The City and the Hospital - by Daniel Skinner & Jonathan R Wynn & Berkeley Franz

About the Book

"In this project, sociologists Jonathan R. Wynn and Berkeley Franz and political scientist Daniel Skinner set out to examine why so many communities surrounding hospitals are economically distressed and medically underserved. On the one hand, hospitals anchor the communities that surround themoften staying in their communities for decades. Hospitals craft strategies to engage with the surrounding community, many of them focused on buying and hiring locally. On the other hand, hospitals will often only provide care to the surrounding community through emergency rooms designed to manage crises quickly, reserving advanced medical care and long-term treatment for those who can pay for it. Many hospitals buy real estate in their neighborhoods and advocate for development programs that drive gentrification and displacement. To understand how urban health care institutions work with their communities, the authors address power, history, race, and urbanity as much as the workings of the medical field. The project focuses on three urban hospitals: Connecticut's Hartford Hospital, the crown jewel of the Hartford Healthcare system; the Cleveland Clinic, which coordinates with other providers for routine care while its main campus provides specialty care; and the University of Colorado Hospital, a rare example of an anchor institution that moved out of its urban area. Through this examination, the authors recast urban hospitals in a new light: as not only medical institutions, but also a complex urban force"--

Book Synopsis

A surprising look at how hospitals affect and are affected by their surrounding communities.

An enduring paradox of urban public health is that many communities around hospitals are economically distressed and, counterintuitively, medically underserved. In The City and the Hospital two sociologists, Jonathan R. Wynn and Berkeley Franz, and a political scientist, Daniel Skinner, track the multiple causes of this problem and offer policy solutions.

Focusing on three urban hospitals--Connecticut's Hartford Hospital, the flagship of the Hartford Healthcare system; the Cleveland Clinic, which coordinates with other providers for routine care while its main campus provides specialty care; and the University of Colorado Hospital, a rare example of an urban institution that relocated to a new community--the authors analyze the complicated relationship between a hospital and its neighborhoods. On the one hand, hospitals anchor the communities that surround them, often staying in a neighborhood for decades. Hospitals also craft strategies to engage with the surrounding community, many of those focused on buying locally and hiring staff from their surrounding area. On the other hand, hospitals will often only provide care to the neighboring community through emergency departments, reserving advanced medical care and long-term treatment for those who can pay a premium for it. In addition, the authors show, hospitals frequently buy neighborhood real estate and advocate for development programs that drive gentrification and displacement.

To understand how urban healthcare institutions work with their communities, the authors address power, history, race, and urbanity as much as the workings of the medical industry. These varied initiatives and effects mean that understanding urban hospitals requires seeing them in a new light--not only as medical centers but as complicated urban forces.

Review Quotes

"The joy of this book is in the richness of its case studies. The hospitals are explored across a series of substantive chapters covering the historical context for relationships between communities and hospitals, the community engagement work hospitals undertake, and the frictions that arise within more informal "zones of contact" between hospitals and local residents, especially within communities of color. The authors expertly marshal data to bring alive the neighborhoods and institutions they describe, conveying the voices and perspectives of community organizers, activists, and residents alongside hospital staff and management."-- "American Journal of Sociology"

"An important and timely contribution for those who care about the life of the American city, about inequalities, and about our medical system. Benefiting from three scholarly perspectives, this work provides a beautifully written and empirically rich assessment of how hospitals fit within communities, and provides clear policy prescriptions for how these institutions could better serve their mission and our cities."--Shamus Khan, Princeton University

"Across America, communities are often excluded from the world-class care provided walking-distance from their homes. This book chronicles these gut-wrenching urban health disparities--how they came to be, how hospitals and policymakers learned to tolerate them, and what we must do about them. The City and the Hospital is essential reading for any citizen, policymaker, and hospital leader who wishes to address this profound failure of America's medical political economy."--Harold Pollack, University of Chicago

"By comparing three different hospitals and their communities, The City and the Hospital shows how hospitals are not only medical institutions but powerful and complex forces within urban contexts. This truly novel recasting generates important insights about policy interventions that could transform hospital/city relationships and improve population health."--Sara Shostak, Brandeis University

About the Author

Daniel Skinner is associate professor of health policy in the Department of Social Medicine at Ohio University Heritage College of Osteopathic Medicine, Dublin and the author of Medical Necessity: Health Care Access and the Politics of Decision Making. Jonathan R. Wynn is professor and department chair of sociology at the University of Massachusetts Amherst and the author The Tour Guide: Walking and Talking New York and Music/City: American Festivals and Placemaking in Austin, Nashville, and Newport, both published by the University of Chicago Press. Berkeley Franz is associate professor of community-based health in the Department of Social Medicine at the Ohio University Heritage College of Osteopathic Medicine, Athens, OH.