By Lucia Sayre

Health care is big business in the United States, with national health expenditures topping 20% of the gross domestic product. Hospitals employ more than 5.4 million people and spend more than $340 billion annually on goods and services. 

Hospitals that operate as non-profits (58% of all hospitals in the United States) are required to set aside a certain percentage of their gross revenues for community benefit funds that are dedicated to the improvement of community health through grants and donations. 

With changes in how the IRS defines and regulates community benefits, and the implementation of the Affordable Care Act designed to address population health, we’re seeing the expansion of “upstream” prevention-based programs that can help reduce the burden of chronic disease. A recent and important ruling by the IRS will allow hospitals to claim their community benefit investments “to ensure adequate nutrition”. The ruling is being hailed as a victory for nutrition and sustainable food advocates alike: 

“The health needs a tax-exempt hospital may consider in its CHNA include not only the need to address financial and other barriers to care but also the need to prevent illness, to ensure adequate nutrition, or to address social, behavioral, and environmental factors that influence health in the community.” 

The health care sector is increasingly recognizing the complex interconnections between our unhealthy, industrialized food system and public health, with a commitment among hospitals throughout the country to make healthy and sustainable food a central part of their prevention-based health agenda. 

Healthy food cannot be defined only by the quantity and quality of the food we eat. Within the context of environmental nutrition, healthy food is the product of a food system that conserves and renews natural resources, advances social justice and animal welfare, builds community wealth, and fulfills the food and nutritional needs of the human population. 

This IRS ruling paves the way for the health sector to step up its investments in a wide spectrum of nutrition related programming, from acute food insecurity interventions to long-term efforts in building vibrant regional food systems by supporting local growers and economies.  As anchor institutions, hospitals have the potential to improve public and environmental health and to strengthen the economic vitality of the communities in which they are located. They are rooted in place, hold significant investments in real estate and social capital, are among the largest employers in their communities, and are often explicitly oriented toward supporting community health goals in alignment with their healing mission. Due to their significant purchasing power and trusted role as authorities on health and wellness, hospitals have an important opportunity to not only increase access to healthier, more sustainably produced food for patients, staff, and the community, but to transform the food system towards greater health and sustainability.

Indeed, the momentum behind community benefits investment to improve nutrition is on the rise across the country, and this new ruling can only help accelerate those existing efforts and create new opportunities. A soon-to-be-released report from HCWH, Utilization of Community Benefits to Improve Healthy Food Access in Massachusetts, provides a landscape assessment of the ways in which hospitals throughout Massachusetts are using their community benefit resources to support healthy food access and improve nutrition. In fiscal year 2013, hospitals across the Commonwealth were investing in 80 such activities, including nutrition education, sponsorship of neighborhood farmers markets, fruit and vegetable prescription programs, and grants to support neighborhood-level work through community health centers. 

To quote Gary Cohen, the president and founder of Health Care Without Harm, “We believe that hospitals can play a larger healing role in the communities they serve by using community benefit expenditures and their purchasing power to reweave healthy food systems and improve nutrition-related health outcomes. If we hope to turn the tide on the obesity crisis in America, we need healthcare to kick its own addiction to industrial agriculture and join with others in building a healthy food system.”

Lucia Sayre is Healthy Food in Health Care California Regional Director.