Community Health Improvement Plans: Getting Beyond Access

Community Health Improvement Plans (CHIPs) are vital tools for addressing public health challenges and promoting community well-being. By identifying, defining, and acting on health priorities, CHIPs aim to reduce disparities and improve outcomes. Yet, while experts emphasize the crucial role of Social Determinants of Health (SDOH) such as housing, education, and economic stability, most CHIPs today still focus overwhelmingly on healthcare access – often to the exclusion of other priorities.

This emphasis, while understandable, limits the broader potential of CHIPs. To achieve the vision of Public Health 3.0, a CHIP should be developed within a comprehensive strategy that leverages community partnerships to address systemic issues that go far beyond healthcare access.

The Limited Scope of SDOH in CHIPs

A recent study highlighted the unequal representation of SDOH in a review of 80 CHIPs from communities across the United States. Researchers found:

• Nearly 90% of CHIPs addressed healthcare access.
• About two-thirds addressed food insecurity, neighborhood infrastructure, or affordable housing.
• Less than one-third addressed education access, economic stability, or safe housing.

This imbalance reflects systemic constraints but also reveals missed opportunities. Even when CHIPs in this study did include strategies for addressing SDOH they did so within the healthcare context rather than more broadly addressing these community needs. For example, workforce development strategies within CHIPs often focus exclusively on healthcare careers, while transportation initiatives target access to medical services rather than improving overall mobility.

Why Healthcare Access Dominates CHIPs

Healthcare access dominates CHIPs for a couple key reasons:

1. Perceived Feasibility: Interventions like increasing clinic hours or provider availability are more straightforward to implement and measure compared to complex, long-term efforts such as implementing affordable housing policies or addressing income inequality.
2. Healthcare Influence: Many CHIPs are developed in partnership with hospitals to satisfy IRS requirements for Community Health Needs Assessments (CHNAs). Since hospitals naturally prioritize health services, their involvement tends to steer CHIPs toward healthcare-centric initiatives.
3. Resource Availability: When hospitals are in the service area and/or involved in CHIP development and implementation, there tend to be more resources available to address healthcare access and barriers to care as compared to other SDOH-related needs.

A Paradigm Shift: Addressing Root Causes

To move beyond healthcare access, public health leaders should embrace their role as Chief Health Strategists, using partnerships, policy, and data to tackle the root causes of health inequities across different social and economic domains.

However, expanding the focus of CHIPs to include broader SDOH is no small task. Public health leaders face significant hurdles, including limited resources, complicated and slow-to-change systems, and competing priorities. Even so, progress can be achieved through strategic and incremental changes that are carried out over time. For example, communities can:

• Start Small: Focus on one or two additional SDOH domains and use data to track progress. Alongside healthcare access, domains like housing stability, food security, and education have important implications for public health.
• Leverage Partnerships: Collaborate with schools, housing authorities, and community organizations to share the workload and amplify impact. Such diverse partners are critical to creating integrated, community-wide solutions. This work may require building new relationships with sectors you’ve not previously engaged with but can yield impactful results for the CHIP and beyond.
• Iterate Over Time: Treat CHIPs as living documents that evolve with new data, community needs, and opportunities. As external factors change, it is important to revisit the CHIP regularly to assess progress and to ensure continued relevance to the community’s health improvement goals.  
• Advance Policy Change: The previously mentioned research noted that policy change is one of the most underutilized approaches to health improvement within CHIPs – despite being one of the most effective approaches for addressing SDOH. Implementing policies such as living wage laws, affordable housing zoning, and equitable tax benefits can drive systemic change for long-term health improvements.  

Conclusion: Building Sustainable Impact

CHIPs are promising tools, but their potential impact is limited if they focus solely on healthcare access. By broadening their scope to address diverse SDOH domains and embracing innovative, cross-sector strategies, public health leaders can drive meaningful change.  

This work is challenging and requires a phased, collaborative approach. Incorporating SDOH into CHIPs is not a one-time task but a long-term commitment to creating equitable communities. Including meaningful strategies for addressing SDOH in the CHIP can help communities move beyond treating symptoms and facilitate their ability to work together to address the root causes of health disparities.