Prioritize Health! How should a hospital contribute to the health of the community it serves?

Meeting health needs for diverse urban populations is a challenge that is arguably best accomplished by asking guidance from a cross-section of that constituency. Public deliberation (PD) is a method of stakeholder engagement... [ view full abstract ]

Meeting health needs for diverse urban populations is a challenge that is arguably best accomplished by asking guidance from a cross-section of that constituency. Public deliberation (PD) is a method of stakeholder engagement used to gather public input for institutions and/or policy makers on values-based decisions that cannot be adequately addressed with technical information alone. This presentation describes a project that used PD to provide guidance to a New York City hospital in a very diverse community on best approaches to prevent chronic disease.

PD sessions included presentations on chronic disease prevention, focusing on evidence-based clinical, community, and policy approaches, health conditions and disparities, social determinants of health, and use of evidence. Participants informed by experts discussed case studies in small and large groups, bringing in their own values and experience to prioritize approaches, populations and particular interventions. To assess the impact of the PD on participant knowledge and attitudes, and the quality and effectiveness of the deliberative sessions, participants completed pre- and post-surveys.

Sixty six individuals, diverse with respect to age, race, ethnicity, culture, neighborhood of residence and educational attainment, participated in three 2-day deliberative sessions. A majority of participants across all sessions prioritized community-based or policy-based interventions versus clinic-based prevention approaches. Additionally, participants recommended that the hospital focus prevention efforts on populations at highest risk of disease due to their socioeconomic status. The hospital is reviewing recommendations from the PD for implementation.

Our findings suggest that members of the public see an important role for hospitals in activities other than clinical care, including community programing that is appropriate and responsive to a diverse, urban community. In addition, they expressed a greater interest in the common good than in their own needs, prioritizing programs that address those at highest risk of disease due to social factors.