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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 accessAbstract
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)](/paper-figures/1a044f7cac084afdb5d1893ee48c9fec/evidence-that-collaborative-action-between-local-health-departments-and-figure-1.jpg)
![Fig. 2 A Map of Included Communities and their Social Capital Index Values [35]. Permission was received to use and adapt the copyrighted image](/paper-figures/5391cc115a8c4a23af133552b536e4a9/evidence-that-collaborative-action-between-local-health-departments-and-figure-2.jpg)
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“The health information of a patient may be distributed among an unspecified number of healthcare facilities. A hospital's medical information are not interchangeable and accessible to another health institution.”
From Interoperability of heterogeneous health information systems: a systematic literature review (2023) · cites this paper as [7]
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“In a given situation, the health professional does not have access to the whole of the patient's medical information unless the patient is conscious and can provide the information that the health professional requires to make an informed and individualized decision on the best course of action at the time [7].”
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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
- Venue
- BMC Health Services Research
- Published
- 2021-01-02
- Volume
- 21
- Issue
- 1
- Pages
- 1-1
- ISSN
- 1472-6963 (ISSN-L)
- 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
- gold
- doi.org
- 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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