Monthly Archives: February 2013

Going outside the hospital walls to improve health

Obamacare provision requires nonprofit hospitals reach out to the community, emphasizing link between poverty and poor health

This article was co-authored with David Zuckerman, and originally appeared in the Baltimore Sun.

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.

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Interview with Elias Crim for Solidarity Hall: Living in the New “Pre-History”

This interview originally appeared on Solidarity Hall

To begin with, tell us about the Democracy Collaborative’s focus on community wealth-building. How can that be done?

We also use the term community-sustaining economy—and we’re interested in forms that build democracy, community and equity. In smaller companies, we know that worker ownership is a useful device. Indeed, we are strong supporters of worker coops and worker-owned companies in general. In large firms, worker ownership in some industries might produce different equity results. That is, the larger community has a stake in the impact of their operations.  And we’ve been interested in how you can blend these different interests most successfully.

The problem with pure worker ownership of large industries is that the worker/owners are under the same market pressures as any other company. They are therefore as likely to pollute the environment, for example, if they’re under competitive pressures to do so, as the next guys.  So that means the worker-owned company’s interests are somewhat different from that of its surrounding community—which includes elderly people, young people, all those who happen to be out of the workforce. After all, half the society at any one time is not part of that worker ownership.

So we think it’s critical, to use economists’ language, to begin to internalize the externalities through structures that reflect the broader community’s interests, rather than putting workers’ interests at odds with them. The Evergreen Cooperatives in Cleveland, for example, is a key initiative that reflects this worker-community model, and which we helped design. Read More »

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