Chapter 11

Leveraging Community Assets to Address SDOH

From the outset, the Coalition hoped to create an affirmative plan for addressing SDOH that reflected the community’s aspiration for a comprehensive approach to its own development.  Soon after the MIT Report was completed, the Coalition again worked with MIT’s Phil Thompson to consider a development plan.  


What readers will learn:

  1. The role played by anchor institutions in local economies

  2. How wealth is lost from local economies; what measures can be taken to stop the loss

  3. What the wellness-based approach to development is and how it links health and wealth

Thompson noted that “[i]n Central Brooklyn, problems begin with employment. Unemployment and under-employment are stressful conditions to live under, and often lead to other forms of instability such as lack of housing, lack of quality food, and to depression and various forms of “self-medication,” like drug and alcohol abuse.” He noted that these challenges also contribute to drug dealing, violence, incarceration, and associated mental disorders; crime discourages use of open space. Bad housing leads to roaches, rodents, and mold, which in turn contribute to asthma.   Thompson's development plan proposed a comprehensive approach to tackling these issues together.81

Stopping the Drain of Local Wealth

Central Brooklyn has plenty of resources. But they are not coordinated with the needs of local communities.  For example, beyond healthcare service delivery, hospitals have many other resources as “anchor” institutions.  Anchor institutions are large nonprofit institutions that, once established in a community, tend not to move.  Their purchasing (procurement), employment, real estate, building infrastructure, and other assets are key drivers of local economies.

However, in Central Brooklyn, hospitals purchase goods and hire services and employees from outside of the borough. This causes wealth to leave Central Brooklyn, rather than circulate within its neighborhoods to improve the lives and wellbeing of residents. Poverty and health worsen when local markets lack enough pathways for ownership and development that retains wealth for residents.

Thompson and the Coalition proposed a resident-driven approach to community health that engaged all the stakeholders who had been involved in the fight to save Interfaith: labor leaders and healthcare workers; nurses; community health and mental health providers; doctors; the New York City’s Department of Health and Mental Hygiene (DOHMH); local elected officials; and leaders of religious, educational and community organizations. They would look to discover untapped assets and create new kinds of collaborations that could improve health and wealth.82

Together, CCB and the Coalition decided on a strategy to change the ways that communities and healthcare institutions relate to each other economically, politically and culturally. Hospitals would redirect resources to help strengthen the local Central Brooklyn economy.83 Community participation would be valued as a critical dimension of health and wellbeing, encouraging residents to understand the role of local anchors and use their voices to influence anchor priorities.84  This new form of accountability would encourage local institutions to focus on leveraging their power and assets for increasing neighborhood health and wealth.

“[T]he wellness-based approach is . . . a public health approach, and an emerging public health practice for institutions to think about how their bottom line is also impacting all the determinants of health for people. It’s not just . . . about health outcomes, but what are the economic, education, political indicators that all intersect with whatever we’re focused on.”

-Torian Easterling, Assistant Commissioner of the NYC’s DOHMH Bureau of Brooklyn Neighborhood Health

Anchor Institutions as a Development Asset

In early 2018, Thompson organized a trip for Coalition and CCB leaders to visit the Greater University Circle Initiative and the Democracy Collaborative’s Evergreen Cooperatives  in Cleveland, OH.  Inspired by the Democracy Collaborative’s community wealth building strategy, the Greater University Circle Initiative was founded by a group of Cleveland-based anchor institutions and local government. It seeks to create living-wage jobs in six low-income Cleveland neighborhoods with a median household income below $18,500.

Source: Evergreen Cooperatives

The Evergreen Cooperative is building worker-owned businesses with the capacity to meet the procurement needs of local anchors and generate wealth for neighborhood residents. To date, Evergreen has founded a cooperative laundry, commercial greenhouse, energy efficiency company and business services arm.85

In Cleveland,  CCB and Coalition leaders were able to witness a living example of local anchor institutions supporting worker-owned cooperatives. The trip provided a sense of possibility for what could be achieved in Brooklyn. Roger Green recalled: “We started looking . . .  at what would happen if all of the hospitals in Central Brooklyn were redirecting opportunities to local businesses, and at how some of those local businesses could be organized as unionized work coops to provide a living wage and broad-based profit sharing to residents in Central Brooklyn—and how that might address some of the toxic triggers of poor health.”86

CCB staff and Coalition members visit a Hydroponic Farm at Evergreen Cooperatives in Cleveland, Ohio; Source: Community Care of Brooklyn

Inspired by the trip to Cleveland, and committed to addressing SDOH, CCB and the Coalition began working to create what MIT CoLab calls a “wellness-based development” vision for Central Brooklyn. The vision focuses on building community wealth through encouraging anchors to fill their procurement needs through local businesses (“localizing procurement”) and developing worker-owned, unionized cooperatives and Minority/Women-owned Business Enterprises (“MWBEs”).

Where possible, CCB and the Coalition are looking to support businesses that advance community well-being. For example, they have identified the cultivation of a healthy food value chain as an opportunity to build wealth and wellness simultaneously. They are also looking to take on racial disparities, identifying “blocks and pockets within neighborhoods where residents are disproportionately likely to experience toxic triggers causing poor health . . .”  The Coalition refers to these areas within neighborhoods as “Health and Wealth Domains” that require additional attention and intervention.

Chapter 11 Questions

  1. Why does a comprehensive approach to SDOH require a focus on unemployment?

  2. What is an anchor institution and how does it influence the local economy?

  3. Describe the “drain of local wealth.”  How can localizing procurement help stop it?

  4. What is the Greater University Circle Initiative and how does it apply to other cities?

  5. How does “wellness-based development” help address SDOH in communities?

1. An Epidemic of Hospital Closures
2. Crisis at Interfaith
3. Time to Mobilize: Forming the Coalition to Save Interfaith
4. Protest and Resolution
5. Medicaid Reform
6. Research-Based Action
7. Participatory Action Research as a Tool for Change
8. Healthcare System Reform: Cross-Sector Collaboration
9. Reinventing Interfaith
10. Focus on Health Equity
11. Creating Healthier Communities: Leveraging Community Assets
12. Community Planning for Healthier Communities
13. Making Health a Shared Value: Building Civic Infrastructure
14. Building a Culture of Health: Outcomes
15. Planning for the Future
16. Sustaining Transformation in the Face of Challenge
About the Report