Engaging Allies in the Culture of Health Movement


Stakeholder Meeting #4


Key Takeaways


On March 12, 2019, The National Academy of Medicine (NAM), in partnership with the Robert Wood Johnson Foundation (RWJF), convened the fourth stakeholder meeting of the Culture of Health Program, titled Engaging Allies in a Culture of Health Movement. The meeting focused on the role of anchor institutions in promoting health equity in their communities. The objectives of the meeting were to:

  • Discuss why anchor institution strategies are a key component to advancing health equity and a culture of health in neighboring underserved communities
  • Explore how to shape and use an anchor institution mission for universities, hospitals, and health systems to advance health equity and a culture of health in communities highlighting promising models
  • Explore how to shape and use an anchor institution mission for businesses, non-profit foundations, and municipalities to advance health equity and a culture of health in communities highlighting promising models
  • Share information and lessons learned to determine a way forward in taking purposeful action through an anchor institution approach to address health inequities and advance a culture of health in communities

Below are key takeaways from the meeting.

What is an Anchor Institution? 


Anchor institutions are large place-based institutions that are spatially immobile and have “sticky capital”—an economic self-interest in helping to ensure that the communities in which they are based are safe, vibrant, and healthy. Hospitals, universities, faith-based entities, and other locally-based organizations are examples of anchor institutions. Collectively, anchor institutions have tremendous economic impact on a national scale. Two types of anchor institutions—hospitals and universities—employ 8 percent of the U.S. labor force and account for more than 7 percent of the U.S. gross domestic product. Learn more about anchor institutions and their role in promoting health equity.

Why Anchor Institutions and Health Equity

  • Anchor institutions are not only affected by their locale, but they also play a unique role in helping the communities where they reside due to their vast array of resources and the human and intellectual capital they possess.
  • Anchor institutions are important to community wealth building. Community wealth building builds on existing assets within communities that directly benefit local residents and creates a sustainable system that is inclusive and ultimately establishes a new normal of economic activity. Learn more about community wealth building.
  • Institutions that develop an anchor mission—a commitment to consciously apply the long-term, place-based economic power of an institution in combination with its human and intellectual resources—can have an impact on the long-term welfare of the communities in which they are anchored.
  • Strategies for anchor institutions to leverage existing assets to support community well-being include:

Inclusive local hiring: This goes beyond just hiring members of the community. It includes establishing hiring pipelines and practices that prepare community members for high quality, high demand jobs, and purposefully creates opportunities for employment and career advancement.
Inclusive local sourcing: This means deliberately finding ways to direct institutional spending and purchasing to local businesses, and to connect local vendors to contracting opportunities within the institution. This increases the ability of local businesses or contractors to meet supply chain needs while simultaneously supporting the community.
Place based investing: This designates a percentage of investible assets to investments that will improve the lives of everyone within an economic region. It may bring together private capital, public resources, and philanthropic assets to build a better and stronger long-term economic region.

  • Health and health equity in a community can be viewed through the lens of its anchor institutions, which are often valuable in helping to better understand local inequities and have the potential to rebalance power dynamics in communities by bringing community members to the table and placing them in leadership positions.

Source: Drivers of Community Wealth Building. Kelly and McKinley, 2015 (presented by David Zuckerman, The Democracy Collaborative)

Source: Rush Anchor Mission Playbook. David Zuckerman, The Democracy Collaborative

Promising Models from the FieldUniversities, Hospitals, and Health Systems


  • Anchor institutions face both internal and external challenges in promoting health equity and decreasing inequities. Some challenges include: (1) a perceived risk that comes with shared decision-making power between anchor institutions and the communities in which they reside and (2) misalignment between the goals of the institution and the goals of the community.
  • Community members are essential to the success of anchor institutions, and these institutions must purposefully invest time and energy to directly include communities in their missions, the development of programs, and the allocation of resources that will affect community prosperity.
  • Programming, partnerships, and investments must also be culturally tailored to the communities that they serve. Anchor institutions are more effective when their institutional identities reflect the ideals, culture, and needs of the communities in which they reside.

Highlighted Models

Green Family Foundation NeighborhoodHELP (Andres Gil, Florida International University)
Dr. Gil highlighted the NeighborhoodHELP program, an education and community service program in which health care students provide household-centered care to local community residents. This program helps community residents overcome access barriers and connect to the health system. Learn more >>

Healthy Homes Collaborations Initiative (Jennifer Britton, Drexel University)
Drexel University has begun incorporating the needs and interests of campus neighbors into their academic mission, business operations, and volunteer power, fundamentally transforming how the university operates and educates. They do this through three dimensions of civic engagement: (1) Student and employee volunteerism within the community, (2) Academic integration, and (3) Institutionally supported neighborhood investment. Drexel supports several initiatives that aim to improve economic opportunity in its surrounding neighborhoods. These initiatives include:

Through these efforts, the university has substantially changed its relationship with its neighbors, establishing more trust and collaboration.

Bon Secours Health System and the Healthy Community Initiative [Edward Gerardo, Bon Secours Health System (formerly)] Since the 1990s, the Bon Secours Health System has operated under an anchor institution approach to community and economic development. Their work focuses on revitalizing neighborhoods by rehabilitating housing, providing family services, and offering youth employment and workforce development. These practices have been institutionalized through Bon Secours’ Healthy Community Initiative and requires all hospitals within the health system to develop community-specific initiatives that address the social determinants of health. Several key elements to their success that other health systems can consider when adopting similar approaches are:

  • Define health and well-being holistically
  • Focus on systemic improvement within a defined geographic area
  • Build diverse citizen participation and community ownership
  • Commit to share resources, responsibilities, risk, and rewards
  • Create a shared vision with the community
  • Build capacity by leveraging community assets and strengths
  • Make multi-level interventions including environment and public policy
  • Take informed risks and persevere
  • Benchmark and measure progress and outcomes

Learn more about Bon Secours’ work.

Kaiser Permanente’s Anchor Approach (John Vu, Kaiser Permanente)
Mr. Vu began by noting Kaiser Permanente’s overall responsibility to the health of the community, not just the health of individual Kaiser Permanente members. Over the last 15 years, Kaiser has worked to strategically impact the health of the communities it serves by focusing on chronic disease prevention and identifying gaps in health and well-being through the use of life expectancy maps. While work is still underway, Vu noted several recent accomplishments in Kaiser’s plan to act more purposefully as an anchor institution in community development. These accomplishments include:

  • Actively shifting their purchasing power to support minority and women-owned businesses.
  • Setting a goal to shift purchasing power to spend $2 billion in minority and women-owned purchases.
  • Setting aside $200 million in impact investing. Impact investing has been largely focused on affordable housing. Kaiser made their first housing investment in December 2018 and have nine additional investments lined up for 2019.

Source: Drexel’s Three Dimensions of Civic Engagement: A Place-Based Strategy. Jennifer Britton, Drexel University

Promising Models from the FieldBusinesses, Non-Profits, and Municipalities


  • Oftentimes, the best way to motivate anchor institutions to invest in their community is to provide them with actionable data. Using data, they can better align health promotion with their institutional objectives and ultimately ingrain a culture of health in every part of their organization.
  • Many companies are beginning to invest in the health and well-being of their employees through health promotion programs. Although the research pertaining to the return-on-investment of health promotion programs is limited, empirical evidence suggests favorable financial return from increased worker well-being. Buy-in from leadership is essential for the implementation of these programs and policies.
  • One of the most overlooked nuances of community engagement is the language that is used when businesses engage with or talk about their communities. Anchor institutions must actively avoid language that can be perceived as patronizing or condescending to the community. To build trust, businesses must consistently test their messages with local community members and actively engage community members on a regular basis for input and feedback on programs, policies, and investments.

Highlighted Models

Health Competitiveness Initiative (Ralph Schulz, Nashville Area Chamber of Commerce)
In developing and implementing their workplace health promotion program, the Nashville Area Chamber of Commerce noted key findings that are crucial to the success of the program:

  • Successful workplace health promotion starts with an intrinsic organizational commitment.
  • Consistent and engaging communication regarding health promotion is essential for success. Additionally, a holistic organizational understanding and commitment to health as a core focus ensures that leadership and employees understand their role in promoting health equity.
  • Business involvement in employee health has a powerful role in broad policy discussions.

Building Better Outcomes for the Atlanta Region [Kathryn Lawler, Atlanta Regional Collaborative for Health Improvement (ARCHI)]

  • Founded in 2011, ARCHI is a strategic partnership of more than 70 individuals and organizations in Atlanta who are committed to upstream, cross-sector work to create and sustain a healthy population and drive a vibrant economy.
  • Using the ReThink Health Systems Dynamics model, ARCHI formulated a 28-year plan to comprehensively drive health equity in the Atlanta region. This plan goes beyond health care to include and capture many of the social determinants of health, including transportation and housing. ARCHI has four overarching priority areas and three financing mechanisms. Their priority areas include fostering healthier behaviors, creating pathways for advantage for families and students, improving care coordination, and improving access to insurance coverage. Their financing mechanisms include an innovation portfolio, a contingent global payment, and capturing and reinvesting cost savings from health care payers.
  • ARCHI uses four critical strategies to accomplish their work.
  • Since launching, ARCHI has increased worker productivity by 7%, increased access to preventive and chronic care by 16%, and has lowered health care costs by 13%.

Source: ARCHI Strategy. Kathryn Lawler, Atlanta Regional Collaborative for Health Improvement

Open Discussion and Closing Remarks


  • Data use and data sharing are necessary for anchor institutions to develop effective policies and strategies that support health and health equity in their communities. While there are successful examples of anchor institutions supporting health equity, additional benefits can be gained from the development of a data repository that contains information about anchor institution successes, failures, and case studies that help guide other institutions.
  • Not all anchor institutions look the same in every community. It is essential that anchor institutions in all communities—rural, urban, and suburban—feel as though their voices are included in the ever-evolving conversation about the impact of their work on the communities they serve.
  • Participants concluded that it is helpful not to think of “the community” as a separate entity, but rather “our community”—something that your institution is a part of. This mindset can help anchor institution leadership understand and fully appreciate the legacy of their community and their role in supporting its future well-being. This, in turn, can help build trust and lay the groundwork for effective community engagement.

Follow our Culture of Health Program by visiting our Culture of Health homepage and subscribing to our mailing list.

Join Our Community

Sign up for NAM email updates