Editor’s Note: Throughout 2015, an AAMCNews series explored how medical schools and teaching hospitals are addressing social determinants of health in their communities through research, clinical care, and education.
In 1995, Massachusetts General Hospital (MGH) began working with three area communities to identify unmet health needs. After collecting and analyzing local health statistics, MGH staff shared results with community stakeholders and asked them to prioritize the most pressing health issues based on the data and, perhaps more important, their own experience as community members and leaders.
This was MGH’s first community health needs assessment, or CHNA, the process of collecting data to identify health needs, with the ultimate goal of using the results to engage community stakeholders, define priority health issues, and develop initiatives that address those issues. Staff from the MGH Center for Community Health Improvement (CCHI) worked with local leaders to develop sustainable programs that focused on preventing violence, reducing substance abuse, and improving access to care for vulnerable populations.
Since then, MGH has repeated assessments roughly every three years in each of the three communities. The work has had a “transformative impact” on MGH, according to Joan Quinlan, MPA, CCHI executive director. In 2007, the institution added a charge to its mission statement to improve the health and well-being of area communities. In 2011, MGH received the AAMC’s Spencer Foreman Community Service Award for its work with communities.
MGH has been working on CHNAs for years, but many teaching hospitals are just beginning similar assessments, in part because of an Affordable Care Act (ACA) regulation that mandates 501(c)(3) hospitals conduct a CHNA every three years to maintain federal tax-exempt status. Hospitals that fail to meet the requirements can face up to $50,000 in fines. An AAMC Analysis in Brief , published in December 2014, explored CHNA strategies among AAMC-member teaching hospitals, with the goal of helping institutions strengthen capacity to address health inequities and improve community health. While many respondents reported a lack of time and resources to conduct CHNAs, 83 percent of respondents planned to use the CHNA to form community-academic partnerships to address prioritized health needs, and 80 percent were planning to develop community-focused health improvement initiatives.
In New Mexico, Tassy Parker, PhD, RN, is examining CHNA data with an eye toward improving health equity for the state’s Native American population. As director of the Center for Native American Health at the University of New Mexico (UNM) Health Sciences Center, Parker takes a different direction than institutions that are incorporating CHNAs because of the ACA requirements, although the ultimate goal is the same.
As sovereign nations, Native American tribes are not required to follow ACA requirements, but as Parker explained, there are still many reasons CHNAs can be helpful for these populations. “Just because [CHNAs are not] a requirement doesn’t mean that the tribes should not have access to good quality health data so they can prioritize what resources they do have in their communities,” she said. CHNAs can also provide tribes with “more ownership and authority over their own resource expenditures,” added Parker, who also is assistant dean of academic affairs at UNM School of Medicine.
For Parker, the data that come out of a CHNA are critical in part because findings can help community members and stakeholders make informed decisions about how to allocate finite resources. She and her team at the Center for Native American Health regularly work with Native American tribes in a co-learning effort to identify best practices for conducting CHNAs that are aligned with tribal cultural value systems. That work has led one large tribe to seek accreditation from the nonprofit Public Health Accreditation Board, which does require CHNAs.
Other tribes are reaching out to allies to assist in building their own local public health systems.
While the data are invaluable, researchers will not get very far if they do not engage communities in the process of data interpretation and implementation, Parker reported. “Sometimes you can sit in the office and say, ‘According to the statewide statistics, this is what we should prioritize,’ and that will not help you to move the mountain of local persistent health disparities and inequities, nor will it sustain the CHNA process,” she said.
Back on the East Coast, Victor Carrillo, MPA, director of community health and research at NewYork- Presbyterian Hospital (NYP), agreed. “The data are important,” he said. “But I can’t overemphasize the importance of engaging your community as an active member of the process. You can’t build programs in a vacuum. You have to engage your community partners; you can’t do it alone.”
“You can’t build programs in a vacuum. You have to engage your community partners; you can’t do it alone.”
With CHNA findings, NYP pioneered Choosing Healthy & Active Lifestyles for Kids (CHALK), an obesity prevention program that encourages kids to learn about healthy lifestyles. The program, which began in public schools near NYP, has expanded to 225 schools in 42 states and is a model for first lady Michelle Obama’s Let’s Move! Active Schools program. In 2014, NYP received the AAMC’s Spencer Foreman Community Service Award in part because of work with the CHALK program and other initiatives to improve health in surrounding neighborhoods.
As more institutions conduct CHNAs, MGH’s Quinlan suggested they look at the ACA requirements as an opportunity.
“I think to the extent hospitals can view these as an opportunity as opposed to a regulatory burden, it’s a great way to form those relationships with communities,” she said.
This article originally appeared in print in the January 2015 issue of the AAMC Reporter.