Science, complemented with stories, can help us best message the connection between environmental health and overall wellness. The science can be found in journals like The Lancet. The stories, on the other hand, come from people. Stories can be captured through internal environmental rounds, employee and patient surveys, and community assessments. Kaiser Permanente and Catholic Health Association of the United States (CHA) can help tell the story-the story of environmental stewardship and its connection to community benefit.

Community benefit reporting

CHA started exploring community benefit activities and reporting more than 20 years ago with its social accountability budget. As recently as 1989, a healthcare community benefit report was hard to find, but with CHA's work and support, most not-for-profit hospitals have some form of community benefit reporting or it is included in their annual report.

CHA followed up with its Guide for Planning and Reporting Community Benefit (revised in 2008) to assist hospitals with standardized accounting, prudent use of resources, and continued critical commitment to those in need of care.

Through Catholic Health Association's leadership, not-for-profit hospitals are required to report their community benefit activities and other information to the Internal Revenue Service (IRS) through the use of Form 990 in order to maintain their tax-exempt status and demonstrate transparency and accountability to their communities through the use of Form 990. In 2008, the IRS added to its Form 990 by including a “Schedule H” just for hospitals. During the first tax year, completing Schedule H was a voluntary effort. But in 2009, it was required for all not-for-profit hospitals.

Part II of Form 990 Schedule H is about “community building”-specific activities outside of the facility that impact the community. The community building section has eight categories:

  • Physical improvements and housing;
  • Economic development;
  • Community support;
  • Environmental improvements;
  • Leadership development and training for community members;
  • Coalition building;
  • Community health improvement advocacy; and
  • Workforce development.

Accepted activities include removing lead paint, cleaning up a contaminated site, or testing water quality. But, becoming mercury free, preventing waste, or conserving energy do not meet the definition of community building because they are activities internal to the organization.

Catholic Health Association and Practice Greenhealth's Environmental Sustainability Getting Started Guide.


CHA urges facilities to list all sustainability and community engagement activities on this form. Those initiatives that fall outside of the IRS definition of community building can be listed in Part VI, which is for supplemental information (other activities promoting the health of the community.)

Kaiser Permanente's story

Three years ago, Kaiser Permanente reengineered its environmental stewardship program, creating an executive level position of environmental stewardship officer and a council made up of 10 high-level executives. This council is accountable for the direction and performance of environmental stewardship across the system. Within that council is a working group, which oversees day-to-day stewardship activities for the system. The council developed a package of multi-year strategies, priorities, and guidelines that were endorsed by leadership and the board of directors. Environmental stewardship resides in the community benefit department, but accountability is widely decentralized. Kaiser Permanente is one of few systems with a designated environmental supply chain manager, but that's another story.

“Kaiser Permanente's mission is to improve the health of our members and communities we serve. We can't do that without helping to address environmental contributors to disease. We work on safer chemicals, climate action, and sustainable food in order to prevent cancer, new infectious diseases, diabetes, and other conditions linked to pollution,” says Kathy Gerwig, vice president, workplace safety and environmental stewardship officer, Kaiser Permanente.

Kaiser Permanente went beyond the minimum requirements of filling out Form 990 Schedule H and listed its additional activities in Part VI, including reduction of toxins in the supply chain, reducing vehicle trips, designing buildings to reduce carbon dioxide emissions, and water conservation. The new IRS Form 990 Schedule H provides a forum for documenting environmental activities that benefit communities. Gerwig explained the value of describing additional activities in Part VI of Schedule H. “By including Kaiser Permanente's sustainability activities in section six, we are informing financial and compliance leaders in the healthcare sector about sustainability initiatives that they may have otherwise never had an opportunity to learn about and may not recognize their connection to our mission and community benefit,” she says.

A focus on the food system is a good example of Kaiser Permanente's approach to weaving together healthy communities and environmental sustainability. “We support programs that help provide healthy and affordable food to underserved communities. We also support local food and pesticide-free food when available, which reduces environmental pollution. We call these integrated approaches ‘healthy environments,’” Gerwig says.

Health reform and community benefit

The Affordable Care Act requires charitable, tax-exempt hospitals to conduct a community needs assessment and develop an implementation strategy to meet the needs that are identified. This requirement offers a potential for collaboration and increased communication. In a resource being prepared by CHA, community benefit leaders are urged to look at the root cause of community health problems as they develop strategies to address community health needs. Often, environmental hazards can be found at the root of health problems. This is where community benefit and environmental teams can work together.

Often, environmental hazards can be found at the root of health problems. This is where community benefit and environmental teams can work together.

Environmental teams are accustomed to setting environmental goals after capturing baseline data for materials and waste, and energy and water. But by sitting down with the community benefit department and participating in the community assessment process and implementation strategy, there may be a way to identify opportunities to both meet the needs identified through the community assessment and improve environmental performance, safety, and community engagement.

At facilities everywhere

Green teams and sustainability coordinators may consider reaching out to a community benefit department to explain their role in sustainability activities and see if there's room for participation in the development of a community health assessment. They may then plan and collaborate in identifying appropriate sustainability activities. An oversight committee or leadership team, like the one described at Kaiser, would be a good place for capturing the stories and data related to various programming, such as:

  • Quality;
  • Safety;
  • Environment of care;
  • Community benefit;
  • Construction;
  • Development;
  • Healing teams;
  • Patient experience;
  • Human resources;
  • Communications;
  • Ethics;
  • Mission demonstration; and
  • Leadership.

All of these details can be captured and compiled in a formal report to better understand how all of the pieces fit toget

What's next?

CHA and Practice Greenhealth released their Environmental Sustainability Getting Started Guide, and CHA's next project is a book on developing a community health assessment-from team development to prioritization and plan development. HCD

For more information, visit Kaiser Permanente's Green Resource Center at, Catholic Health Association at, or Practice Greenhealth at Janet Brown is the director of sustainable operations and green building at Practice Greenhealth. She can be reached at Healthcare Design 2011 April;11(4):20-22