February 18, 2016

Research on the social determinants of health has demonstrated the impact of social and environmental conditions, including neighborhoods, on health. In recent years, there has been an increased interest in place-based interventions which address contextual factors that contribute to health inequities.

During the Population Health Spotlight presentation this month, Hortensia Amaro, PhD, described how “anchor institutions” can be a helpful upstream approach to addressing the social determinants of health in a given geographic location. Hospitals and universities are large, economic power-houses with not only purchasing and procurement powers, but the power to provide many jobs in the community. She described how anchor institutions are tied to the place; the location is part of their identity.

“Anchor institutions have incredible resources, they have incredible economic power,” said Dr. Amaro, Dean's professor of Social Work and Preventive Medicine and associate vice provost of Community Research Initiatives at the University of Southern California. She noted that universities and hospitals employ 8 percent of the U.S. labor force combined and represent more than 7 percent of the GDP. “Usually the way these institutions carry out their good neighbor mission is to develop programs, usually run out of a civic engagement arm within the university. Those are fine, but we’re talking about…the way the way the university does business to benefit the local community.”

Anchor institutions can commit to go beyond just being a “good neighbor” and instead improve the community by doing business with the locality. It takes civic engagement a step further and changes the way in which anchor institutions do business to include and benefit the communities they are in.

An Anchor Institution Task Force and Movement, started in 2009, created dashboard metrics in order to evaluate the effects of these place-based interventions. Numerous institutions are part of this task force and committed to the anchor mission, including Drexel University. Drexel is also one of six institutions to pilot the Anchor Dashboard framework via the Democracy Collaborative.

The translation of evidence on social determinants of health into an effective practice requires understanding of how heavily health is influenced by place and “expertise in the design of community level interventions and engaging communities,” Amaro wrote in a recent op-ed piece for the American Journal of Public Health. 

Dr. Amaro described a place-based intervention happening in Cleveland, Ohio. The University Hospitals in Cleveland are procuring laundry services, catering, and other services from the local community. If goods or a needed service aren’t available, the institution is working with the community to build capacity and establish local sources.

When it comes down to it, Amaro said, “it is not just about giving people employment, but giving neighborhoods wealth.” Although there is need for improved intervention evaluation, models like the Cleveland hospitals are making it easier to show institutions the benefits of assuming the role of an anchor institutions.