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In July 2017, Ted Howard visited the Health Foundation to present on the work of the Democracy Collaborative and the role of health systems as anchor institutions. We spoke with him to understand how anchor institutions can improve population health by building an inclusive and sustainable local economy. Ted Howard is president and co-founder of the Democracy Collaborative, an NGO based in the United States.


The role of hospitals as anchor institutions in improving population health from The Health Foundation on Vimeo.


You talk about ‘anchor institutions’. What do you mean by that term?

Anchor institutions’, as we define it, are very large, usually not-for-profit or public institutions. Hospitals, health systems and universities are called ‘eds and meds’ by some. What defines an anchor institution is they’re the kinds of organisations that are rooted in place, unlike for-profit corporations, which move all over the world and change their locations. Universities and hospitals, tend to stay where they’re founded, and that’s why they’re called anchors.

What do you see as the role of the hospital as an anchor institution?

Hospitals are incredibly important. First, their mission, is not just about providing health care, but operating themselves in a way that they intervene upstream in the ‘social determinants of health’. In the US, hospitals represent over a trillion dollars of economic activity every year. We think that if that activity is focused to benefit the local community, through localised purchasing, hiring, investment, that hospitals as anchor institutions can really have a transformative effect on the lives of people and the health of the community, and in particular those who are in a low income or poverty situation.

How have you engaged hospitals to date in this role?

The Democracy Collaborative works with health systems and hospitals all over the United States. What we’re working on is empowering them to localise their economic activity through hiring, purchasing and investment.

The Healthcare Anchor Network is an initiative that the Democracy Collaborative launched, bringing together 30 major health systems in the United States. They explore what we call the ‘anchor mission of healthcare’ and how to focus and harmonise all of the functions of the institution to benefit the community. They have a commitment to take what they learn and bring it back to the entire health system of the United States, to try to transform it. So this is really an effort over time, to not only change the business culture of the institutions that are participating, so that they’re more beneficial to their communities, but to do something even bigger, which is to try to transform over time what is basically one-fifth of the American economy.

What have been the successful factors that have been key to ensuring success?

We talk about the ‘anchor mission of health care’. The anchor mission is harmonising all of the aspects of the institution to benefit the locality. So: ‘How do you hire people in a way that really helps the local community? How do you issue your contracts so that you’re purchasing from local businesses.’ In this process, what’s very important is leadership. The CEO of these institutions needs to be fully behind this. Change is in the business model. But it’s not enough to just have the CEO as part of the process. All down the line – the procurement officers, the human resources people – they all need to embrace this idea of the anchor mission. Once you start to make these changes in the institution, you really start to get a kind of economic engine that can really benefit the local community.

Community engagement is absolutely key. If you don’t engage the community, what you’re really doing is not acting in partnership but doing something ‘to’ the community. And that’s never appreciated, even if you have the best of motives. One really needs to engage directly with residents, and their intermediaries, non-profit organisations, community based organisations. There needs to be a kind of spirit of reciprocity.

How can change happen?

My question back to you would be: ‘What is going on in the UK that might provide the kind of incentive for directors of hospitals to start to move in a more demonstrably community benefiting direction?’

They need to look at their community, identify what are the major health problems and then articulate a strategy to deal with those health problems. Well, if you start to look in that way, you see that 80 per cent of what impacts a person’s health, and a community’s health, has nothing to do with access to health care, nor quality of health care; it has to do with your income level, the kind of housing you live in, the transportation in your community, your social structure. Health systems now, by focusing on the needs of the community, they’re starting to say, ‘Aha, maybe we should start to conduct our business in a way that provides more jobs for people in the community because then they’ll be healthier.’

I do know, the process of devolution that’s taking place, the emphasis on local growth, and communities, the sustainability plans, I think these things start to push in the direction of a more engaged institution in the life of the community.

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