Podcast Summary:

New Books Network
Episode: Daniel Skinner et al., "The City and the Hospital: The Paradox of Medically Overserved Communities"
Host: Laura Stark
Guest: Professor Jonathan Wynn (co-author; University of Massachusetts)
Date: December 4, 2025

Episode Overview

This episode features a rich conversation with Professor Jonathan Wynn, one of the co-authors of The City and the Hospital: The Paradox of Medically Overserved Communities (U Chicago Press, 2023). The book unpacks the central paradox: despite living near vast and resourceful hospitals—so-called "anchor institutions"—urban communities often suffer the poorest health outcomes. Drawing on 200+ interviews across Hartford, CT; Cleveland, OH; and Aurora, CO, the authors analyze how race, history, policy, and institutional practices co-produce underserved urban environments. Throughout, the discussion weaves in insights from sociological theory, qualitative research, and urban studies—providing listeners with both academic and practical policy perspectives.

Key Discussion Points & Insights

1. Genesis of the Project and Collaborative Process

[03:16–06:27]

• The collaboration began organically among friends from graduate school, specifically Jonathan Wynn and Daniel Skinner, later joined by Berkeley Franz.
• Each author brought different expertise: Wynn with qualitative, place-based research; Skinner with theory and medical policy. The puzzle of hospitals’ urban paradox emerged after their collaboration began—a search for a research question, not an answer for a predetermined problem.
  • “It actually came about coming together and searching for a puzzle, which I think is sometimes the case.” – Jonathan Wynn [05:17]

2. The Importance of Place in Studying Hospitals

[06:39–11:20]

• Wynn explains his fascination with "place"—from cities' cultures to unique neighborhood stories. While medicine is often imagined as increasingly placeless (telehealth), he advocates for the necessity of localized, spatially grounded analysis.

• Hospitals may be similar inside ("behind the walls") but have vastly different relationships with their immediate neighborhoods, shaped by local histories and demographics.

• Personal storytelling: Wynn likens his curiosity about place to running after stories in an alley, referencing sociologist Howie Becker.

  • “I am a complete sucker for how communities are different...I want to know what the thing is in these different places...” – Jonathan Wynn [09:32]

3. Sociological Theory: W.E.B. Du Bois and Fundamental Cause Theory

[11:44–13:11]

• Stark brings up the influence of Du Bois’ The Philadelphia Negro and “fundamental cause theory” by Phelan and Link: systemic social determinants (class, power, race) shape health outcomes more than immediate medical care.

• The book moves fundamental cause theory beyond class, foregrounding race and the historical dynamics between majority-white hospital professionals and communities of color. This ongoing divide shapes access, trust, and engagement.

  • “You're adding into that serious strong consideration and attention to race...that this really shaped the formation stories as you write about in chapter two, that affected then the possibilities for what the hospital could do...” – Laura Stark [13:11]

4. Crafting Community Stories Without Homogenizing

[14:32–18:03]

• Wynn discusses the challenge of representing diverse community voices without reduction or stereotyping.

• The stories chosen for the book were those repeated and resonated across interviews, not single outliers. The authors were careful to avoid imposing their own perspectives, focusing on stories that truly emerged from the data.

  • “We wanted to know how to best tell this story without having our own prejudices against us...allow ourselves to be open to what the communities were saying and talking to us about.” – Jonathan Wynn [18:44]

5. Navigating Researcher Positionality and Community Representation

[18:03–21:23]

• The team, being racialized as white researchers, remained conscious of their outsider status throughout.

• Their approach was intentionally nonpartisan: not pro- or anti-hospital, resulting in the project being “universally disliked”—hospital associations felt criticized, while activists found it insufficiently radical.

  • “We probably would have had a more successful book if we came out pro hospital or anti hospital. But it's universally disliked, I think, because…” – Jonathan Wynn [21:11]

6. Institutional Definitions vs. Lived Community Realities ("Community Benefit")

[24:00–27:13]

• Discussion of “community benefit” as a legal requirement for non-profit hospitals (Affordable Care Act, EMTALA).

• The term is often interpreted loosely by hospitals, sometimes claiming broad, institution-wide activities as community benefit even if the direct impact is limited.

  • “There’s certainly plenty of horror stories in...hospitals claiming all sorts of things, because there’s a lot of looseness when it comes to what you can claim as being community benefit…” – Jonathan Wynn [25:00]

• Recommendation: tighten legal definitions, look to alternative frameworks (like the Lown Institute’s racial equity rankings for hospitals).

7. Universities as Parallel Anchor Institutions

[27:45–29:14]

• The critique is extended to other anchor institutions, especially universities, which, through their property holdings and tax exemptions, also reshape city economies and landscapes.
  • “We could also be looking at universities as urban institutions...because of their tax free status, should be compelled to do more and beyond just pilot programs...” – Jonathan Wynn [27:45]

8. Defining “Community” in Research and Policy

[29:32–31:42]

• Hospital administrators often strategically define “community” to maximize favorable statistics and minimize liability.

• The book takes a straightforward, geographic approach, mapping census tracts surrounding each hospital, instead of using more subjective or institutionally biased boundaries.

  • “Their definitions of community were highly strategic...My definitions...was...census tracts...so what I was trying to do was not to try and bias our estimations…but just by geography.” – Jonathan Wynn [30:25]

9. The “Contact Zone”: Mismatched Engagement and Erasure

[33:27–35:19]

• Hospitals’ primary points of contact with the surrounding community are often limited to emergency departments (EDs) or tokenistic outreach (e.g., local hiring, farmers’ markets).
• Acquisition of local property can erase or replace critical community institutions (like funeral homes), undermining organic contact zones and further alienating residents.
  • “When they bought that property...they’re actually erasing community zones as well or contact zones as well.” – Jonathan Wynn [34:39]

10. Gentrification, Security, and Symbolism

[35:30–37:47]

• Hospital-driven development can accelerate gentrification and displacement.
• Tactics like heightened security—ostensibly for safety—often reinforce barriers rather than facilitating genuine community connection.
• Institutional practices sometimes serve symbolic goals (e.g., advertising at airports for “medical tourism”) more than the health of neighboring communities.

11. Policy Recommendations: Addressing Distal Causes

[36:43–41:25]

• Emphasize indirect determinants of health—education, jobs, neighborhood investment—as focal points for hospital-led community benefit strategies.

• Public safety is discussed as a key but underappreciated “contact point” between hospitals and their communities. Hospitals often work closely with urban police, an intersection fraught with historical and racial tensions.

  • “We stepped back...and said what is the story...that we're really going to be scared of if we don't include it...public safety...serves as a branch...most obvious public facing part [of hospital-community relations]...in tandem with urban policing, which...is a racialized institution as well.” – Jonathan Wynn [37:56–38:57]

• Suggests more substantive, community-led investments and tighter legal standards for what qualifies as “community benefit.”

12. Medical Tourism and Who the Hospital Serves

[40:15–41:11]

• Hospitals market themselves to out-of-state and international patients, often to the detriment of local, underserved populations.

• The proximity paradox: the closest neighbors typically receive the least benefit from these globally-focused institutions.

  • “Medical tourism...it’s not because Cleveland is an international community. It is because people are flying into the clinic...It’s the folks who live around the hospitals who are actually being treated least by it.” – Laura Stark & Jonathan Wynn [40:39–41:11]

13. Integrating Community Health in Medical Education

[41:11–41:54]

• The book’s call for community health to become part of standard medical curricula is highlighted as a critical, if underemphasized, final recommendation.

  • “This should be mandatory reading...we should be assigning this book...I still feel that way.” – Jonathan Wynn [41:25]

Notable Quotes & Memorable Moments

• On Research Motivation:
  “It wasn’t a puzzle searching for an answer and bringing these people together. It actually came about coming together and searching for a puzzle...” – Jonathan Wynn [05:17]

• On Studying Place:
  “When I go to a neighborhood or a new city, I want to know what the thing is. I will eat the thing. I will eat anything that any place has.” – Jonathan Wynn [09:32]

• On Story Selection:
  “We brought up the stories that really, we heard over and over and over again. Right. And so it was not the case that we picked one that just was the most resonant. We picked the stories that actually, you know, came up in our neighborhoods and our communities repeatedly.” – Jonathan Wynn [15:47]

• On Research Neutrality:
  “We probably would have had a more successful book if we came out pro hospital or anti hospital. But it's universally disliked, I think, because…Some hospital folks...didn't like it.” – Jonathan Wynn [21:11]

• On “Community Benefit” Loopholes:
  “There’s a lot of looseness when it comes to what you can claim as being community benefit, including...a hospital saying that its entire med school...counts as community health.” – Jonathan Wynn [25:00]

• On Defining Community:
  “Their definitions of community were highly strategic...In Cleveland...the focus on Fairfax county...while literally turning their back on the huff in the more African American community...” – Jonathan Wynn [30:25]

• On Institutional Erasure:
  “When they bought that property...they’re actually like erasing community zones as well or contact zones as well.” – Jonathan Wynn [34:39]

• On Medical Tourism:
  “It's not because Cleveland is [so] international. It is because people are flying into the clinic...It’s the folks who live around the hospitals who are actually being treated least by it.” – Laura Stark & Jonathan Wynn [40:15–41:11]

• On Gentrification and Security:
  “There’s things like actual physical barriers...also there’s pretty strong policing and security around hospital areas...and displacement, which is definitely something that’s happened...” – Laura Stark [35:57]

Timestamps for Important Segments

• [03:16] – Introduction to research team and genesis of the project
• [08:00] – Importance of place-based research in healthcare
• [11:44] – Application of sociological theory (Du Bois, fundamental cause)
• [14:32] – Including and selecting community stories
• [18:03] – Representation without homogenization and researcher positionality
• [24:00] – Defining and critiquing “community benefit” in policy
• [29:32] – Conflicting definitions of “community” between hospitals and residents
• [33:27] – The “contact zone” concept and how hospitals shape/erase community
• [36:43] – Policy recommendations: shifting development for equity
• [41:11] – Medical education and integrating community health

Conclusion

This episode delivers a nuanced analysis of how hospitals, as supposed community anchors, paradoxically coexist with poor health in their shadow. Through an engaging blend of sociological theory, urban history, and policy critique, Wynn and his co-authors challenge listeners to rethink assumptions about healthcare access, institutional responsibility, and the deep-seated forces that produce persistent urban health disparities.