The Paradox of Colorblind: Private Nonprofit Hospital Community Benefit Investments and the Social Determinants of Health
Nonprofit hospitals are required to provide “community benefits,” although this term and the associated levels of spending are not clearly defined. Over 75% of private nonprofit hospital community benefits are allocated to providing medical services for those who cannot afford care, and fewer investments are made to address structural and social determinants of health (SDOH). In particular, this spending is rarely used to redress racial inequities that shape health. In addition to spending on charity care and medical services, some private nonprofit hospitals invest in non-medical strategies to improve health outcomes. In California, private nonprofit hospitals report $12 billion in annual community benefits that include spending on non-medical strategies intended to improve health promoting conditions for vulnerable populations. This comparative case study analyzes data from organizational documents, interviews, and media communications to examine how hospital community investments in housing and workforce development are rationalized and deployed to address SDOH in Los Angeles County. Findings indicate that community-based resources are essential to align hospital investments with community need and to avoid “colorblind” decisions that emphasize socioeconomic need yet do not adequately address racialized barriers to health. Policy and practices that promote targeted capital investments and prioritize the disproportionate needs of communities of color are needed instead of colorblind hospital community investments that perpetuate racial inequities in health.