Abstract
Parks and greenspaces provide well-documented benefits for physical, mental, and social health. Nonprofit hospitals, required to conduct Community Health Needs Assessments (CHNAs) and invest in social determinants of health, could therefore advance health and health equity by supporting park access and quality. We reviewed CHNAs from 51 large nonprofit hospitals in U.S. cities ranking in the lower half of the 2024 Trust for Public Land ParkScore Index. We analyzed how parks and greenspaces were addressed in CHNAs and conducted interviews and focus groups with 29 representatives from hospitals, park agencies, and community organizations. Mental health, access to care, and chronic disease were the most frequently identified community priorities in CHNAs. Although 56.9% of CHNAs included data on greenspaces and 54.9% identified parks as a community need, many CHNAs gave limited attention to parks - largely due to limited familiarity, capacity constraints, and competing priorities rather than opposition. Qualitative findings revealed 4 key themes: (1) CHNAs often included community input but lacked resources and coordination to address built environment needs; (2) parks were widely recognized as vital to mental health and social connection but constrained by inequitable access, safety concerns, and underinvestment; (3) existing collaborations between hospitals, parks, and community groups demonstrated promise yet faced capacity barriers; and (4) historical and ongoing structural racism shaped inequities in park access and investment. Our findings reveal an under tapped opportunity for hospitals to integrate parks and greenspaces into CHNAs, strengthen partnerships with park agencies, and direct community benefit investments toward parks to improve community health outcomes. Doing so could help align hospital community benefit spending with upstream drivers of health. We conclude with recommendations for hospitals, park agencies, and community organizations to collaborate in advancing park equity and health equity.