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Evidence that collaborative action between local health departments and nonprofit hospitals helps foster healthy behaviors in communities: a multilevel study

Open access
Cramer, Geri Rosen, Young, Gary J., Singh, Simone, McGuire, Jean, Kim, Daniel·2021·BMC Health Services Research
DOI 10.1186/s12913-020-05996-8PMC PMC7777410
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Abstract

Background: The Patient Protection and Affordable Care Act of 2010 (ACA) encouraged nonprofit hospitals to collaborate with local public health experts in the conduct of community health needs assessments (CHNAs) for the larger goal of improving community health. Yet, little is known about whether collaborations between local health departments and hospitals may be beneficial to community health. In this study, we investigated whether individuals residing in communities with stronger collaboration between nonprofit hospitals and local public health departments (LHDs) reported healthier behaviors. We further explored whether social capital acts as a moderating factor of these relationships. Methods: We used multilevel cross-sectional models, controlling for both individual and community-level factors to explore LHD-hospital collaboration (measured in the National Association of County and City Health Officials (NACCHO) Forces of Change Survey), in relation to individual-level health behaviors in 56,826 adults living in 32 metropolitan and micropolitan statistical areas, captured through the 2015 Behavioral Risk Factor Surveillance System (BRFSS) SMART dataset. Nine health behaviors were examined including vigorous exercise, eating fruits and vegetables, smoking and binge drinking. Social capital, measured using an index developed by the Northeast Regional Center for Rural Development, was also explored as an effect modifier of these relationships. Results: Stronger collaboration between nonprofit hospitals and LHDs was associated with not smoking (odds ratio, OR 1.32, 95% CI 1.11 to 1.58), eating vegetables daily (OR 1.29; 95% CI 1.06 to 1.57), and vigorous exercise (OR 1.17; 95% CI 1.05 to 1.30). The presence of higher social capital also strengthened the relationships between LHD-hospital collaborations and wearing a seatbelt (p for interaction = 0.01) and general exercise (p for interaction = 0.03). Conclusions: Stronger collaboration between nonprofit hospitals and LHDs was positively associated with healthier individual-level behaviors. Social capital may also play a moderating role in improving individual and population health.

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Fig. 1 A Modified BARHII Public Health Framework for Reducing Health Inequities [13] (adapted)
Fig. 1 A Modified BARHII Public Health Framework for Reducing Health Inequities [13] (adapted)CC BY · PubMed Central
Fig. 2 A Map of Included Communities and their Social Capital Index Values [35]. Permission was received to use and adapt the copyrighted image
Fig. 2 A Map of Included Communities and their Social Capital Index Values [35]. Permission was received to use and adapt the copyrighted imageCC BY · PubMed Central

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Research works printed but not linked: 10

  1. University of Wisconsin Population Health Institute. County Health Rankings Key Findings 2018. 2018. Available at: https://www.countyhealthrankings.org/resources/2018-county-health-rankings-key-findings-report. Accessed on May 18, 2020.
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  7. National Association of County and City Health Officials (NACCHO). About. 2019; https://www.naccho.org/about. Accessed June 10, 2019.
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Metadata

Authors
Cramer, G. R., Young, G. J., Singh, S., McGuire, J., & Kim, D.
Affiliations
  • Northeastern University (US)
  • University of Michigan (US)
Corresponding author
Kim, Daniel
ORCID
Venue
BMC Health Services Research
Publisher
Springer Science and Business Media LLC
Published
2021-01-02
Volume
21
Issue
1
Pages
1-1
ISSN
1472-6963 (ISSN-L)
DOI
10.1186/s12913-020-05996-8
PMC
PMC7777410
OpenAlex
W3119111511
Cited by
179
References
21
Citations by year
2026: 5 · 2025: 52 · 2024: 38 · 2023: 28 · 2022: 44 · 2021: 12
FWCI
34.54
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Health Services Research (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Deep Blue (University of Michigan) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • University of Michigan Library
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Community Health and Development
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Public Health Policies and Education
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Keywords
local health departments, nonprofit hospitals, community health needs assessment, social capital, health behavior, smoking, fruit and vegetable intake, physical activity, seat belt use, binge drinking, Affordable Care Act, community health
MeSH terms
Adult, Cross-Sectional Studies, Hospitals, Humans, Organizations, Nonprofit, Public Health, United States, Health Behavior, Patient Protection and Affordable Care Act

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