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Health care reform --- Public health administration --- Health administration --- Health care administration --- Health sciences administration --- Medical care --- Public health --- Health services administration --- Health reform --- Health system reform --- Healthcare reform --- Medical care reform --- Reform of health care delivery --- Reform of medical care delivery --- Medical policy --- Health insurance --- Administration

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Health care reform. --- Health care reform --- Public health administration --- Health administration --- Health care administration --- Health sciences administration --- Medical care --- Public health --- Health services administration --- Health reform --- Health system reform --- Healthcare reform --- Medical care reform --- Reform of health care delivery --- Reform of medical care delivery --- Medical policy --- Health insurance --- Administration

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Transcultural medical care --- Minorities --- Linguistic minorities --- Cultural competence --- Standards --- Evaluation. --- Medical care

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Health is increasingly understood to be shaped by more than individual genetics, clinical care, and health behavior. Structural factors that shape the distribution of power and wealth in society are also responsible for health inequities, and social determinants of health (SDOH) have overlapping impacts on health outcomes and well-being that account for approximately 70 percent of the variance in health status. Hospitals and health systems are also facing challenges related to (1) regular use of the emergency department for nonemergency care and social service needs and (2) new payment and care delivery models that shift financial incentives for providers toward achieving and maintaining the health of their patient populations. Collectively, these trends point to an opportunity to think differently about the role of hospitals and health systems in the improvement of population health. Recognizing the value of partnered approaches, the Hospital Community Cooperative (HCC) aims to bring hospitals and community organizations together to collectively address key social determinants of health in their communities and promote health equity. This report includes key findings and lessons learned that should be of interest to various audiences seeking to expand the capacity of hospital-community partnerships to address SDOH, including other hospitals, other health systems, and community partners seeking to leverage the support and resources of their local health care institutions (whether these approaches are occurring within a formal HCC or not). In addition, this report should be of use to foundations or other funding agencies that might support similar partnered approaches to improve health inequity in their communities.

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The one-year U.S. Equity-First Vaccination Initiative (EVI), launched in April 2021, aimed to reduce racial inequities in coronavirus disease 2019 (COVID-19) vaccination across five demonstration cities (Baltimore, Chicago, Houston, Newark, and Oakland) and over the longer term strengthen the United States' public health system to achieve more-equitable outcomes. This initiative comprised nearly 100 community-based organizations (CBOs), who led hyper-local work to increase vaccination access and confidence in communities of individuals who identify as Black, Indigenous, and People of Color. In this report, the second of two on the initiative, the authors examine the results of the EVI. They look at the initiative's activities, effects, and challenges, and provide recommendations for how to support and sustain this hyper-local community-led approach and strengthen the public health system in the United States.