Aligning Investments to Improve Population Health

  • A mature couple looking at vegetables at a farmer's market

Aligning Investments to Improve Population Health: A Statewide Strategy to Address the Social Determinants of Health


The COVID-19 pandemic and related economic challenges have heightened focus on the role that the physical environment and social determinants of health1 play in wellbeing and economic growth. Simultaneously, the nation is reckoning with the consequences of inequality that further emphasize the need to address the social determinants of health that contribute to poor health outcomes for many vulnerable individuals and families.

Hospitals are in a unique position to invest in community development efforts that support the health of local residents and reduce hospital costs associated with preventable emergency room and inpatient utilization. Now is the time for coordinated action across institutions and sectors to improve community health in New Hampshire. We propose a statewide strategy to engage health, community development, and other stakeholder leaders in New Hampshire to align investments and promote policies that address the social determinants of health.


The overarching goal of this long-term project is to leverage hospital and community stakeholder connections and expertise to:

  1. Develop a statewide fund for collective community investment
  2. Create a common policy agenda for health care leaders that focuses on building capacity to address the social determinants of health

Project Overview

This data-driven project will be conducted in two phases. Phase 1, the planning and research or “blueprint” phase, will last approximately 12 months. In the initial Phase 1, the goal is to use quantitative and qualitative data to inform Phase 2, which includes the development of a fund, targeting of initial investments, and establishing a shared policy agenda.

This project is a multidisciplinary collaboration between the Center for Impact Finance at the Carsey School of Public Policy at UNH, the Center to Advance Community Health and Equity (CACHE) at the Public Health Institute, the Institute for Health Policy and Practice at UNH, and the New Hampshire Hospital Association/Foundation for Healthy Communities. Michael Swack, director of the Center for Impact Finance at the Carsey School, serves as the co-principal investigator of the project along with Kevin Barnett of the Public Health Institute.

The New Hampshire Hospital Association (NHHA) and its Foundation for Healthy Communities, in partnership with the Center for Impact Finance at the Carsey School of Public Policy at UNH and the Public Health Institute, has already hosted a series of convenings of hospital and community development leaders to advance this agenda. Teams of hospital and community development leaders met in April and October 2018, and most recently in May 2019 to discuss a statewide collaborative strategy that takes optimal advantage of existing assets and inspired leadership. Through these convenings, 20 New Hampshire hospitals have already committed to participating.

center to advance community health and equity logo
institute for health policy and practice logo
Foundation for healthy communities logo

The project is be overseen by a 14-member steering committee comprised of hospital leaders, community development leaders, public health officials, public agency leaders, representatives from philanthropic organizations and bank representatives.

Board Members: 

  • John Hamilton – Acting President, New Hampshire Community Loan Fund
  • Katy Easterly Martey – Executive Director, New Hampshire Community Development Finance Authority
  • Dean Christon – Executive Director, New Hampshire Housing Finance Authority
  • Maureen Beauregard – President and CEO, Easterseals 
  • Woullard Lett – Regional Lead, New England Region of the Unitarian Universalist Association
  • Patrick Tufts – President and CEO, United Way 
  • Robert Tourigny – Executive Director, NeighborWorks Southern New Hampshire
  • Cynthia McGuire – President and CEO, Monadnock Community Hospital 
  • Michael Peterson – President and CEO, Androscoggin Valley Hospital
  • Ben Bulkley – Finance and Strategy Course Director, The Dartmouth Institute
  • Sally Kraft – VP of Population Health, Dartmouth-Hitchcock Hospital 
  • Dick Jennings – Senior Vice President, Commercial Loan Officer for Mascoma Bank 
  • Beth Koester – Associate Medical Director, NH for Harvard Pilgrim Health
  • Tym Rourke – Director of New Hampshire Tomorrow, New Hampshire Charitable Foundation
  • Trinidad Tellez – Principal, [Health] Equity Strategies, LLC

1. Definition: The economic and social conditions and their distribution among the population that influence individual and group differences in health status. They are health promoting factors found in one's living and working conditions (such as the distribution of income, wealth, influence, and power), rather than individual risk factors (such as behavioral risk factors or genetics) that influence the risk for a disease or vulnerability to disease or injury. (Sources: and