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Health Aff (Millwood). 2017 Jun 1;36(6):1102-1109. doi: 10.1377/hlthaff.2017.0033.

The Role Of Nonprofit Hospitals In Identifying And Addressing Health Inequities In Cities.

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Amy Carroll-Scott is an assistant professor in the Department of Community Health and Prevention, School of Public Health, at Drexel University, in Philadelphia, Pennsylvania.
Rosie Mae Henson is a project manager in the Urban Health Collaborative, School of Public Health, Drexel University.
Jennifer Kolker is an associate professor in the Department of Health Management and Policy, School of Public Health, Drexel University.
Jonathan Purtle ( is an assistant professor in the Department of Health Management and Policy, School of Public Health, Drexel University.


For nonprofit hospitals to maintain their tax-exempt status, the Affordable Care Act requires them to conduct a community health needs assessment, in which they evaluate the health needs of the community they serve, and to create an implementation strategy, in which they propose ways to address these needs. We explored the extent to which nonprofit urban hospitals identified equity among the health needs of their communities and proposed health equity strategies to address this need. We conducted a content analysis of publicly available community health needs assessments and implementation strategies from 179 hospitals in twenty-eight US cities in the period August-December 2016. All of the needs assessments included at least one implicit health equity term (such as disparities, disadvantage, poor, or minorities), while 65 percent included at least one explicit health equity term (equity, health equity, inequity, or health inequity). Thirty-five percent of implementation strategies included one or more explicit health equity terms, but only 9 percent included an explicit activity to promote health equity. While needs assessment reporting requirements have the potential to encourage urban nonprofit hospitals to address health inequities in their communities, hospitals need incentives and additional capacity to invest in strategies that address the underlying structural social and economic conditions that cause health inequities.


Affordable Care Act; Community Benefit; Community Health Needs Assessment; Health Equity

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