Date of Conferral





Public Health


Cheryl L. Anderson


The role of hospitals as partners in community health improvement is changing, especially for nonprofit hospitals receiving tax exemptions in exchange for providing benefits to the community. There are examples of reported health improvement activities funded through hospitals' charitable donations, but there's a gap in the literature on the effect of policy and legislation on hospitals' investments in community building activities that address the social determinants of health. Grounded in eco-social theory, this quantitative, correlational study compared secondary data from CA's nonprofit hospitals' annual 2009 and 2012 reports to determine what, if any, changes have occurred in the hospitals' investments in community building since the 2010 implementation of the IRS' new community benefit standard. Matched-pair t test and chi-square goodness of fit tests were used to determine if there is a relationship between IRS regulations and how hospitals distribute their charitable dollars. Independent sample t test and ANOVA were run to determine if the characteristics of the hospitals studied were predictive of the changes found. Aside from a shift in the distribution of community building investments by types of activities, this study found no significant change in the use of nonprofit hospitals' community benefit funds to address the social determinants of health. Analysis did not indicate that current public policy supports hospitals' shift from sick-care institutions to institutions that promote population health. Rather, it revealed that CA's hospitals currently make only small financial contributions to activities that address the social determinants of health missing opportunities to leverage their resources to more effectively impact multi-sector efforts to improve population health and reduce health inequities.