Resources from the Democracy Collaborative

TDC Advisory

The Democracy Collaborative is a nationally recognized nonprofit that provides advisory services to health systems, universities, local governments, and community foundations who wish to develop and implement strategies that leverage local purchasing, hiring, and investment resources to build community wealth in disinvested low-income communities and communities of color.  To learn more about how we can help your institution embrace its anchor mission and build community wealth, contact Dave Zuckerman, Manager of Healthcare Engagement, at

Can Hospitals Heal America’s Communities?

“All in for Mission” is the Emerging Model for Impact
Tyler Norris, Vice President of Total Health Partnerships, Kaiser Permanente
Ted Howard, President and co-founder, The Democracy Collaborative

Healthcare’s role in creating healthy communities through increasing access to quality care, research, and grantmaking is being complemented by a higher impact approach; hospitals and integrated health systems are increasingly stepping outside of their walls to address the social, economic, and environmental conditions that contribute to poor health outcomes, shortened lives, and higher costs in the first place.

They are doing so for several reasons: by addressing these social determinants of health through their business and non-clinical practices (for example, through purchasing, hiring, and investments), hospitals and health systems can produce increased measurably beneficial impacts on population and community health. By adopting this “anchor mission,” they can also prevent unnecessary demand on the healthcare system. This in turn can contribute to lower costs and make care more affordable for all, especially those truly in need. Simply put, this approach can improve a health system’s quality and cost effectiveness while simultaneously significantly benefiting society.

With hospitals and health systems representing more than $780 billion in total annual expenditures, $340 billion in purchasing of goods and services, and more than $500 billion in investment portfolios, this approach expands the set of resources and tools institutions have at their disposal to carry out their mission. It shifts the discussion of community benefit from the margins of an institution’s operations to overall accountability, where all resources can be leveraged to benefit the communities in which institutions are located.

Can hospitals and health systems heal America’s communities?

Read the paper now 

Hospitals Building Healthier Communities

Embracing the Anchor Mission
David Zuckerman, The Democracy Collaborative

A massive shift is taking place across the nation: hospitals have increasingly become the economic engines of their communities. With annual purchasing of half a trillion dollars and billions in their investment portfolios, hospitals are a powerful economic force that, if employed strategically, could have a major positive impact on community health and well-being. As a result, a growing number of hospitals are engaging in community economic development, recognizing the importance of environmental hazards, poverty, unemployment, and other social factors in determining health outcomes and the vibrancy of their communities.

In moving further upstream to address socioeconomic factors, these innovative hospitals have  advanced beyond their traditional practice of simply providing acute care, acknowledging that today this historical core competency is insufficient if they are to accomplish their nonprofit and public missions of “health promotion.”

Some hospitals, like Bon Secours Health System, have explored affordable housing to reduce homelessness and inadequate housing conditions. Others, like Dignity Health, have recognized that utilizing a portion of their endowment for community lending can send powerful and positive ripple effects through the communities they serve. University Hospitals in Northeast Ohio has prioritized localizing its nearly $1 billion in annual procurement, “discovering that hospitals can help heal entire cities through economic development,” as its CEO Tom Zenty noted. Leveraging previously untapped institutional resources, Kaiser Permanente has adopted a philosophy called “Total Health,” understanding the environmental, community and economic factors that impact health outcomes, and has begun to fully realign their organization to achieve this vision.

Another critical factor driving these shifts is an often overlooked provision of the Affordable Care Act, which requires every nonprofit hospital to complete a Community Health Needs Assessment in their community every three years. This is a strategic new opportunity to shift the conversation: a health system must for the first time engage its local community on its health—not healthcare—problems and explain how the hospital intends to address them. Often, when so engaged, communities identify joblessness, poverty, affordable housing, and clean and safe streets—and not just the presence or absence of disease—as major factors affecting the health of their community.

In many communities, anchor institutions like hospitals remain on the sidelines in the face of pressing economic and health challenges. But across the country, more and more healthcare institutions are shifting their historically inward gaze away from a circumscribed and incomplete vision of health promotion and outwards toward the total well-being of the communities they serve — a positive trend that will hopefully continue to grow.

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The Anchor Dashboard

Aligning Institutional Resources for Low-Income Community Needs

Anchor institutions are enterprises such as universities and hospitals that are rooted in their local communities by mission, invested capital, or relationships to customers, employees, and vendors. As place-based entities that control vast economic, human, intellectual, and institutional resources, anchor institutions have the potential to bring crucial, and measurable, benefits to local children, families, and communities. All told, U.S. hospitals and universities combined spend over $1 trillion a year, have endowments in excess of $500 billion, and employ 8 percent of the labor force.

Many anchor institutions regularly report on community programming and activities. Some go even further and seek to pursue an anchor mission—making a commitment to consciously apply their long-term, place-based economic power, in combination with their human and intellectual resources, to better the long-term welfare of the communities in which they are anchored. Yet, to date, few tools exist to help institutions reflect and assess broadly the long-term impact of their anchor-mission activities, and particularly their impact on low-income communities.

This Democracy Collaborative paper and report proposes a set of indicators to begin to fill this gap. Developed through extensive research and in-depth interviews conducted with more than 75 leaders of anchor institutions, national nonprofit organizations, federal agencies, and community organizations, The Anchor Dashboard identifies twelve critical areas where anchor institutions can play an effective role. Additionally, it develops illustrative indicators that: 1) provide a baseline to assess conditions in the community; and 2) evaluate institutional effort—e.g., dollars spent, procurement shifted, people hired, policies and accountability procedures in place.

Our hope is that The Anchor Dashboard will be a valuable mechanism to help the field more clearly focus on what it means for a hospital or university to pursue an anchor institution mission. By outlining best practices in economic development, community building, education, health, safety, and the environment, along with potential mechanisms to track progress using already available data, we intend that this publication move the conversation from “programs” to “institutional impact”—and, especially, on how anchor institutions can conduct themselves to deliver crucial, and measurable, benefits for low-income children, families, and communities.

Read the paper now 

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