Evidence that collaborative action between local health departments and nonprofit hospitals helps foster healthy behaviors in communities: a multilevel study

Geri Rosen Cramer; Gary J Young; Simone Singh; Jean McGuire; Daniel Kim

doi:10.1186/s12913-020-05996-8

Evidence that collaborative action between local health departments and nonprofit hospitals helps foster healthy behaviors in communities: a multilevel study

BMC Health Serv Res. 2021 Jan 2;21(1):1. doi: 10.1186/s12913-020-05996-8.

Authors

Geri Rosen Cramer¹, Gary J Young², Simone Singh³, Jean McGuire⁴, Daniel Kim⁵

Affiliations

¹ Bouvé College of Health Sciences and the Center for Health Policy and Healthcare Research, Northeastern University, Boston, MA, USA.
² Bouvé College of Health Sciences, D'Amore-McKim School of Business and the Center for Health Policy Healthcare Research, Northeastern University, Boston, MA, USA.
³ Department of Health Management and Policy, University of Michigan, Ann Arbor, USA.
⁴ Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA.
⁵ Bouvé College of Health Sciences and the School of Public Policy and Urban Affairs, Northeastern University, Boston, MA, USA. d.kim@northeastern.edu.

Abstract

Background: The Patient Protection and Affordable Care Act of 2010 (ACA) encouraged nonprofit hospitals to collaborate with local public health experts in the conduct of community health needs assessments (CHNAs) for the larger goal of improving community health. Yet, little is known about whether collaborations between local health departments and hospitals may be beneficial to community health. In this study, we investigated whether individuals residing in communities with stronger collaboration between nonprofit hospitals and local public health departments (LHDs) reported healthier behaviors. We further explored whether social capital acts as a moderating factor of these relationships.

Methods: We used multilevel cross-sectional models, controlling for both individual and community-level factors to explore LHD-hospital collaboration (measured in the National Association of County and City Health Officials (NACCHO) Forces of Change Survey), in relation to individual-level health behaviors in 56,826 adults living in 32 metropolitan and micropolitan statistical areas, captured through the 2015 Behavioral Risk Factor Surveillance System (BRFSS) SMART dataset. Nine health behaviors were examined including vigorous exercise, eating fruits and vegetables, smoking and binge drinking. Social capital, measured using an index developed by the Northeast Regional Center for Rural Development, was also explored as an effect modifier of these relationships.

Results: Stronger collaboration between nonprofit hospitals and LHDs was associated with not smoking (odds ratio, OR 1.32, 95% CI 1.11 to 1.58), eating vegetables daily (OR 1.29; 95% CI 1.06 to 1.57), and vigorous exercise (OR 1.17; 95% CI 1.05 to 1.30). The presence of higher social capital also strengthened the relationships between LHD-hospital collaborations and wearing a seatbelt (p for interaction = 0.01) and general exercise (p for interaction = 0.03).

Conclusions: Stronger collaboration between nonprofit hospitals and LHDs was positively associated with healthier individual-level behaviors. Social capital may also play a moderating role in improving individual and population health.

Keywords: Collaboration; Health behaviors; Local health department; Nonprofit hospital; Population health; Social capital.

MeSH terms

Adult
Cross-Sectional Studies
Health Behavior
Hospitals
Humans
Organizations, Nonprofit*
Patient Protection and Affordable Care Act*
Public Health
United States