Everyone should have an equal opportunity to live a healthy life

However, patients’ health outcomes are tied not only to the healthcare they receive but also to the conditions of the communities in which they live. Economic insecurity and its consequences often emerge as leading factors explaining differences in health outcomes. In fact, the disparities between high-income and low-income communities often result in significant life expectancy gaps—of sometimes more than twenty years—between neighborhoods just a few miles apart in cities across the country.1 

Stable employment, a leading indicator of economic well-being, is a critical driver of health and is foundational to individual and community well-being.2 All people deserve the opportunity to access employment that provides safe working conditions, stability, a living wage, and an opportunity to build assets. Yet, residents in under-resourced communities—characterized as areas with concentrated, deep-seated poverty and low median incomes3—face significant systemic barriers to finding good jobs and achieving economic stability.4 These neighborhood-level barriers encompass a range of factors, including historical neglect, discriminatory practices, and limited access to nearby employment options, quality education and childcare, and reliable transportation.5 

Unfortunately, the proportion of residents living in under-resourced communities continues to grow, and has expanded beyond traditional city centers into metropolitan suburbs. 6

Black and Hispanic/Latino populations continue to make up a disproportionately large share of people living in under-resourced communities; a stark imbalance underscored by the fact that non-Hisplanic White individuals make up only 25% of the population in under-resourced communities, compared to 61% of all U.S. residents.7 

Low-income rural families also face several challenges to achieving economic security such as lower rates of educational attainment, geographic isolation, and reduced access to healthcare and affordable child care, with persistently high-poverty counties being disproportionally rural.8, 9  Compounding this, rural areas also suffer from a severe shortage of skilled professionals, especially in fields related to healthcare, education, and social assistance, which account for 22.3% of the employment sectors in rural communities.10

These trends across the country highlight the urgent need for interventions that promote economic security and mobility, such as robust job training, supportive employment services, and policies ensuring living wages. By enabling stable employment, we can significantly improve residents’ physical and mental health, thereby advancing overall well-being and prosperity for all.

In response to these challenges, health systems are advancing impact workforce programs as core components of an anchor mission strategy for improving health outcomes, building wealth, and increasing financial stability in the communities they serve. An impact workforce strategy has two main components: outside-in and inside-up. Outside-in strategies connect residents from nearby economically under-resourced neighborhoods to quality jobs and career pathways, preparing them for high-demand jobs at the healthcare institution through training, skills development, and support services; and providing specific entry points for these candidates. Inside-up strategies then connect these hires, and other incumbent workers, to accessible learning opportunities and clear pathways to advancement within the institution. Each component also includes institutional systems and policy change to integrate these impact workforce programs as part of an organization’s people strategy.

Through impact workforce programs, health systems can invest in an ecosystem of success that lifts up local residents through stable employment and high quality jobs, and support neighborhoods. In the process, health systems can develop a more effective way to hire and train workers, and ultimately improve the health of their communities. Building out an impact workforce strategy is an important first step towards embracing your health system’s role as an anchor institution. This toolkit can help you get started.

Impact Workforce and the Anchor Mission Framework

Health systems, along with universities, local governments, and community foundations, are geographically tied to their communities through their social or public-facing mission, invested capital, or clientele. These anchor institutions have a vested interest in the long-term health and well-being of their surrounding communities, and they are economic engines—large purchasers, employers, and investors—offering opportunities to align resources to create new local opportunities.

When an institution is linked to the long-term well-being of the community it calls home, both the institution and the community can benefit from existing resources leveraged creatively to address key issues. An anchor mission is a commitment to intentionally apply an institution’s place-based economic power in partnership with the community in order to mutually benefit the long-term well-being of both—leading to improvements in the health, well-being, resilience, and economic security of all community residents. By building intentional outside-in hiring pathways, expanding opportunities for career advancement, and reviewing internal policies and procedures around career paths for entry-level and mid-level employees (inside-up), health systems are investing in a workforce that is more productive and engaged, and in a community that is healthier and more economically secure.

This toolkit offers a comprehensive guide for health systems to develop and implement workforce strategies in partnership with communities.