Many times the social and economic determinants of health are proxies for health inequalities within a community. Factors such as income, education, physical environment (where you live), social isolation, and the concentration of poverty often have more to do with the health of an individual or a community than availability or access to medical care. Because many people struggle with these larger structural issues on a daily basis, individual well-being or personal health can become impossible to achieve without addressing these broader issues. While it may seem that these factors only burden individuals, in truth hospitals and health systems bear some of these costs as well, through increased asthma visits to the emergency room, for instance, when their housing is in need of environmental interventions. It is in the best interests of both consumers and providers that providers address not only a patient’s specific health ailment, but also the root causes that lie in these social and economic determinants of health.  

 To help improve community health the Affordable Care Act (ACA) now requires that non-profit hospitals assess and attempt to address the unmet needs of the communities they serve through a Community Health Needs Assessment (CHNA) every three years. Under proposed IRS rules, non-profit hospitals must consult public health experts including local health departments, as well as “leaders, representatives, or members of medically underserved, low-income, and minority populations, and populations with chronic disease needs” for assessment guidance. Other providers, consumer advocates and non-profits, academics, and businesses should be engaged in the process.

 Hospitals must then use the CHNA to develop and adopt implementation strategies in a formal and transparent Implementation Plan that addresses the identified unmet community health needs. These strategies can include coalitions that reduce youth violence or substance use disorders, safe communal spaces like parks, safe and affordable neighborhood housing, food banks or farmers markets, training for community health workers, or even workforce development programs that insure a culturally competent workforce.

 By using the CHNA to conduct culturally competent discussions on community health concerns, hospitals can get both useful information about the community’s needs and simultaneously increase awareness and access to prevention and treatment options that address population health. When conducting the CHNA process, hospitals should be mindful of the fact that consumers unfamiliar with hospital settings and etiquette are often intimidated by long, technical surveys, or by surveys with forced choices that may not be in their native language. Consequently, to encourage participation in the CHNA process, hospitals should be careful to be inclusive in constructing their data collection methods. Surveys  should be available in the various languages spoken in the community along with translators who can provide assistance in clarifying concepts. Focus groups, stakeholder interviews, or community meetings should partner with organizations trusted by community participants. Culturally competent measures such as these are central to enhancing the ability of individuals to speak freely about personal or community health issues.

 CHNA-related conversations are an opportunity for hospitals to highlight the fact that health is not limited to surgeries or prescriptions. Health improvement interventions can address factors such education, employment or poverty in a culturally sensitive and competent manner. By shedding light on how social and economic factors impact an individual’s health, the CHNA can be a powerful tool to benefit both hospitals and community members, and to address health inequities. 


Jessica Liao, Health Equity Intern