Abstract
The 2010 Patient Protection and Affordable Care Act requires not-for-profit hospitals in the United States to conduct a community health needs assessment (CHNA) every three years. Hospitals are also required to develop an implementation plan addressing the needs observed in the CHNA, or provide reasons for not addressing these identified needs. The extent to which CHNAs account for the structural and social determinants of health is open to investigation, particularly when doing so may call on hospitals to go beyond a narrow focus on individual behaviours as the source of preventable morbidity and premature mortality. Our work examines CHNA reports from hospitals in Chicago, Illinois. Our analysis contrasts the first wave of reports (published in the 2012–2013 period) with a second wave of reports (published in the 2015–2016 period). Our results reveal considerable differences in how hospitals met their CHNA requirements, with only a small number of hospitals offering historically deep and community-driven reports in the first wave of CHNA. Important differences also existed in how hospitals conceptualised causality of health inequities in their service areas—in the first wave of reports, most hospitals focused on individual behaviours rather than the root causes of poor health in Chicago, including economic inequality, racism/discrimination, and other aspects of structural violence. By the second wave of the reports a more collaborative approach was taken and a substantially different message emerged, with more hospitals adopting the language of the structural determinants of health. We argue that CHNA reports—which are created at the link between public and private health systems—are an important vehicle through which to understand health inequities in the United States.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
Notes
- 1.
Under the Internal Revenue Service (IRS) guidelines for CHNA reports, a hospital may define its own community boundary: ‘a hospital facility may take into account all of the relevant facts and circumstances, including the geographic area served by the hospital facility, target population(s) served, and principal functions. However, a hospital facility may not define its community to exclude medically underserved, low-income, or minority populations who live in the geographic areas from which the hospital facility draws its patients’ (Internal Revenue Agency 2014). In practice, this has meant that hospitals are largely free to define their own community areas—some hospitals claim the entire city, others a smaller geographic section. Differences may also exist between community hospitals and larger academic health centres, since the former will have higher utilisation rates in local communities than the latter.
- 2.
These reports were written by the same consulting agency, which used identical text in the various reports.
References
Abraham, L.K. (1993). Mama Might be Better Off Dead: The Failure of Health Care in Urban America. Chicago: The University of Chicago Press.
American Hospital Association. (2019). AHA Hospital Statistics. Chicago: American Hospital Association.
Ansell, D. (2017). The Death Gap: How Inequality Kills. Chicago: The University Of Chicago Press.
Beatty, K.E., Wilson, K.D., Ciecior, A. and Stringer, L. (2015). Collaboration among Missouri nonprofit hospitals and local health departments: content analysis of community health needs assessments. American Journal of Public Health, 105(2), pp. S337–S344.
Begun, J.W., Kahn, L.M., Cunningham, B.A., Malcolm, J.K. and Potthoff, S. (2017). A measure of the potential impact of hospital community health activities on population health and equity. Journal of Public Health Management Practice, 24(5), pp. 417–423.
Budrys, G. (2011). Our Unsystematic Health Care System. Lanham: Rowman and Littlefield.
CDPH. (2014). Chicago Hospitals and the Affordable Care Act: New Opportunities for Prevention. Chicago: Chicago Department Of Public Health.
CDPH. (2015). Chicago Hospitals and the Affordable Care Act: More Opportunities for Prevention. Chicago: Chicago Department Of Public Health.
Coates, T.N. (2014). The case for reparations. The Atlantic, 313(5), pp. 54–71.
De Maio, F., Shah, R.C., Mazzeo, J. and Ansell, D. (eds.) (2019). Community Health Equity: A Chicago Reader. Chicago: The University Of Chicago Press.
De Maio, F.G., Mazzeo, J. and Ritchie, D. (2013). Social determinants of health: a view on theory and measurement. Rhode Island Medical Journal, 96, pp. 15–19.
Dircksen, J.C., Prachand, N.G., Adams, D., Bocskay, K., Brown, J., Cibulskis, A. and White, M. (2016). Healthy Chicago 2.0: Partnering to Improve Health Equity. Chicago: City of Chicago.
Grant, C.G., Ramos, R., Davis, J.L. and Lee Green, B. (2015). Community health needs assessment: a pathway to the future and a vision for leaders. Health Care Management, 34(2), pp. 147–156.
Harper-Jemison, D., Thomas, S. and Woldemichael, G. (2009). Leading Causes of Death in Chicago. Health Status Index Series. p. Xviii.
Herring, B., Gaskin, D., Zare, H. and Anderson, G. (2018). Comparing the value of nonprofit hospitals’ tax exemption to their community benefits. Inquiry: The Journal of Health Care Organization, Provision and Financing, 55, 46958017751970.
Hunt, B., Tran, G. and Whitman, S. (2015). Life expectancy varies in local communities in Chicago: racial and spatial disparities and correlates. Journal of Racial and Ethnic Health Disparities, 2(4), pp. 425–433.
Illinois Department Of Healthcare And Family Services. (2015). Medicaid Expansion Numbers: September 2015. Available at: www.Illinois.Gov/Hfs/Sitecollectiondocuments/Acaenrollmentsummarydata.Pdf.
Illinois Health Matters. (2015). Illinois Marketplace Signups. Available at: http://Data.Illinoishealthmatters.Org/Enrollment/Il-Marketplace-Enr-2015-Data.Html.
Krieger, N. (2011). Epidemiology and the People’s Health: Theory and Context. Oxford: Oxford University Press.
Laymon, B., Shah, G., Leep, C.J., Elligers, J.J. and Kumar, V. (2015). The proof’s in the partnerships: are affordable care act and local health department accreditation practices influencing collaborative partnerships in community health assessment and improvement planning? Journal of Public Health Management and Practice, 21(1), 12–17.
Lightfoot, A.F., De Marco, M.M., Dendas, R.C., Jackson, M.R. and Meehan, E.F. (2014). Engaging underserved populations in affordable care act-required needs assessments. Journal of Health Care for the Poor and Underserved, 25(1), pp. 11–8.
Link, B.G. and Phelan, J. (1995). Social conditions as fundamental causes of disease. Journal of Health and Social Behavior, Spec No, pp. 80–94.
Marmot, M. (2017). Social justice, epidemiology and health inequalities. European Journal of Epidemiology, 32(7), pp. 537–546.
Marmot, M. and Wilkinson, R.G. (eds.) (2006). Social Determinants of Health. Oxford: Oxford University Press.
Martin, M. (2013). Community benefit: beyond health fairs and form 990. Healthcare Financial Management, 67(1), pp. 84–90.
Massey, D.S. (1990). American apartheid: segregation and the making of the underclass. American Journal of Sociology, 96(2), pp. 329–357.
Massey, D.S. and Denton, N.A. (1989). Hypersegregation in U.S. metropolitan areas: black and hispanic segregation along five dimensions. Demography, 26(3), pp. 373–391.
Mathews, A.L., Coyle, B.S. and Deegan, M.M. (2015). Building community while complying with the affordable care act in the Lehigh Valley of Pennsylvania. Progress in community health partnerships. Research, Education and Action, 9(1), pp. 101–112.
McKnight, J. (1980). Community health in a Chicago slum. Health PAC Bulletin, 11(6), pp. 13–18.
Office For National Statistics. (2015). Trend in Life Expectancy at Birth and at Age 65 by Socio-Economic Position Based on the National Statistics Socio-Economic Classification, England and Wales: 1982–1986 to 2007–2011. Available at: www.ons.gov.uk.
Pennel, C.L., Mcleroy, K.R., Burdine, J.N. and Matarrita-Cascante, D. (2015). Nonprofit hospitals’ approach to community health needs assessment. American Journal of Public Health, 105(3), pp. e103–e113.
Phelan, J.C., Link, B.G. and Tehranifar, P. (2010). Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. Journal of Health and Social Behaviour, 51(1_suppl), pp. S28–S40.
Powell, R.E., Doty, A.M.B., Rising, K.L., Karp, D.N., Baehr, A. and Carr, B.G. (2017). A content analysis of nonprofit hospital community health needs assessments and community benefit implementation strategies in Philadelphia. Journal of Public Health Management and Practice, 24(4), pp. 326–334.
Prybil, L.D., Scutchfield, F.D., and Dixon, R. (2016). The evolution of public health-hospital collaboration in the United States. Public Health Reports, 131(4), pp. 522–525.
Rosenbaum, S., Kindig, D., Bao, J., Byrnes, M. and O’Laughlin, C. (2015). The value of the nonprofit hospital tax exemption was $24.6 billion in 2011. Health Affairs, 34(7), pp. 1225–1233.
Singh, S.R., Cramer, G.R. and Young, G.J. (2018). The magnitude of a community’s health needs and nonprofit hospitals’ progress in meeting those needs: are we faced with a paradox? Public Health Reports, 133(1), pp. 75–84.
Wilson, K.D., Mohr, L.B., Beatty, K.E. and Ciecior, A. (2014). Describing the continuum of collaboration among local health departments with hospitals around the community health assessments. Journal of Public Health Management and Practice, 20(6), pp. 617–25.
Young, G.J., Chou, C.H., Alexander, J., Lee, S.Y. and Raver, E. (2013). Provision of community benefits by tax-exempt U.S. hospitals. New England Journal of Medicine, 368(16), pp. 1519–1527.
Zuckerman, S., Waidmann, T.A. and Lawton, E. (2011). Undocumented immigrants, left out of health reform, likely to continue to grow as share of the uninsured. Health Affairs, 30(10), pp. 1997–2004.
Acknowledgements
We are grateful to David Ansell, Maureen Benjamins, Fran Collyer, Marty Martin, John Mazzeo, and Karen Willis for helpful comments on early drafts of this work.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 The Author(s)
About this chapter
Cite this chapter
De Maio, F., Shah, R.C., Burke, K. (2020). Chapter Four: ‘Looking Outside Their Walls’: Exploring Community Health in Chicago Hospitals. In: Collyer, F., Willis, K. (eds) Navigating Private and Public Healthcare. Palgrave Macmillan, Singapore. https://doi.org/10.1007/978-981-32-9208-6_4
Download citation
DOI: https://doi.org/10.1007/978-981-32-9208-6_4
Published:
Publisher Name: Palgrave Macmillan, Singapore
Print ISBN: 978-981-32-9207-9
Online ISBN: 978-981-32-9208-6
eBook Packages: Social SciencesSocial Sciences (R0)