Does Collaboration Between Local Health Departments and Nonprofit Hospitals Foster Community Health?

Abstract

We investigated whether stronger collaboration between local public health departments (LHDs) and nonprofit hospitals within a community is associated with individual-level healthier behavior. In accordance with a conceptual framework we developed that was motivated in part by theoretical perspectives on social exchange and social capital, we assessed the strength of LHD-hospital collaboration within communities using data from the National Association of County and City Health Officials (NACCHO) Forces of Change Survey. Health behavior data came from the 2015 Behavioral Risk Factor Surveillance System (BRFSS) SMART dataset. For social capital we used an index developed by the Northeast Regional Center for Rural Development at Penn State. We estimated multilevel models controlling for both individual and community-level factors. Stronger LHD-hospital collaboration was positively and significantly associated with several types of health behaviors including not smoking (odds ratio, OR=1.32, 95% CI=1.11-1.58), eating vegetables daily (OR=1.29; 95% CI=1.06-1.57) and vigorous exercise (OR=1.17; 95% CI=1.05-1.30). There was some evidence of a modifying effect for social capital. Our results should spur policymakers to encourage greater collaboration between these two sectors. Additionally, social capital may play a moderating role in improving community health.