Who’s Accountable for Community Health?

Amy Einhorn, St. David’s Foundation


Accountable Communities for Health (ACH) is a model that takes the health care system out of the driver’s seat of advancing health equity, focusing, instead, on a shared vision and responsibility with community for creating conditions for health.
Photo courtesy of St. David’s Foundation

Last year, St. David’s Foundation invested in the Texas Accountable Communities for Health Initiative (TACHI), envisioned and led by our long-standing Foundation partner and peer funder, Episcopal Health Foundation, to accelerate its implementation in Central Texas and experiment with this strategy for achieving our goal of achieving substantive, long-term improvements in community health and well-being.

This investment reflects St. David’s Foundation’s understanding that addressing root causes of poor health and disparities in health outcomes cannot solely be solved in hospitals or doctors’ offices. Our grantees, peer funders, and collaborators understand the urgency of addressing the “upstream” health factors that impact the health and wellness of our community rather than focusing only on providing treatment when disease presents itself.

“What excites us about this work is the profound opportunity it provides us to have one foot in ‘today’ and one foot in ‘tomorrow,’” said Dr. Edward Burger, President and CEO of St. David’s Foundation. “Rethinking how to lower systemic barriers and advance health equity in a meaningful, sustainable way requires the entire community to come together.”

Photo courtesy of St. David’s Foundation

The TACHI work provides a structure for changing how a community creates the conditions for health and how power is shared – especially among low-income populations, people of color and other typically underserved populations.

Historical approaches that centered the health care system to support and improve health by addressing social factors have often faced a specific set of challenges, including:

- funding streams being siloed and short-term in nature,

- individual organizations having competing priorities,

- data systems being disconnected,

- equity not being embedded in heath policy and practice, and

- the lack of authentic engagement among communities and stakeholders in what they perceive as initiatives led by the health care system.

In response…

The Accountable Communities for Health (ACH) model is intended to create multi-sector, community-based partnerships that bring together health care providers, public health, health care payors, social service organizations, local government, and other local partners and residents to address the unmet health and social needs of the individuals and communities they serve.

The model serves as a local platform for bringing stakeholders and residents together to achieve greater equity on a sustainable basis rather than provide “one-time” interventions based around a health care delivery system. There are several key elements that are central to ACH:


- a shared vision among the participants, an inclusive governance structure,

- an incorporation of strategies for long term sustainability and funding,

- commitment for ACHs to hold themselves accountable to community stakeholders and to advance equity in the community.

Through our work, we recognize that systemic problems can’t be solved in silos. Our investment in TACHI reflects an evolution of our strategy that connects people with resources outside the walls of traditional health care settings and embraces the unique opportunity of clinics to holistically serve patients through upstream interventions that have the potential to create positive change in the overall health and wellness of the communities St. David’s Foundation serves.

Photo courtesy of St. David’s Foundation
We are eager to continue to learn how we can remove barriers to improve community health and ensure health equity. We appreciate being in partnership with Episcopal Health Foundation and the ACH sites in Central Texas to integrate learning across this exciting initiative to create the conditions for health in our community.