Five Forgetful Hospitals

Five Forgetful Hospitals in West Los Angeles. Major players, big names. If we don't intervene, they will forget, as before, to include healthy transportation in their program of community benefits. The process, required by the IRS, is called CHNA: Community Health Needs Assessment: It serves to confirm the non-profit status of a hospital. Currently they are working on a plan for the period 2019 - 2021.

While many doctors and all public health experts do know a whole lot about the health benefits of active modes (walking, cycling), the five forgetful hospitals are on the path to overlook the disease burden in their communities that could be lifted if people had more opportunities, and more encouragement, to leave the car at home. Prevention. Population Health. Cheap and effective.

Whence that forgetfulness? Why is it so difficult to implement public health knowledge in our local community? The stereotype that everybody drives in LA is overwhelming. The roads so crowded, the parking lots so full, the cyclists so few. Pedestrians? - Send the police to arrest them. We have been so firmly socialized into vehicular living that a special mental effort is required to recognize automobility as a health condition. But reduce driving we must, for our own well-being, and for that of our planet.

Hospitals are only in the business of curing bodies broken by too little exercise, bodies shattered by vehicles which move too fast? Prevention is none of their business? Not according to the IRS. Prevention is right up the CHNA alley. Even better, the IRS allows expenses for lobbying (like lobbying a council member for more and safer bicycle infrastructure!) Also allowed are expenses for community building activities like environmental improvements, community health improvement advocacy, leadership development and training for community members, coalition building, etc. IRS (schedule H, part II)

If that sounds like an opportunity, here are the CHNAs that currently face updating: Cedars Sinai (pdf), UCLA Ronald Reagan (pdf), UCLA Medical Center, Santa Monica (pdf), Kaiser Permanente West Los Angeles Medical Center, (pdf) (See also KP Data), Providence Saint Johns (Santa Monica) (pdf)

The CHNA process takes into account input from persons who represent the broad interests of the community served by the hospital, including those with special knowledge of , or expertise in, public health, or expertise relevant to the health needs of the community. There is a great deal of demand for healthy transportation in the Westside. Active transportation is an emerging issue that will be overlooked if stakeholders do not share their local knowledge. We need much much much more than the famous Westside Walkers who meet (drive there, of course) in a shopping mall to walk (laughter). What about a concerted effort, with local partners, aiming to offer our neighborhoods a safe way to leave the car at home and walk or ride a bike? Our hospitals must find a way to support advocates who demand healthy transport options for our neighborhoods. Doctors will be able to prescribe safe cycling training, hospital facilities will lead the way by conducting a bicycle master-plan for their premises and associated medical practices. Hospitals are quick to demand that streets must be suitable for their ambulances, now we want to hear from them that streets also need to be suitable for those neighbors who should move about without a car. Now is the time to take apart the poisonous notion that everybody drives in LA.

The current CHNA process for five forgetful hospitals is conducted by Biel Consulting. So far no public meetings have been scheduled. Which is a not a good sign. Through public meetings the hospital can build essential partnerships with community stakeholders. Failing a public meeting, the next best way to have your voice heard is to make written comments on the previous CHNA. Pick your favorite hospital and send emails to CommunityBenefit@cshs.org, smunoz@mednet.ucla.edu, CHNA-communications@kp.org, Ronald.Sorensen@providence.org. These comments count as public input and offer a privileged way to participate in the process. Now. Or wait three years for the long overdue dialogue of transportation and health.

Community Health Needs Assessment (CHNA)

Every three years, hospitals need to submit a CHNA to the IRS to secure their status as a tax-exempt organisation. Community health benefits listed in the CHNA can take many forms. They should be based on statistical data, but also on community input to identify emerging issues. The CHNA for the Ronald Reagan UCLA Medical Center (2016) often reminds us of an in-house questionnaire which includes the question: "Is this work a community benefit?" Adding up all the "Yes" answers in a large organization, you invariably end up with a very long list. These activities are then arranged in priority areas, but even at that level it lacks the overarching coherence of a well designed community intervention. The result is one grand confusion of initiatives and programs. It is hard to make out the encompassing vision for the community.

In the following we outline a new area of community benefits which is currently missing. Healthy transportation initiatives will have a positive effect on many of the health needs listed. They impact the community as a whole. They comprehensively address separately listed health needs such as diabetes, heart disease, cancer, obesity, mental health, etc. The empirical evidence for the effectiveness of such interventions is not in doubt. We hope the hospital will consider these suggestions and include support for healthy transportation as an overarching community benefit in the next CHNA.

1) UCLA Health Bikeway Corridor: This innovative project provides a comprehensive plan for a bike route between the hospitals in Westwood and Santa Monica. It is currently managed by UCLA Transportation. The implementation itself is not funded. It represents a tangible community benefit by supporting safe infrastructure for healthy modes. It is part of the evolving issue of healthy transportation and sustainability which has received much attention recently. UCLA Health should associate its brand with this admirable project. I would also have a role in educating the community about the health benefits of active modes. As the pathway nears its implementation phase, UCLA Health should take full ownership of this project, provide funding and help present its advantages to stakeholders in the community. It should lobby local agencies for it. IRC 501(h) allows lobbying expenses. Bicycle infrastructure is a evidence-based community health intervention <link>.

2) Additional Interviews, Community Meetings, Partnerships: Prioritizing local needs is partly based on interviews with community stakeholders. The list of stakeholders is impressive but is biased by the leadership roles of those included. Do they live in the community? How are these selected? What kind of expertise do they have? Is the selection biased because it fails to include persons who commute by bicycle?
A well facilitated stakeholder meeting provides much better insight into community needs. A series of interviews lacks transparency and dialogue, whereas a series of meetings can lead to local partnerships which are the best way to implement community benefits. The next CHNA should include such meetings for stakeholders. The following stakeholder groups should be consulted in future CHNAs.

• The Healthy Campus Initiative at UCLA is a very valuable interlocutor, both for their expertise, but also for the community connections they have developed. It seems negligent to exclude these local experts from this process 
• The list does not include researchers from the Fielding School of Public Health who have worked on population health. It seems negligent to exclude these local experts from this process 
• Community groups advocating for healthy and sustainable transportation in the community (Calbike, Los Angeles County Bicycle Coalition, UCLA Bicycle Academy, Better Bike Beverly Hills, Santa Monica Spoke, losangeleswalks.org, etc)
• Neighborhood groups or councils (The new NWWNC, midcityneighbors.org, etc)
• Youth groups and educational stakeholders, especially the Saferoutespartnership.org which advocates for safe ways to get kids to school without a car
• The AARP has taken very progressive positions on transport policy and health for the elderly recently. They support Ciclavia events in Los Angeles and have a clear view of the transportation needs of those who can no longer drive a car (Stephanie Ramirez sramirez@aarp.org)
• DPP Diabetes Prevention is an important aspect of population health and its voice should not be missing here

3) Modeling Best Practice: UCLA Health should make community involvement a central part of its mission, not a triennial statistical exercise. This will require some input from the leadership. Spisso has repeatedly spoken about the importance of community health. She says that health is not only about repairing a broken organ, it is about healthy practices and healthy contexts. Establishing healthy practices in and around the hospital and the medical offices in the community can transform the UCLA Health into a local leader, but the leadership needs to think "outside the bed". The NHS in the UK has developed some guidelines as to how a health provider should do business in the community: Bicycle parking is better than valet car parking. Inviting stairs are better than elevators. Bike parking and transit information is absent from all UCLA Health webpages that contain way-finding info.

4) UCLA Health and its Communities. Recently the UCLA Vice Chancellor has conducted a discussion about a revised mission statement for the campus. During this process, UCLA Health has remained largely silent or MIA. Does the hospital have a vision for community involvement? Perhaps it could be of interest to the leadership that Part II of IRS Schedule H (Form 990) allows expenses for community building activities like environmental improvements, community health improvement advocacy, leadership development and training for community members, coalition building, etc

Healthy transportation programs are a perfect fit with the UCOP 2025 Carbon Neutrality Initiative. In order to see results in this area, leadership is needed, work needs to be done, relationships with community stakeholders need to be developed, advocacy needs to be prepared, and effects need to be evaluated. In short: UCLA Health needs to actively dismantle the stereotype that everybody drives in LA. The process of converting car parking into bicycle parking will position UCLA Health at the vanguard of population health and sustainability in California. Which is exactly where you want to be.