I have spent most of my career in large anchor institutions, and much of my work has been focused on addressing long-standing disparities in health and other life outcomes that disproportionately impact low-to-moderate income communities of color. What began as a collaborative, community-engaged, academic attempt to describe how the social determinants of health influence life expectancy, chronic disease, mental health, and other outcomes, while I was a faculty member at Washington University in St. Louis, led to my leading the community health improvement strategy as a vice president for one of the nation’s largest nonprofit health systems, BJC HealthCare.
I have reported on the data and delved deeply with community partners into a wide range of solutions, some with lasting impact. It has become increasingly clear to me at every turn that the most promising way to achieve equitable outcomes is by major institutions making significant investments in changing the economic conditions on the ground in communities that have been excluded and neglected. Among the work that I am most proud of during my time at BJC was the commitment to an anchor strategy made by visionary leadership and a supportive board. We were first movers among larger anchor institutions in the impact investment space, inspiring others to put millions of dollars to work expanding access to small business, home mortgage, and other lending in areas of the St. Louis region that have faced decades of disinvestment.
Part of our community health improvement strategy also included working with critical system supply chain partners on supplier diversity goals and infrastructure, and engaging with colleagues in human resources to advance local hiring efforts. While I knew the core mission and business of BJC was the delivery of excellent healthcare, I also believed that we could be of tangible and significant benefit to the community and its health in the course of doing business. I was incredibly gratified to be joined in that belief by leaders and fellow team members throughout the system. But we always recognized that we could not do this work alone.
When BJC had the opportunity to more fully commit to an emerging effort that initially involved one of our hospitals in an area of high need, the response from leadership was enthusiastic. Indeed, BJC CEO, Rich Liekweg, played an active role in recruiting other regional health systems and additional anchor institutions to the St. Louis Anchor Action Network (STLAAN). Where other anchor initiatives might have focused on the immediate environs of a single hospital within a particular neighborhood, STLAAN encompassed a 22-zip code footprint characterized by poverty rates of at least 20 percent and majority-Black populations. It became a way of organizing and coordinating the activities of not only major health systems, but also universities, corporations, and civic institutions. The work of STLAAN is just beginning, but we believe so much in its potential to have considerable economic impact for individuals and communities that the James S. McDonnell Foundation, which I now lead as president, made a multi-year commitment to building its capacity.
My belief in collaborative efforts like STLAAN—and the others from around the country that are described in this playbook—is informed by over a decade of study and hands-on work that has spanned three industries. The elegance of the anchor mission approach has to do with the mutually reinforcing interests it has the potential to combine. Anchor institutions have a vested interest in the communities they call home. The strength of those communities allows them to attract and retain talent, consumers, donors, and investors. Unhealthy and inequitable communities do not grow at the same rate or experience the same levels of economic mobility as those that have more evenly and fairly distributed access to opportunity and resources. And they do not support optimal quality of life for any of their residents. Due to decades of intentional disinvestment and exclusion, facilitated by both the public and private sectors, Black communities and other communities of color have faced barriers to full economic participation that reliably and repeatedly co-occur with poorer health and shorter lives.
It is in the interest of those communities and others where low-to-moderate income households are concentrated, including in rural areas, to enjoy the benefits of economic integration that anchor institutions can provide. These communities need durable pathways to thriving-wage jobs, equitable access to the capital and contracts that grow diverse small and midsize businesses, and financial ecosystems that can be viably supported by impact investment. This is the very definition of economic justice, but it is also good business and good for communities.
When anchor institutions collaborate, they amplify the good that they can do in the course of doing business. And when those institutions represent healthcare, they are part of the 17.3 percent, or $4.5 trillion, of GDP that is tied to health spending, according to the Centers for Medicare & Medicaid Services. That is a tremendous amount of economic activity, which can be leveraged to meaningfully address systemic barriers to access that have prevailed in this country for too long. Working alongside anchor institutions in other sectors to address key social and structural determinants of health, healthcare organizations also have the potential to influence health disparities that are reflected in their exam rooms, emergency departments, and patient floors every day. In the politically polarized and deeply divisive moment in which we find ourselves, this common sense collaboration among institutions tied to their communities can serve as an example of what can be done to meaningfully change the material conditions of families across the country.
Jason Q. Purnell, PhD, MPH, President of the James S. McDonnell Foundation
For more than a decade, I have been researching and advocating for the most promising practices for how health systems and other anchor institutions could maximize their local impact as the incredible community assets they are. When I started in this work, the phrase anchor collaborative did not exist. Granted, there were some early attempts at the concept from Hartford to Cleveland, but the idea that individual anchor institutions should intentionally leverage all of their assets—including their hiring, purchasing, investing, real estate, and voice—in concerted partnership with their peers and the community to address economic and racial inequities, and to create more inclusive, local economies, was not part of the conversation.
Fast forward to today, and this idea has taken root in cities across the country. Still, the field is nascent, understudied, and under-resourced. At the Healthcare Anchor Network (HAN), we believe there is incredible power in this collective strategy, and through this playbook we attempt to capture and organize what we believe is the most comprehensive set of learnings to date from this growing body of work. Core to seeing this strategy succeed is that each one of us continues to champion the significant mindset shift required to see the anchor mission not only fully realized within institutions, but scaled through multiple institutions working together in place.
I have seen the impact that one anchor institution alone can have by thinking differently about its assets and collaborating internally to leverage those resources more intentionally. And anchor institutions alone cannot address local economic and racial inequities; they will need to partner with community-based organizations, leverage intermediaries, and encourage for-profits to join the fray. But there is unique potential in the largest local institutions—those that are most rooted in a place and most civically oriented—coming together in long-term partnership to create a vibrant local economy that will also ensure their long-term organizational success.
We are now only beginning to see the possibilities of what can happen when multiple institutions begin to work together to address systemic inequities over the long term. I can only imagine the impact that would be created if we could sustain these complex, place-based collaborations for the years and decades required to reverse a legacy of disinvestment and discrimination that impacts so many communities across this country.
There exist incredible obstacles for working in this manner; it is counter to how institutional cultures have evolved to focus on competition and standardization, and they have only become more siloed and inert to change as they have become larger and more bureaucratic. In this playbook, we provide a framework for partnership and action that offers the seeds for another way—a culture of collaboration and local investment based on the success factors we have observed in the existing anchor collaboratives across the country.
For HAN, it is important that these anchor collaboratives are leveraged in service of advancing economic opportunity, equitable economic development, and building community wealth. There is not enough space in this playbook to dive into the details of individual institutional strategies for impact workforce, purchasing, and investment strategies; but we provide the reader links to the many existing toolkits and resources in those areas wherever possible to help institutions and collaboratives on their anchor mission journeys.
Instead, we focus on uplifting the stories and progress from those anchor collaboratives across the country, even if their efforts to scale and align individual strategies are still in the very early stages. It is important that we shine a light on these many examples, which have often evolved independently from each other, and begin to forge a field of practice around structuring and resourcing these powerful partnerships for success over the long-term.
David Zuckerman, President and Founder, Healthcare Anchor Network
[1] “National Health Expenditure Fact Sheet,” Centers for Medicare and Medicaid Services, last modified December 13, 2023, https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/nhe-fact-sheet.
About this playbook
Over the past 20 years, anchor institutions—in particular health systems and universities—have increasingly explored how to leverage their significant assets to benefit the health and well-being of their communities. More recently, institutions have recognized that a deeper commitment to collaboration is required to move the needle on systemic inequities, advance equitable economic development, and support wealth building within the low-income and communities of color they serve. This playbook details how groups of anchor institutions are building effective place-based partnerships together with community partners to improve individual and family well-being and build equitable local economies.
Anchor collaboratives represent an emerging approach to equitable economic development. Our intent in publishing this playbook is to share what we believe is the most comprehensive set of learnings from this growing body of work and showcase the power and opportunity behind this collective strategy.
The playbook introduces core anchor strategies and defines key success factors that need to be present for an anchor collaborative to get started, build momentum, and be sustainable. The playbook was informed by the experiences of eighteen existing anchor collaboratives, the expertise of key informants and thought leaders, and the Healthcare Anchor Network and The Democracy Collaborative’s efforts over the last decade to define the role of anchor institutions in addressing racial and economic inequities and building community wealth. More information on the development of this playbook can be found in Methods. The playbook serves as a resource for groups of anchor institutions and backbone organizations looking to align around a shared strategy for equitable economic development and community wealth building in their communities.
This work is not possible without a dedicated and committed backbone that is responsible for organizing anchor institutions, coordinating the many players involved, and keeping the collaborative moving forward. The primary audiences for the playbook are backbone organizations and anchor institutions who are current or prospective founders or members of anchor collaboratives. While healthcare institutions are highlighted throughout the playbook, its principles and insights are applicable to a wide range of anchor institutions, including universities, local governments, community and place-based foundations, and others.
With no one-size-fits-all model for anchor collaboratives, each practitioner's experience will be unique. This playbook provides a flexible framework to help practitioners get started in building an anchor collaborative, and encourages readers to engage with the content in whatever way works best for them—by reading chronologically or moving directly to sections of interest. The playbook was written for readers who possess a foundational understanding of anchor mission principles, and have at least begun to investigate how structural inequities manifest through social and economic conditions in their communities.
This playbook is organized into three sections:
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Section 1: Introduction
Defines core concepts, provides a brief history of anchor collaboratives, and discusses the core functions of an effective backbone for an anchor collaborative. -
Section 2: Understanding Anchor Strategies
Introduces core anchor strategies, steps for getting started, recommended metrics, and examples from anchor collaboratives in the following pillars:- Impact Workforce
- Impact Purchasing
- Place-based Investing
Section 2 also discusses complementary anchor strategies: policy advocacy, community giving, land and real estate, and skills-based volunteering. Those unfamiliar with anchor strategies are encouraged to read Section 2 before moving on to Section 3.
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Section 3: Success Factors
Describes the key components that need to be present for anchor collaboratives to be effective and impactful. Success factors include:- a shared imperative
- activated champions
- effective governance
- collaboration with community
- sustainable resourcing
- quality data and impact measurement
- strategic communications
Continuum of Progress: each success factor subsection ends with a “continuum of progress” — a tool for practitioners to self-assess their progress relative to each success factor.
Acknowledgements
