive local economies,” said David Zuckerman, healthcare engagement manager at the Democracy Collaborative, a Washington D.C.–based advocacy organization that works to promote greater economic equity within communities.
The program is being launched in Albuquerque, where the University of New Mexico Health Sciences Center is participating in collaboration with Presbyterian Healthcare Services, First Choice Community Healthcare, Central New Mexico Community College and the Albuquerque Public Schools. It's sponsored by the Robert Wood Johnson Foundation.
The initiative, Hospitals Aligned for Healthy Communities, is a resource for health providers looking to engage their communities in order to buy and hire locally.
The model for the program was based on a collaborative conducted in Cleveland over the past 10 years that has involved University Hospitals along with Cleveland Clinic and Case Western Reserve University, which combined employ more than 60,000 and spend nearly $3 billion a year in goods and services.
Standley said the efforts of the collaborative have been responsible for creating 1,800 new jobs and connecting 429 local residents with career training.
“We can't fix everything,” Standley said. “But as a hiring entity for people, we've created a unique track to identify individuals in those communities that we could help become employees of UH.”
Collectively, hospitals and health systems spent $342 billion in 2009 on goods and services and employed more than 5 million people, according to the American Hospital Association (PDF).
Some of the recommended strategies to improve local hiring include changing policies regarding the employment of individuals with criminal records, and adjusting tuition reimbursement in order to advance tuition for certain lower wage employees.
Standley said the goal of such efforts is not to create a scenario where the neighborhoods that are being helped become gentrified and end up moving low-income residents out, but rather to improve their quality of life through community engagement.
“We pretty much know from our doctors that people who are unemployed usually don't have the money to buy their medication after they've been in the hospital,” Standley said. “We also know that that type of lifestyle leads to all types of other issues in these neighborhoods like security and crime.”
A growing amount of evidence in recent years has linked living in poverty with poorer health outcomes. Low-income adults are nearly five times more likely to report being in either fair or poor health than households with incomes at or above 400% of the federal poverty level, according to a 2015 report by the Urban Institute. Poor adults also have higher rates of such chronic conditions as diabetes, cancer, heart disease, hypertension and stroke than those with higher incomes.