ECC hosted a half-day roundtable discussion in Los Angeles and Oakland on The Role of California Health Institutions in Promoting Community Health and Wealth. The event was sponsored by The California Endowment and represented a collaborative effort with Health Care Without Harm, Blue Green Alliance, Health Care Advancement Project, MIT-CoLab and GPS Capital, with the common vision of greener, healthier and wealthier communities. We applied a comprehensive lens to healthy and energy efficient buildings, green purchasing practices, local procurement, jobs and business development, green workplace practices and broader community health strategies. Dr. Robert Ross, President of The California Endowment, issued the mandate to move health reform "from a plethora of activities into a coherent strategy.” The Chairman of the LA County Board Supervisors, Supervisor Mark Ridley-Thomas, and Alameda County's Supervisor Keith Carson provided examples of the vitality of health institutions in the regional economy. After hearing best practices in health reform from Kaiser Permanente and health economies from Ted Howard of the Democracy Collaborative, participants representing hospitals, community health centers, and public health agencies spent two hours discussing the requirements of maximizing the outcomes of health reform. The summarizing take-aways from the convenings are: 1) the nexus between health and economic development is not yet structured into the DNA of health institutions; 2) there is growing interest and participation in sustainable practices among health institutions but help is needed to channel this toward economic outcomes; 3) health reform does not value the economic determinants of health but enlightened hospitals understand it to be important to their bottom line; 4) a comprehensive approach to health reform that is inclusive of a stronger economic platform does not exist. The participants in LA and Oakland urged us to continue the dialogue.