Abstract
Adverse social determinants of health, such as unequal access to health care, lack of educational opportunities, and food insecurity are noted for shaping health disparities across race, ethnicity, and geographic context. Underlying racial discriminatory practices and policies catalyze and reinforce these disparities. Health care and academic medicine leaders must consider adopting strategies and programs that target health-related social needs by addressing underlying structural racism that shapes the uneven distribution of adverse social determinants. We present a groundwater allegory from the Racial Equity Institute to describe how leaders can leverage hospitals' role as anchor institutions within communities to ensure that the communities they serve have equitable resources and opportunities to improve their health. We describe how hospitals-through their economic power, policy influence, and wealth of data-can advance health equity through policies and practices that move beyond the individual level health-related social needs to change local social, political, and economic structural conditions that create disparities. We depict three potential ways for hospitals, by embracing their role as anchor institutions within communities, to address the groundwater conditions that have the most significant impact on community health.