Every day, we learn more about how patients’ health outcomes are tied not only to the healthcare they receive but also to the conditions in the communities where they live. Social and economic inequities, amplified by race, often emerge as the leading factors explaining differences in health outcomes and life expectancies. As this evidence grows, healthcare systems must consider how they can build a culture of health in the communities they serve. This shift is sparking conversations and rapid learning about the nonclinical strategies that institutions can deploy to achieve better outcomes and reduce health disparities inside and outside their walls.

Health systems are uniquely positioned as leading economic engines and employers in their communities. In addition to providing quality healthcare, they can leverage their business practices to help address the economic factors that contribute to a community’s overall well-being. Through local and inclusive hiring, health systems can invest in an ecosystem of success that lifts up local residents; helps create career pathways for low-income, minority, and hard-to-employ populations; and begins to transform neighborhoods. In the process, health systems can develop a more efficient workforce pipeline, meet sustainability and inclusion goals, and ultimately improve the health of their communities. Establishing a local and inclusive hiring strategy is an important first step towards rethinking your health system’s role in the community. This toolkit can help you get started.

Around the country, communities are becoming more diverse. By 2045, the US will be a majority-minority country. At the same time, the difference in living standards between well-resourced and low-income communities continues to grow, and these differences are often linked to race. In the most dramatic sense, this is illustrated by large life expectancy gaps of more than twenty years between low-income and high-income neighborhoods just a few miles apart in cities across the country.¹Sabrina Tavernise, “Disparity in Life Spans of the Rich and the Poor is Growing,” New York Times, February 12, 2016, accessed July 7, 2016, nyti.ms/1PRn2nx; Original study: Barry Bosworth, Gary Burtless, and Kan Zhang, “What growing life expectancy gaps mean for the promise of Social Security” (Washington: Brookings Institution, 2016), www.brookings.edu/research/reports2/2016/02/life-expectancy-gaps-promise-social-security#recent/. Framed another way, in the most distressed quintile of US zip codes, 25 percent of adults have no high school degree and only 45 percent of adults are working. In the most prosperous quintile, only 6 percent have no high school degree and 65 percent of adults are working.²The 2016 Distressed Communities Index: An Analysis of Community Well-Being Across the United States(Washington, DC: Economic Innovation Group, 2016). accessed May, 2016, eig.org/dci/report; Matt Bruenig, “White High School Dropouts Have More Wealth Than Black And Hispanic College Graduates,” Policy Shop, Demos, September 23, 2014, accessed May, 2016, www.demos.org/blog/9/23/14/white-high-school-dropouts-have-more-wealth-black-and-hispanic-college-graduates.

In an era of unstable and precarious local economies, and with the disappearance of middle class careers for recent high school graduates, the need to build better pipelines to the careers of the future is critical to creating economically secure and healthy communities. Health systems, along with universities, local governments, and community foundations, represent “sticky capital” because their nonprofit and public ownership status coincides with a deep investment in place that is often inextricable from their mission.  Such “anchor institutions” offer opportunities to align resources to create new local opportunities.

Health systems can partner with workforce intermediaries and community-based organizations to ensure that residents from low-income communities, often people of color who face challenges finding employment, can access life-changing opportunities at their institutions. By reviewing internal policies and procedures around career trajectories for frontline and mid-level employees, health systems can ensure that jobs become careers for their workers. To expand the impact of local and inclusive hiring strategies, health systems can help bring together other large employers to build a sustainable community infrastructure advancing this approach to local job creation and career development.

When an institution is linked to the long-term well-being of the community it calls home, both the institution and the community can benefit when existing resources are leveraged creatively to address key issues. An “anchor mission” is an institutional commitment to increasingly align operations and intellectual resources to benefit the communities of need the institution serves, improving the health, well-being, resilience, and economic security of all community residents. Building robust and inclusive local hiring pipelines is a long-term investment in a workforce that is more productive and more invested in institutional success, and in a community that is healthier and more economically secure.

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