We have known for decades that environmental factors contribute to morbidity and mortality in children with asthma. Poverty, pests, and mold all contribute to asthma disparities and in many cities environmental abatement organizations, like Green and Healthy Homes in Baltimore, work to improve home environments to reduce asthma burden. In this month’s issue of Pediatrics, researchers from the Children’s Hospital of Philadelphia (CHOP) present their advocacy work taking the issue of housing improvement to a whole new level in, “Home Repairs for Children with Asthma” (10.1542/peds.2022-058351). But before discussing the newly released article, it is important for everyone to understand the context of community benefits for non-profit hospitals and health systems.
In the US, not-for-profit health systems must provide community benefits and not solely use their profits to enhance services and facilities. The Internal Revenue Service (IRS) sets the community benefit standard for non-profit hospitals, but many hospitals seem to meet the “letter of the law, but not the spirit” as “nonprofit hospitals spent $2.30 of every $100 in total expenses incurred on charity care, which was less than government ($4.10) or for-profit ($3.80) hospitals.”1 In this context, there are examples of true community benefit efforts that improve the surrounding community in a constructive and sustainable manner, and the work on housing repairs from CHOP is one of these.
So what did they do? The Community Asthma Prevention Program (CAPP) was established in 1997 at CHOP to reduce asthma disparities by offering clinic-, home-, and community-based education services to children with asthma. Out of this program, they realized that just addressing non-structural housing issues was inadequate, so they developed the CAPP+ program in order to address fixing structural housing issues such as plumbing, kitchens, holes in walls, and replacing carpet. To do this, the hospital partnered with local non-profit home repair agencies and leveraged the community benefits funding from CHOP along with philanthropy to fund the endeavor. They ended up fixing 97 homes between 2018-2021, and their evaluation showed qualitative improvements in asthma, housing stability, and livability in the house. I encourage all of you to read the full article and see the details of what they accomplished.
Overall, I would say this is a gold standard for non-profit hospital community benefits. If there is an award from the IRS for actually doing the work in the community, CHOP should get it. I am hopeful that other hospitals and children’s hospitals across the country will look at this model and try to emulate the type of work that they have done to improve the well-being of children with asthma in their community.
Reference:
- Analysis Suggests Government And Nonprofit Hospitals’ Charity Care Is Not Aligned With Their Favorable Tax Treatment Ge Bai, Hossein Zare, Matthew D. Eisenberg, Daniel Polsky, and Gerard F. Anderson Health Affairs. 2021;40:4,629-636
