Communities in Action

Pathways to Health Equity

Anchor Institutions

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When it comes to important health metrics, your zip code may matter more than your genetic code.

Map of life expectancy disparities in Kansas City, Missouri.
Map of life expectancy disparities in Kansas City, Missouri.
SOURCE: RWJF. Used with permission from the Robert Wood Johnson Foundation.

Map of life expectancy disparities in New Orleans, Louisiana.
Map of life expectancy disparities in New Orleans, Louisiana.
SOURCE: RWJF. Used with permission from the Robert Wood Johnson Foundation.

For example:

  • life expectancy in the U.S. can vary by 15 years, depending on income level, education, and where a person lives.
  • while the mortality rate for non-Hispanic white babies is 5 in every 1,000, that rate jumps to 11 in every 1,000 for African Americans.
  • rates of serious conditions like obesity, heart disease, cancer, and stroke are substantially higher in the poorest parts of the country.

Disparities like these stem from systems and structures that make it a lot harder for poor people to live heathy lives. Health inequities are a problem for us all, adversely affecting our nation’s children, our business efficiency and competitiveness, our economic strength and national security, and our standing in the world.

Communities are able to take action on the factors that shape health, but they can’t do it alone. Community-based solutions rely on multi-sectoral collaborations ensuring varied approaches to improving community health equity and well-being. A report from the National Academies of Sciences, Engineering, and Medicine offers promising approaches for promotion of health equity.

For the past 30 years, discussion has evolved on the role of anchor institutions in the economic, cultural, and social fabric of communities. Anchor institutions are large, usually nonprofit organizations tethered to their communities, like universities, medical centers, or local government entities. They have significant economic and social impact on their communities, and they also have an economic self-interest in making sure these communities are healthy and safe. What is the role of anchor institutions?

About Anchor Institutions

Collectively, anchor institutions have tremendous economic impact on a national scale. Two types of anchor institutions—hospitals and universities—employ 8 percent of the U.S. labor force and account for more than 7 percent of U.S. gross domestic product.

Locally, the economic, intellectual, and human capital places an anchor institution in a unique position to improve and enrich the surrounding community in partnership with other key place-based stakeholders from sectors such as government, business, and faith, as well as community-based organizations and local residents. Moreover, community viability is a main driver of anchors’ long term success in workforce development, recruitment, and quality of service.

How Can Anchor Institutions #PromoteHealthEquity?

Anchor institutions can play an important role in uplifting community conditions through a series of multilevel strategies and economic investment, including creation of workforce training and living-wage jobs with good benefits, creating and improving affordable housing, increasing local safety and access to parks, and many others.


Anchor institutions can and should make expanding opportunities to promote health equity in their community a strategic priority. This could be done by using specific strategies to address the multiple determinants of health, through multi-sector collaboration, and by assessing the effects of anchor institutions in their communities and determining how negative impacts may be mitigated. One tool for monitoring impact is the Democracy Collaborative’s anchor institution community benefit dashboard. Click here to see the dashboard.


Anchor institutions can embrace community wealth building, an alternative approach to economic development. While traditional economic development assumes that development will “trickle down” benefits to residents, community wealth building employs and builds on existing assets within the local community to build sustainable ecosystems that promote equity and provide direct benefit to local residents. The figure below outlines the drivers of community wealth building and highlights the differences between community wealth building and traditional approaches.

Figure outlining the drivers of community wealth building and highlights the differences between community wealth building and traditional approaches
FIGURE 7-3 Approaches to and drivers of community wealth building to improve economic development.
SOURCE: Kelly and McKinley, 2015.


What can specific anchor institutions do to promote health equity? Read sector briefs about universities and hospitals and health systems to find out.

Examples of Action

Community-driven solutions can take into account the range of factors that contribute to health inequity in the United States, such as income and wealth or employment. These factors are the social determinants of health. The Cleveland Model example below works in the areas of physical environment, housing, employment, income and wealth, and social environment.

The Cleveland Greater University Circle Initiative

The Cleveland Greater University Circle Initiative (known as the Cleveland Model) involves a multi-sectoral partnership of more than 50 anchor institutions that also includes the Cleveland Orchestra, the Cleveland Museum of Art, the Cleveland Museum of Natural History, the Cleveland Public Library, Case Western University, and others. The Cleveland Model revolves around four overarching goals:

  1. buy locally (increasing opportunities for anchors to purchase goods and services locally)
  2. hire locally (increasing the number of residents from the neighborhoods hired by the anchors)
  3. live locally (supporting employer-assisted housing to contribute to neighborhood stability)
  4. connect (seeking to foster community networks and engagement).

The Cleveland Model stakeholders recognize the importance of documenting impact and have invested in monitoring and evaluation efforts. Documented indicators of success include significant financial investments, institutional changes, adoption of anchor institution approaches such as worker co-owned cooperatives, workforce training programs, and more.

The Henry Ford Health System

The Henry Ford Health System generates more than $1.7 billion per year. It is the fifth largest employer in Detroit, which faces major economic challenges and is the most segregated city in the United States.

In collaboration with other anchor institutions, the Henry Ford Health System has engaged in community work to promote health equity, including:

  • (1)neighborhood revitalization that includes campus expansion, transportation, and façade improvements in local neighborhood acquisition, and the rehabilitation of properties with the state’s housing development authority;
  • (2) significant local and minority purchasing and a transparent sourcing policy to increase minority business opportunities;
  • (3) land acquisition to attract large suppliers to Detroit;
  • (4) contract opportunities for local small businesses;
  • (5) employer-assisted housing programs;
  • (6) a 5-year clinical degree program for high school students;
  • (7) nonprofit technology business incubator services; and
  • (8) health systems partnerships to reduce infant mortality.


Anchor institutions are deeply rooted economic engines in the communities they serve, holding significant social capital. They are often trusted leaders in their communities, well positioned to help lead multi-sector work aimed at eliminating health disparities. By leveraging their economic power, good will, and human resources, anchor institutions can make significant advancements in the promotion of health equity.

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Copyright 2018 by the National Academy of Sciences. All rights reserved