Realizing the Anchor Mission

Healthcare Anchor Network (HAN) defines anchor institutions as nonprofit or public institutions including hospitals, universities, local governments, utilities, large cultural organizations, and place-based foundations. Anchor institutions are geographically tied to their community through their social or public-facing mission, invested capital, or clientele. Due to the scale of their operations, anchor institutions produce a significant economic impact in their surrounding community, and given their social mission and place-based focus, have a vested interest in the long-term health and well-being of their surrounding community. Many communities also include large for-profit companies with a long history of capital investment and social engagement in their own definition of anchor institutions.

Anchor institutions wield significant economic power. The Federal Reserve’s Anchor Economy Dashboard quantifies the economic impact in the US of two main types of anchor institutions: universities and hospitals. In 2022, these entities (sometimes referred to as “eds and meds”) accounted for 9 percent of total US employment, 6.3 percent of total US income, and 8.1 percent gross value added that year. This translates to 18 million jobs, $1.1 trillion in income, and $1.7 trillion in goods and services added to the economy.

As influential economic actors with a social or publicly facing mission, anchor institutions have both the ability and motivation to activate their institutional practices—such as hiring, purchasing, and investment—to address the health and wealth disparities that persist in the communities they serve. In many communities across the country, life expectancy can differ by as much as 30 years between wealthier, predominantly White communities and lower income, predominantly Black, Indigenous, or People of Color (BIPOC) communities just miles apart. Research demonstrates that unemployment, lower income, food insecurity, less than high school education, and lack of health insurance are associated with premature death. In addition to the tremendous cost in lives lost, racial inequities in health cost the US economy an estimated $451 billion in 2018. Further, rising income inequality reflects disparate opportunities to build wealth across racial and demographic groups. In 2019, the average per capita wealth of White Americans was $338,000 compared to $60,000 for Black Americans—a six-fold difference. Both residents and institutions benefit when communities are equitable, healthy, and sustainable.

The health and wealth disparities we see today are the result of policies and practices designed to direct resources to some and not others on the basis of class, race, and other socio-economic factors.^, We know that social determinants—where people live, learn, work, and play—are the key drivers of health and wealth outcomes for people, and that inequitable conditions in communities across the country contribute to drastic differences in health and wealth across socio-demographic groups. There is ample evidence to support the positive impacts of housing, education, and economic opportunity on an individual’s health and wealth^,, and the ways in which addressing inequities within these social determinants can create more prosperous communities.^,,

Implementing anchor mission strategies should not be viewed as charity—when organizations apply an anchor mission lens to their business practices, they can operate in ways that also generate positive social impact. For example, applying an anchor mission lens to hiring, anchor institutions can partner with community-based organizations to build career pathways programs that train and hire individuals in high-unemployment areas into jobs within anchor institutions. This strategy should be able to address worker shortages that put upward pressure on wages, reduce turnover and recruitment times, and create a better prepared staff.

Applying an anchor mission lens to their supply chain, anchor institutions can keep dollars circulating in the local economy by intentionally procuring goods and services from local, high-impact (e.g., employee-owned) businesses who reflect the socio-demographic diversity of their community and who have traditionally faced systemic barriers to growth. This strategy should focus initially on identifying and addressing pain points or vulnerabilities in the supply chain, while uncovering and building the capacity of diverse, local businesses to provide better quality products and services, therefore creating a more responsive and resilient vendor base.

Applying an anchor mission lens to their financial assets, anchor institutions can allocate a sliver of their investment portfolio to place-based investments to increase the flow of affordable and flexible capital for community needs such as affordable housing, financing for small, local, and minority-owned businesses, childcare facilities, and access to healthy food. Accepting slightly concessionary returns on a small fraction of the institution’s overall investment portfolio should not have a material impact on an organization's bottom line. Meanwhile, such investments generate goodwill, bolster community partnerships, and strengthen community conditions in ways that do have a material impact on the long-term health and well-being of workers, families, patients, students, and other key constituencies.

The most immediate cost to implementing anchor strategies is staff time. Most organizations leverage external resources (e.g., foundations, public funding) to offset staff time associated with standing up or maintaining an impact hiring, purchasing, or place-based investing strategy. In our experience at HAN, we have no evidence to support that these strategies materially impact the organization's financial performance over time. Equally important as the resources devoted to the anchor mission is the mindset shift and evaluation of internal processes required for success—that is, a shift in the way an anchor institution sees its role in the community and in response, a shift in the way it operates.

Groups such as the Healthcare Anchor Network exist to accelerate the adoption of anchor mission principles by creating space for anchor institutions to connect with one another, learn best practices, and advance anchor strategies in their respective communities. Similarly, groups such as the Coalition of Urban and Metropolitan Universities, the Anchor Institution Task Force, and National League of Cities provide opportunities for anchor institutions across sectors to exchange ideas and institutionalize practices that enable intentional, transformative change.

As this work progresses at the institutional level, this playbook invites anchor institutions to think bigger about what they can accomplish when they work together toward a shared vision of equity in their communities.

The Emergence of Anchor Collaboratives

Perhaps the oldest recorded anchor collaborative still in existence is Southside Institutions Neighborhood Alliance (SINA), formed by three anchor institutions in Hartford, Connecticut in 1978 alongside community groups to address issues of mutual concern, build trust, and strengthen social and cultural institutions. The group launched a community newspaper and a Community Development Corporation that still exist today. Back then, SINA did not call itself an anchor collaborative, and up until around 2010, the concept of anchor collaboratives was uncommon within economic or community development practice.

As evidence mounted suggesting that an individual’s zip code and income were stronger predictors of life expectancy than their genetic code,^, the healthcare sector began to expand its scope to focus on the root causes of poor health outcomes—the social determinants of health. Many health systems began to expand their missions to reflect a more holistic commitment to community health and well-being. Passed in 2010, the Affordable Care Act required hospitals to complete Community Health Needs Assessments (CHNAs) every three years, and a series of federal policies and new regulations emphasized the non-clinical factors that impact people’s health—pushing the sector to prevent poor health in addition to providing clinical care that responds to it.

The higher education sector experienced a similar shift around that time. The University of Pennsylvania’s Netter Center published the Anchor Institutions Toolkit: A Guide for Neighborhood Revitalization in 2008 and subsequently launched the Anchor Institution Task Force in 2009. In 2010, the Living Cities Integration Initiative provided initial funding for anchor institution partnerships in Baltimore, Cleveland, Detroit, and others, to pilot new approaches to equitable economic development. With more health systems and universities adopting anchor mission mindsets and strategies, the potential of working together to enable the success of impact hiring, purchasing, investing, and other anchor mission strategies became clear. Anchor collaboratives began to evolve in more cities across the country, often catalyzed by a trusted convener like a place-based foundation, city government, or civic leader. (See Section 3.1 Shared Imperative for more on trusted conveners.)

While some collaboratives formed slowly over time and others can be traced back to a single catalyzing moment, anchor collaboratives are an institutional response to social, racial, and economic inequities that persist in their communities. The roots of these collaboratives stem from historical moments including the Great Recession, Occupy Wall Street, the Ferguson Uprising, and the nationwide protests following the murders of Ahmaud Arbery, Breonna Taylor, and George Floyd in 2020. Such movements call attention to structural inequities, including racism and discrimination, which produce generational trauma, poverty, and disparate outcomes in health, education, and economic opportunity among historically marginalized people.^,

In 2018, The Democracy Collaborative, a research and change-agent nonprofit focused on community wealth building strategies nationally, hosted a national convening of twenty-seven anchor collaboratives, representing seventeen states, plus D.C., Toronto, Ontario; and Preston, England. In 2019, The Democracy Collaborative summarized early observations of this emerging field in their report on anchor collaboratives, which served as a foundational resource for this playbook. Since then, countless more collaboratives have formed.

Because of their localized nature, anchor collaboratives vary across nearly every measure: sectors represented, budgets, number of staff, geographies served, goals, activities, and stage of progress. Anchor collaboratives are most transformative when grounded in the principles of community wealth building: a system-changing approach to community economic development that works to produce broadly shared economic prosperity, racial equity, and ecological sustainability through the reconfiguration of institutions and local economies on the basis of greater democratic ownership, participation, and control. As defined by The Democracy Collaborative, the community wealth building framework calls for developing place-based assets of many kinds, working collaboratively, tapping large sources of demand, and fostering economic institutions and ecosystems of support for enterprises rooted in community. The aim is to create a new system that en­ables inclusive enterprises and communities to thrive, and helps families increase economic security.

While no two collaboratives look the same, anchor institutions in every community can work together to implement anchor mission strategies at a larger scale. They can pool place-based investment funds to increase the flow of affordable capital in the community investment ecosystem. They can develop joint hiring pipelines that increase economic opportunity among residents in high unemployment areas. They can partner on vendor outreach and capacity-building programs to increase contracts with local businesses who are diverse in race, ethnicity, gender, and other identities that have faced systemic barriers to growth.

Anchor institutions cannot address systemic issues alone. Anchor collaboratives catalyze a new standard for how large institutions operate in partnership with communities. Equally important as the programs and initiatives associated with anchor strategies is the mindset shift and evaluation of internal processes required for success. By creating a community of learning where anchor institutions can support and motivate one another, the anchor collaborative helps build the capacity of anchor institutions to collectively deliver on their commitments.

Getting Started: Forming the Collaborative and the Backbone

Behind every successful collaborative there is an initial driving force. Whether the anchor collaborative forms organically over time or intentionally from the start, a respected civic leader from an anchor institution, public sector, or trusted convener will almost always play an outsized role in initiating and coordinating the collaboration between anchor institutions.

These leaders often experience a catalyzing moment that inspires them to act. Such an instance compels these individuals to recognize that business-as-usual is not sufficient to meaningfully address the deep-rooted inequities in the communities they serve. They recognize the need to motivate the largest, most influential, mission-driven employers to act in new or more intentional ways. Such moments and realizations will often underlie the future shared imperative that unites the collaborative.

Perhaps the most effective combination for forming an anchor collaborative is when a senior leader from an anchor institution joins with a respected civic leader who can serve as a trusted convener of anchor institutions and community partners. Together, this team can be especially effective in marshaling the necessary resources for the collaborative, persuading necessary decision makers to join, and building the critical mass needed to move forward. This powerful team can also help preserve continued buy-in from all parties over the long term.

Section 3.1 Shared Imperative dives deeper into the necessity of having a powerful shared imperative for unifying an anchor collaborative’s focus and initial commitments, and Section 3.2 Activated Champions underscores the importance of broadening the coalition of supporters beyond those initial leaders for long-term sustainability and community support.

Catalyzing an anchor collaborative

Several anchor collaboratives have taken shape organically as regional leaders coalesce around shared priorities, particularly in the healthcare sector. In Brooklyn, healthcare organizations had been working together with community groups on Medicaid innovation and healthcare transformation for many years before forming the Brooklyn Communities Collaborative, which is housed within Maimonides Medical Center, which serves as the backbone for the collaborative.

In other cases, civic leaders or leaders of anchor institutions learn of the anchor collaborative model and view the structure as worthy of exploration. A trusted convener—typically a place-based foundation, regional economic development group, anchor institution, or city government—will often initiate the discovery process. Initial steps often involve a series of convenings or individual meetings with leaders from anchor institutions to assess the overall appetite for collaboration, understand organizational commitments to racial equity, share best practices from other anchor collaboratives, and take stock of existing anchor mission strategies that align with community priorities.

In many communities, there is a catalyzing moment that motivates community leaders to unite under a shared recognition that the status quo is unacceptable, and that their organizations have a role and responsibility to address community needs differently. Community coalitions and localized research have been effective in drawing attention to health and wealth disparities across socio-demographic groups and providing a call to action for regional leaders to address underlying causes. West Side United in Chicago and St. Louis Anchor Action Network grew from regional analyses that pointed to undeniable inequities in health and wealth outcomes between low-income communities of color and wealthy, predominantly White communities. The stark findings in these reports (listed below under Catalyzing reports) served as a powerful motivator for anchor institutions to work together.

Other collaboratives formed in response to community improvement plans (e.g., from regional planning authorities), or community health needs assessments (which nonprofit health systems are required to conduct every three years), which helped orient anchor institutions around broadly shared priorities. For instance, regional healthcare organizations serving Baton Rouge, Louisiana, had a history of collaboration on a joint Community Health Needs Assessment before forming their anchor collaborative as part of the mayor’s Healthy City Initiative in 2012. In this case, the City of Baton Rouge was the initiator and has gone on to serve as the backbone. Other collaboratives in Tacoma, Washington, and Ogden, Utah, grew from city plans focused on education, health, safety, and growing the local economy.

Catalyzing reports

• Large Life Expectancy Gaps in U.S. Cities Linked to Racial & Ethnic Segregation by Neighborhood, NYU School of Medicine (2019)

• Forward through Ferguson A Path Toward Racial Equity, the Ferguson Commission (2015)

• Segregation in St. Louis: Dismantling the Divide, Washington University in St. Louis (2018)

• 2025 Strategic Plan for the City of Tacoma, (2015)

Identifying members of the anchor collaborative

The organization or group of individuals who initiated the anchor collaborative should start by identifying anchor institutions in the community that are aligned with the broad vision of the collaborative. Those initiating the collaborative can start to understand the priorities of key anchor institutions by studying annual impact reports, community health needs assessments, strategic plans, or other publicly available resources of civic-minded organizations. Leaders at anchor institutions can be engaged through one-on-one outreach, roundtables, networking events, community forums, and other outreach efforts designed to explore the idea of an anchor collaborative, learn best practices from other communities, and understand the initial appetite for collaboration among organizations. For more on these initial steps, see 3.1 Shared Imperative and 3.2 Activated Champions.

Who should join the collaborative?

There are several considerations to keep in mind when determining who should become members of the collaborative. In the discovery phase, we recommend considering hospitals, universities, local governments, utilities, large cultural organizations, and place-based foundations. Many communities will also consider engaging large for-profit companies with a long history of capital investment and social engagement. It is critical to understand that becoming a member of the collaborative and adopting the anchor mission requires adaptation of institutional practices, a strategic alignment of organizational values and priorities, and a high standard of civic leadership. An organization’s status alone as an anchor institution does not necessarily reflect their commitment to the anchor mission, racial or economic equity, or goals of the anchor collaborative.

Setting a criteria for membership that holds anchor institutions to an achievable standard while setting the bar high enough to affect real change can support long-term engagement and sustainable impact. At minimum, members should endorse the broad goals of the collaborative, nominate key staff for working groups, and participate in annual data collection or other recurring commitments. In section 3.1. Shared Imperative, we discuss organizational goals that the collaborative members can commit to, which can support deeper engagement. For health system anchor institutions, Healthcare Anchor Network developed leadership commitments in impact workforce, purchasing, and place-based investing that can be adapted when shaping the goals of a multisector collaborative. While signing a leadership commitment is not required to join the network, it provides a meaningful, measurable, and feasible framework for members to strive toward, and the opportunity for members to learn and make progress together.

Once established, anchor collaboratives should carefully consider when and how they expand membership to less engaged anchor institutions or to large employers who possess some, but not all, of the characteristics of an anchor institution. Consider whether the value of having all partners at the table supporting an initiative with varying degrees of commitment is more beneficial than the potential misalignment or limited impact that may come when members do not engage at the level necessary for long-term, institutional change. In our observation, the most impactful collaboratives recognize that having more institutions at the table is not always better than having the right ones. In some cases, as an anchor collaborative matures and asks more of its members regarding resourcing and goals, it needs to have honest conversations about whether it is better to reduce members to ensure greater engagement and commitment.

The backbone

The backbone for the collaborative provides the necessary coordination, facilitation, project management, communications, planning, and other key structural functions for the anchor collaborative. Every collaborative needs a backbone. The backbone plays a critical role in ensuring an effective partnership built around the success factors presented in Section 3 of this playbook: a shared imperative, activated champions, effective governance, collaboration with community, sustainable resourcing, quality data and impact measurement, and strategic communications.

The backbone should be viewed by the anchor institutions and community partners as trusted and capable of performing the necessary set of functions for the collaborative. The organization or group of institutions that initiated the collaboration should start by understanding all the functions of a backbone, then determine whether they can serve in that role in the formation period or find other organizations who are better suited to take the lead. Section 3.1 Shared Imperative provides further detail on identifying a trusted convener, who will likely fulfill many of the backbone functions listed below or help resource an independent backbone to do so.

As an individual or team dedicated to the initiative, the backbone takes responsibility for a myriad of logistical and administrative functions required for the collaborative to function smoothly. In the report, Building the Backbone, StriveTogether outlines nine key backbone functions, adapted here for relevancy to anchor collaboratives:

Several organizations may work together to fulfill the backbone functions, with one organization typically taking the lead. As the anchor collaborative takes shape, partners will face questions about what level of structure is necessary to move the work forward. The right backbone structure for the collaborative depends on several factors—history of collaboration among partners, local politics, intended outcomes, depth of relationships with community partners, time and resources committed by anchor institutions, and more. Below are some common backbone structures for anchor collaboratives.

Achieving independent nonprofit status may not be the goal of every collaborative. Some collaboratives find that being nested within an established nonprofit, such as a local economic development organization or private foundation which serves as a fiscal sponsor, gives them the space to focus on programmatic work rather than administrative functions. Others have transitioned to independent nonprofits to increase freedom and credibility as a standalone organization.