Sunday, November 18, 2018

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.

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