Nutrition: A Community Benefit
A new IRS ruling is helping hospitals invest in healthier food.
Health care is big business in the United States. National health expenditures top 20 percent of the gross domestic product, hospitals employ 5.4 million people and spend more than $340 billion annually on goods and services.
But it also offers big benefits. Hospitals that operate as nonprofits (58 percent of all hospitals in the United States) are required to set aside a certain percentage of their gross revenues for community benefit funds dedicated to the improvement of community health through grants and donations.
With changes in how the Internal Revenue Service defines and regulates community benefits and the implementation of the Affordable Care Act (ACA), which is designed to address population health, there has been an expansion of “upstream” prevention-based programs that can help reduce the burden of chronic disease. Hailed as a victory for nutrition and sustainable food advocates alike, a recent and important ruling by the IRS will allow hospitals to claim their community benefit investments through healthy food:
“The health needs a tax-exempt hospital may consider in its CHNA include not only the need to address financial and other barriers to care but also the need to prevent illness, to ensure adequate nutrition, or to address social, behavioral and environmental factors that influence health in the community.”
The health care sector is increasingly recognizing the complex interconnections between our unhealthy, industrialized food system and public health with a commitment among hospitals throughout the country to make healthy and sustainable food a central part of their prevention-based health agenda.
Also, more hospitals are understanding that healthy food cannot be defined only by the quantity and nutritional quality of what we eat. Within the context of environmental nutrition, healthy food is the product of a food system that conserves and renews natural resources, advances social justice and animal welfare, builds community wealth and fulfills the food and nutritional needs of the human population.
As anchor institutions, hospitals have the potential to improve public and environmental health and to strengthen the economic vitality of their communities. They are rooted in place, hold significant investments in real estate and social capital, are among the largest employers in their communities and are often explicitly oriented toward supporting community health in alignment with their healing mission.
Due to their significant purchasing power and trusted role as authorities on health and wellness, hospitals have an important opportunity to not only increase access to healthier, more sustainably produced food for patients, staff and the community, but to transform the food system toward greater health and sustainability. Indeed, the momentum behind community benefits investments to improve nutrition is on the rise across the country, and this new IRS ruling paves the way for the health sector to step up its investments in a wide spectrum of nutrition-related programming, from acute food insecurity interventions to long-term efforts in building vibrant regional food systems by supporting local growers and economies.
Model Project: Massachusetts
A report released this spring by Health Care Without Harm (HCWH), “Utilization of Community Benefits to Improve Healthy Food Access in Massachusetts,” provides a landscape assessment of the ways hospitals throughout Massachusetts are using their community benefit resources to support healthy food access and improve nutrition. In fiscal year 2013, hospitals across the commonwealth invested in 80 such activities, including nutrition education, sponsorship of neighborhood farmers markets, fruit and vegetable prescription programs and grants to support neighborhood-level work through community health centers. Programs varied in their implementation details and target populations, but were aligned in their mission to improve diet in order to prevent or manage chronic diet-related diseases that arose as key challenges in their community health needs assessments.
The study found that programs could be better targeted to meet the needs of specific target populations if hospitals better understood their community food environment and the factors influencing diet. By using secondary data sources such as the U.S. Department of Agriculture’s Food Access Research Atlas and Food Environment Atlas, hospitals can learn more about the regional food system and barriers to access that impact their service area. This data can be complemented with information gathered directly through community surveys, focus groups and/or key informant interviews. Furthermore, improved collaboration between hospitals with shared service areas could enable them to optimize their resources to best meet community needs.
Based on the findings in the report, HCWH will continue to work with Massachusetts health care facilities to follow through on three recommended intervention options: 1) routine food insecurity screening of all patients and the provision of community-based resources for those in need; 2) support for the development of healthy food retail; and 3) support for healthy eating incentives for low-income individuals. Supporting locally grown foods in these programs can help to further amplify the job creation component and support the agricultural economy. Both of these benefits address the underlying issue of poverty, which is an established social determinant of health.
Model Project: Detroit
In Detroit, the Ecology Center—a HCWH partner organization—developed the Fresh Prescription program, partnering with local community health centers, farmers, community-based organizations and a hospital system and using community benefit funds and private foundation support. Fresh Prescription gives health care providers a tangible way to begin addressing fundamental determinants of health such as access to healthy food. The program links patients with local resources to provide support for developing healthy lifestyle behaviors that are critical to chronic disease management and prevention. Through nutrition education, healthy cooking demonstrations featuring seasonal items and support networks, this programming is helping to ensure people have the knowledge, skills, resources and support necessary to make healthy choices in their everyday lives.
In 2014, 85 percent of participants reported eating more fruits and vegetables, and 72 percent reported improving how they manage their health conditions because of the program. Fresh Prescription works to transform the traditional medical model by directly connecting health care with the local community food system. Patients are introduced to local healthy food resources such as farm stands, farmers markets and farm-fresh food boxes that are helping to transform food environments while infusing dollars into the local economy by increasing support for local farmers.
Model Project: Oakland and Richmond, California
HCWH is working with the Emerald Cities Collaborative, the Democracy Collaborative, Kaiser Permanente, Dignity Health, The California Endowment, the University of California and numerous community partners to launch the project Anchors for Resilient Communities. The project will determine ways in which collective investment from anchor institutions can leverage the assets and capacity of the communities of Oakland and Richmond, California, to help build community health and wealth.
Primary focus areas include building a robust regional food system and working to increase healthy food access and workforce opportunities through a variety of food-related programming. The group is assessing the communities to determine existing assets and programs and find opportunities for new programming.
The goal is to address the social determinants of health and develop healthy and prosperous communities, with a focus on meeting the needs of underserved neighborhoods in Richmond and Oakland. It is estimated that 40 percent of their residents’ health problems are related to poverty and environmental/public health. This project will leverage community investment opportunities from the ACA, hospital community benefit programs and hospital procurement needs.