Health Districts: Key Lessons for Municipalities and Partner Health Care Organizations

Todd Fawley-King, Caroline McCarthy, and Judith Taylor

The National Resource Network’s experience working with communities across the country and our research to produce our recent publication - Striking a (Local) Grand Bargain – shows that municipalities and their anchor institutions can substantially increase community stability, economic competitiveness, and health outcomes when they jointly establish a shared long-term community vision and coordinate policy and investments. For cities with large anchor medical institutions, successful health districts integrate medical facilities into mixed-use neighborhoods to support economic, social, and community health goals.

The City of Lancaster, CA approached the Network for assistance conducting preliminary planning for a new health and wellness district it would like to establish in partnership with the Antelope Valley Hospital. The Network provided in-depth case studies of other health districts in similar cities to help Lancaster understand the scope and key elements a health district should include, as well as the potential impacts. In addition, the Network drew on experience planning for healthy communities, including a health district plan for Meridian, MS, and implementation support for a healthy campus in Kansas City, KS. From this research, we have identified several key lessons that may be applicable to other cities considering similar districts.

  • Formal “initial thinking” in collaboration between a municipality and an existing health care institute is a common element of the successful health districts studied.  The health institutions that formed the nucleus of these successful health districts and the municipality often conducted preliminary planning or collaborative work to form and strengthen their partnerships, which then helped increase stakeholder interest in the investment and effort needed to form the district.

  • Health districts can coordinate development among individual institutions to efficiently maximize capital resources, share the burden of infrastructure improvements, and support ambitious projects. Health districts may be especially useful in cities with multiple large medical anchor institutions that have similar investment and infrastructure needs. The dialogue inherent in the formation and maintenance of the health district plan can facilitate creative approaches to finance and encourage shared responsibility of infrastructure upgrades benefitting multiple stakeholders. This process may also encourage the formation of a political coalition necessary to champion ambitious projects and access diverse funding options such as state or federal grants.

  • There are several challenges that can hinder collaboration and realization of a successful health district. Notably,partnerships between institutions with similar market aspirations can be tenuous, especially when the economy contracts. Establishment of a health district where the key members are competing institutions may be challenging; a health district with complimentary facilities may result in greater collaboration and success. In addition, changes in the leadership of the municipality can derail a project that is led primarily by the public sector, making it important to carefully consider what entity should lead the initiative.

  • The right leadership can ensure continued relevance of the plan and support for long-term objectives. Most cities that pursue a health district must choose between a public-leadership of the initiative or assigning a separate non-profit entity to lead. Public-led health district initiatives require long term city commitment and consideration of how to maintain focus during leadership changes.  For some cities, a non-profit coordination organization may be best suited for the lead role because a specially-designated entity can focus and steward the resources necessary to coordinate institutional planning, effectively represent public and private interests, and access financing opportunities such as grants. Additionally, a designated non-profit coordination organization can add dedicated implementation capacity and help maintain focus on the objectives of the plan during leadership changes. However, in considering creating a non-profit coordinating entity, stakeholders must ensure the organization will have sufficient resources to support itself and its mission. Possible revenue sources may include philanthropic support or revenue from assets in the district the non-profit could manage.

  • Successful health districts are comprehensive and actively involve all nearby landowners. Instead of focusing narrowly on the municipality and the medical institutions, successful health districts reach out to all landowners to create a comprehensive vision for the future of the community. This expansive view is necessary to secure widespread community support and better targets the full range of investment by all stakeholders in the district towards achieving the long-term goals and objectives.

  • Cities should actively pursue partnerships with potential new anchor institutions while preparing a master plan. Attraction of new anchor medical institutions to a district is a clear sign of the success of a health district masterplan. Cities have a valuable opportunity during the preparation of the plan to incorporate attractive policies and incentives and thus should reach out to potential anchors during the preparation phase to understand what cost-effective incentives, infrastructure upgrades, or policies might induce new institutions to locate in the planned health district.

Health districts are powerful long-term strategies that require considerable investment of time to develop and maintain. Municipalities considering a health district should assess the resources and institutional capacity necessary to partner productively with a medical institution to make a health district a reality. To ensure success, cities that choose to pursue a health district should carefully consider how to apply the key lessons identified here, and also review the Network’s report on collaboration between municipalities and their anchor institutions.