Mind The Gap: Leadership in Action - The Role of Healthcare Institutions in Building Community Wealth and Addressing the Economic Determinants of Health

Contributors: David Zuckerman and Bich Ha Pham
To learn more about David and Bich, click here.


image010.pngSmart, Bold Leadership to Build up Communities and Improve Health
The Board and leadership at Rush University Medical Center decided in 2016 to take bold action to address the health crises faced by the neighborhoods around the health system’s main campus on the West Side of Chicago. Though the average resident of the Loop, the downtown business district, will live to 85, a resident in neighboring West Garfield Park, a high-poverty area, has a life expectancy of only 69 years. Other measures of community well-being revealed similar disparity, from education attainment to housing to crime. Children and families living in these neighborhoods faced poor public education, environmental damage, high unemployment, lack of jobs, particularly jobs with family-sustaining wages, and disproportionate levels of crime and violence — the negative social determinants of health.

Rush is not unique — many of our world-class medical institutions find themselves confronted with similar economic disparities in the communities they serve. In the wealthiest nation in the history of the world, the difference in lifespan after age 50 between the richest and the poorest has more than doubled — to 13 and 14 years for women and men respectively — since the 1970s.1  Communities in zip codes a few miles apart experience life expectancy differences of more than 20 years.2 

But, along with a growing number of forward-thinking healthcare anchor institutions, Rush University Medical Center has recast its mission from “be the best in patient care” to “improve health” in order to tackle these challenges head on. This has meant taking up an “Anchor Mission” to realign all institutional resources to fight these inequities at their root by building community wealth. It also has required going beyond traditional notions of corporate social responsibility to rethink the very foundation of the institution’s role, and how it can very intentionally align, leverage, and deploy its economic and social assets in the community to address the upstream economic and environmental conditions that have the greatest impact on the health of local residents.

Rush has deployed more than $1 million for impact investing to provide capital for a new construction loan to Enlace Chicago, a community organization which provides education, health, immigration, and violence prevention services; refinancing assistance for a community economic development project for Greater West Town communities; and a pre-development loan for Accion Chicago and/or refinancing for the Puerto Rican Cultural Center. Rush is providing an additional $1.08 million of financing assistance to support the Chicago Neighborhood Rebuild Pilot Program and the People’s Community Development Association of Chicago (Harvest Homes).

As the systemic nature of economic inequities and their impact on health and well-being, together with the limits of clinical interventions, have become more widely acknowledged in the United States, so has the urgent need for a new approach to address the growing disparities in health outcomes. For institutions like Rush, the persistent health, social, and economic inequities are not just a moral crisis — it is a question of how the institution can deliver on its mission. Tackling the social determinants of health across all of its operations is not just the right thing to do; it’s a shrewd business tool to get ahead of the cost curve of providing effective care, by creating and sustaining healthier communities. Rush has elevated this “Anchor Mission” approach as a strategic priority and brought other local anchors into this work, including 9 other healthcare institutions to collaborate on hiring processes and coordinate their purchasing and investing decisions.3  

David Ansell, Senior Vice President for Community Health Equity at Rush, emphasizes “The ultimate goal of the ‘Anchor Mission’ approach is to increase life expectancy, improve well-being, and reduce hardship. These are very complex health outcomes that can’t be fixed with just healthcare interventions. It requires a ‘total healing’ approach.”  

Health Systems Have the Economic Power to Build Community Wealth
The Democracy Collaborative has focused on a new community wealth building approach to economic development, which is designed to narrow these unconscionable disparities to improve health. In this approach, localities inventory the assets they already have and develop place-based methods to leverage these assets collaboratively, equitably, and with an eye toward a systems approach that broadens community ownership and agency.

Health systems and universities together have expenditures of more than $1 trillion annually, have at least $750 billion in investment assets, and employ more than 9 million people.4  They are some of the largest employers and purchasers – and potential investors – in many low-income communities where they are based and where their patients live. If these institutions could leverage and more intentionally align their everyday hiring, purchasing, and investing practices with others to address the root causes of poor health, the impact on systemic inequities could be enormous.

Key to the success of this approach is engaging and leveraging the significant everyday business activities of “anchor institutions.” Non-profit or public institutions such as hospitals and universities have become the leading economic engines in many of America’s communities, and their mission, customer base, and place-based investments inextricably link them to the long-term vitality of the place in which they reside — they both anchor the local economy and are anchored in the communities they serve.5  

Health Systems Leading the Way
In the last few years, an increasing number of leading health systems have embraced an “Anchor Mission,” recognizing the economic and racial inequities that drive poor health in their communities require concrete and extensive interventions deploying every tool at their disposal. 

More than three dozen major systems, which collectively represent 600 hospitals with over 1 million employees in more than 400 cities and towns, have joined the Healthcare Anchor Network, a growing health system-led collaboration focused on improving health and well-being by building more inclusive and sustainable local economies, working in partnership with their communities. The Network includes Rush University Medical Center and other major healthcare institutions, such as Kaiser Permanente, RWJBarnabas Health in New Jersey, and ProMedica in Toledo, Ohio,6 that are using their hiring, purchasing, and investment power to increase wealth in these communities through training and hiring residents for good jobs, purchasing from local small businesses, and investing in projects that build community wealth.7  

The challenges before us are systemic in nature. Our solutions must be equally bold if we are to meaningfully address the racial and economic disparities that limit us from achieving the outcomes in health and well-being that should be within reach for a nation as wealthy as ours. Anything less is an abdication of our individual and institutional moral responsibility, not to mention collectively economically short-sighted. We must change the conversation, develop new relationships and establish new priorities. In a short period of time, Rush University Medical Center leveraged millions of badly needed funds to bring wealth into Chicago’s disadvantaged communities. It will require many more bold leaders from health systems across the country to see the moral imperative to adopt the “Anchor Mission” and focus all of their institutions’ resources to create healthy and wealthy communities in all our neighborhoods. 

To learn more about the Health Anchor Network, contact David Zuckerman at
[email protected] or (202.559.1473 x105)

Toolkits for health institutions on: 1) diverse and locally owned purchasing to leverage supply chains, understanding that a thriving local economy is fundamental to a healthy community; 2) local and inclusive hiring to invest in an ecosystem of success that lifts up local residents; helps create career pathways for low-income, minority, and hard-to-employ populations; and begins to transform neighborhoods; and 3) place-based investing to allow institutions to more effectively improve community health and well-being, even as they continue to earn a healthy rate of return, to help address the resource gaps that keep communities from achieving better health and well-being.




  1. Tavernise S. “Disparity in Life Spans of the Rich and the Poor Is Growing,” New York Times, February 12, 2016, accessed May, 2016, www.nytimes.com/2016/02/13/health/disparity-in-life-spans-of-the-rich-and-the-poor-is-growing.html.
  2. Maciag M. “Live Expectancy Varies Greatly Within Cities,” Governing, February 3, 2016, http://www.governing.com/topics/health-human-services/gov-life-expectancy-neighborhood.html, accessed November 2017.
  3. Rush University Medical Center, Anchor Mission Playbook, Washington, DC: The Democracy Collaborative, August 2017, https://www.rush.edu/sites/default/files/anchor-mission-playbook.pdf, accessed July 2018.
  4. Howard T and Norris T.  Can Hospitals Heal America’s Communities?: “All in for Mission” Is the Emerging Model for Impact, Takoma Park, MD: The Democracy Collaborative, December 2015, https://democracycollaborative.org/content/can-hospitals-heal-americas-communities-0, accessed July 2018.
  5. Zuckerman D and Parker K. Hospitals Aligned for Healthy Communities, Washington, DC: The Democracy Collaborative, 2017, hospitaltoolkits.org, accessed July 2018.
  6. Howard T and Norris T. Can Hospitals Heal America’s Communities?: “All in for Mission” is the Emerging Model for Impact, Takoma Park, MD: The Democracy Collaborative, December 2015, https://democracycollaborative.org/content/can-hospitals-heal-americas-communities-0, accessed July 2018.
  7. Healthcare Anchor Network, 2017, http://www.Healthcareanchor.network, accessed July 2018.