In pursuit of its longstanding vision of a "society of healthy communities where all individuals reach their highest potential for health,” the American Hospital Association supports hospitals, health systems and related organizations in engaging in strategic initiatives that together create a path toward advancing health in America.

While many roads can lead to a healthier America, it has become clear through the work of the AHA and other organizations committed to this goal that better health depends on building a culture that enables everyone to attain and sustain a healthy life.

Broad underpinnings

The Robert Wood Johnson Foundation defines a "culture of health" as “one in which good health and well-being flourish across geographic, demographic and social sectors; fostering healthy equitable communities guides public and private decision-making; and everyone has the opportunity to make choices that lead to healthy lifestyles.”

In an article in the November 2015 issue of Trustee's sister publication Hospitals & Health Networks, AHA board member and past chair Jonathan B. Perlin, M.D., reflects on the critical importance of partnership in achieving better health:

“Improving health, care and value are the tenets of the Triple Aim. ... This kind of transformation requires community partnership that, in turn, demands collaboration, communication and culture change. ... This important goal is impossible without working together with patients, families and many different community organizations.”

In addition to cultivating a culture of health and multisector partnerships, improving the health of our nation’s communities also requires broadening our definition of health. Multiple studies have concluded that about 80 percent of the causes of poor health are a function of multiple factors — whether they are socioeconomic, environmental, genetic or lifestyle choices.

We now understand that poverty, lack of education, violence and crime, and limited access to clean air, water and nutritious food are some of the societal factors that determine health status and outcomes. Serious efforts to create healthier communities must focus on addressing the social determinants of health to ensure that a foundation for supporting better health and well-being for Americans can be reliably sustained.

Instructive study

Building healthier communities through multisector partnerships that address factors that significantly affect health is the focus of a new AHA resource, The Leadership Role of Nonprofit Health Systems in Improving Community Health. This report discusses issues and trends increasing the momentum toward improving community health and the opportunity our nation’s health systems have to play a leadership role in reaching this goal.

This new AHA publication discusses how initiatives that address both improving care for patients and positively influencing the social determinants of health are becoming the focus of collaborative efforts to make communities healthier places to live — efforts in which health systems and their boards are taking a leadership role.

While many systems have devoted significant funding to address these factors, the role of hospitals and health systems often varies and includes sponsoring targeted initiatives, providing sustained backbone support for community collaboration, being an “anchor organization,” and being a partner in larger efforts to improve community health spearheaded by other organizations, such as universities, employers and the business community.

The report's findings are based on interviews with board members, CEOs, chief financial officers, physicians and other leaders guiding strategic planning, population health and community outreach in five health systems that have embraced community health improvement as a core element of their organization’s vision and mission: Beacon Health System/Memorial Hospital of South Bend (Ind.).; Dignity Health in San Francisco; MaineHealth in Portland; Mercy Health in Cincinnati; and Texas Health Resources in Arlington.

Some guidance

The leaders of the participating systems shared their perspectives and documented:

  • Evidence of board and executive commitment to community health improvement.
  • Existence of system- and local-level priorities and targets for community health improvement, and metrics for measuring progress in relation to them.
  • Board oversight of the system’s community health improvement strategies, programs and progress, including examples of the written reports or “scorecards” they receive.
  • Evidence of board and executive commitment to multisector collaboration with other community stakeholders directed at measuring, assessing and improving community health.
  • Metrics employed to date in measuring and assessing the health status of communities and population groups the system serves, and evidence of the effect on health status of system strategies and programs.
  • Features of the system’s overall approach to measuring, assessing and improving community health that the system’s board, clinical and executive leaders believe are proving to be especially effective and potentially applicable and useful in other settings.

Examples of how each system describes its community health improvement initiatives and their impact are included in the report, which also provides links to additional online resources. Finally, the publication offers recommendations for health system boards and leaders to consider as they evaluate their own commitment to and involvement in community health improvement.

The report concludes that making durable progress in improving the health of our nation’s communities is complex, challenging work. It also, however, shares the good news that progress is not only possible but is in fact occurring — not only through the commitment of the boards and leadership of the systems and their partners profiled in the report but of all hospitals and health systems that are translating their vision for a healthier America into reality.

The Leadership Role of Nonprofit Health Systems in Improving Community Health builds on other AHA resources focused on the role of governance in community health improvement such as the 2016 Blue Ribbon Panel Report: Learnings on Governance From Partnerships That Improve Community Health, also available from the Center for Healthcare Governance.

Mary Totten ( is a senior consultant for the American Hospital Association. Lawrence Prybil, Ph.D. (, is professor emeritus at the University of Iowa and retired in 2016 as Norton Professor in Healthcare Leadership at the University of Kentucky.