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.

abstract: In the United States, under the provisions set forth by a policy known as community benefit, nonprofit hospitals receive special tax exemptions from government in exchange for providing a wide range of health care services to the communities in which they are located. In recent years, nonprofit hospitals have claimed billions of dollars as community benefit justifying their tax-exempt status. However, growing criticism by numerous stakeholders has questioned the extent to which the level of community benefit claimed by nonprofit hospitals reflects the exemptions they receive. In addition, a dearth of research exists to understand the relationship between community benefit claims and the impact they have on improving the health of communities. In an effort to better understand the relationship between community benefit claims, tax status, and community health outcomes this study examines the community benefit policies of a nonprofit healthcare system representing hospitals in California, Nevada, and Arizona. It does so by reviewing materials produced by the system, her hospitals, vested stakeholders, and government that have shaped the development, implementation, and assessment of community benefit policy processes. Findings of the study suggest that the majority of nonprofit hospital community benefit claims are consumed by shortfalls reported between costs associated with providing care to Medicare and Medicaid patients and the compensation nonprofit hospitals receive from government. Results of the study also demonstrate that community benefit policies do positively impact the health of communities. However, future community benefit policies need to be refined to include measures that capture the magnitude of community health improvement if the relationship between policy and health outcomes is to be fully realized. / Dissertation/Thesis / Ph.D. Public Policy 2013

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Community benefit schemes in the context of wind power are increasingly provisioned by developers as a means of generating local socio-economic and environmental value, fostering social relations and strengthening acceptance. Determining an appropriate and effective benefit scheme can prove challenging, given the variation of exposed stakeholders, diversity in schemes and the lack of decision making guidance. A multi-criteria decision aid framework for identifying the most appropriate scheme(s) for a hypothetical wind power project is developed. The framework is based on AHP and PROMETHEE II decision support tool, where six (6) alternative schemes are assessed using the preferences of five (5) stakeholders and their relevant criteria. The framework was applied to a fictitious development on the island of Gotland. Results from the applied example indicate that the most locally suited outcome was the ownership based models. It is anticipated that the methodological framework can help identify the scheme(s) that respond to the needs and preferences of the locality. Moreover, a decision making platform of this nature can provide practical support to developers, communities and local authorities, and contribute to a more effective and efficient development and negotiation process surrounding community benefit schemes.

Ecotourism has often failed to deliver appropriate, tangible benefits to host communities living near protected areas in developing regions of Africa. The Robford Community Conservation Benefit Centre (RCCBC) model was developed as a means to overcome many of the common problems of community-based ecotourism and to enhance the range and flow of benefits to such communities by developing a suite of products and programmes aimed specifically at scientists, volunteer tourists and participatory environmental research tourists. This study tests the aims that the necessary tourism, geographic, social and research conditions are present for the implementation of the RCCBC model in a local community situated close to the Great Fish River Nature Reserve (GFRNR) in South Africa. Situational assessment fieldtrips determined that the GFRNR, its immediate tourism egion and the ten settlements surrounding the nature reserve conformed to RCCBC development guidelines and were suitable for further detailed investigation. One of the settlements, Glenmore Village, conformed most closely to the RCCBC model’s guidelines for selecting a preferred host community. A census survey of all households in Glenmore determined a demographic profile of village residents. A random sample survey of 70 Glenmore households established a social profile of the community’s residents and their attitude to various aspects of the RCCBC model. A spatial analysis of the Glenmore precinct determined that sufficient, suitable land was available for the development of RCCBC products and programmes. The findings of the research indicated that the tourism, geographic, social and research conditions were present at Glenmore, the GFRNR and its surrounding tourism region for the implementation of the RCCBC model and the development of the model’s proposed products and programmes at Glenmore Village. Implementation of the RCCBC model at Glenmore and the GFRNR as a pilot study could introduce a new way of bringing tangible, meaningful benefits to select communities located close to protected areas in existing tourism regions that have failed to benefit either completely or partially from traditional forms of ecotourism development in the past. / Environmental Sciences / M. Sc. (Environmental Management)

Ecotourism has often failed to deliver appropriate, tangible benefits to host communities living near protected areas in developing regions of Africa. The Robford Community Conservation Benefit Centre (RCCBC) model was developed as a means to overcome many of the common problems of community-based ecotourism and to enhance the range and flow of benefits to such communities by developing a suite of products and programmes aimed specifically at scientists, volunteer tourists and participatory environmental research tourists. This study tests the aims that the necessary tourism, geographic, social and research conditions are present for the implementation of the RCCBC model in a local community situated close to the Great Fish River Nature Reserve (GFRNR) in South Africa. Situational assessment fieldtrips determined that the GFRNR, its immediate tourism egion and the ten settlements surrounding the nature reserve conformed to RCCBC development guidelines and were suitable for further detailed investigation. One of the settlements, Glenmore Village, conformed most closely to the RCCBC model’s guidelines for selecting a preferred host community. A census survey of all households in Glenmore determined a demographic profile of village residents. A random sample survey of 70 Glenmore households established a social profile of the community’s residents and their attitude to various aspects of the RCCBC model. A spatial analysis of the Glenmore precinct determined that sufficient, suitable land was available for the development of RCCBC products and programmes. The findings of the research indicated that the tourism, geographic, social and research conditions were present at Glenmore, the GFRNR and its surrounding tourism region for the implementation of the RCCBC model and the development of the model’s proposed products and programmes at Glenmore Village. Implementation of the RCCBC model at Glenmore and the GFRNR as a pilot study could introduce a new way of bringing tangible, meaningful benefits to select communities located close to protected areas in existing tourism regions that have failed to benefit either completely or partially from traditional forms of ecotourism development in the past. / Environmental Sciences / M. Sc. (Environmental Management)