BUFFALO, N.Y. -- Even with an imminent Supreme Court ruling on
the health care overhaul law, it's still the primary care physician
and the local community that will determine the path of true health
care reform. That's the message from "Communities of Solution: The
Folsom Report Revisited," a policy paper published online in the
May/June issue of Annals of Family Medicine (http://www.annfammed.org/content/10/3/250.full)
"The Folsom Report, published in 1967, called for a closer
alliance between public health and primary care," says
corresponding author Kim S. Griswold, MD, MPH, associate professor
of family medicine in the University at Buffalo School of Medicine
and Biomedical Sciences. "Now, nearly 50 years later, we're calling
for the same thing. We need to inject -- and maintain -- the public
ingredient in medical care."
The original Folsom Report grew, in part, out of the social
justice movements of the 1960s and 1970s. It was responsible for
several important advances, including the establishment in 1969 of
a new medical specialty called family medicine.
In 2010, Griswold was one of a group of nine family physicians
from throughout the U.S. who were brought together as the Folsom
Group by the American Board of Family Medicine to revisit and
discuss the original Folsom Report.
"Our goal was to look at the intersections of health care reform
at the federal and local levels and to look at health care
disparities," says Griswold, who also is a faculty member in the UB
Department of Psychiatry and in the Department of Social and
Preventive Medicine in the School of Public Health and Health
Professions. "We used Folsom as a springboard to see how we could
create healthier communities across the nation.
"As family physicians, we care about the patient in front of us
and the community from which he or she comes," Griswold says. "I
care about your diabetes but what if there aren't safe places in
your community for you to walk around and exercise? I can provide
the patient with medications but I can't fix the neighborhood he or
she lives in. For that, I need the public health perspective."
Griswold notes that by connecting with public health and other
community health workers, physicians can develop or find resources,
such as a shuttle to a nearby park so patients can safely exercise
or to well-stocked grocery stores, where they can purchase food for
a healthier diet.
The paper mentions that there are now fewer primary care
physicians than in past decades, especially where they are most
needed. It notes that in some communities, such as Buffalo, the
addition of community health workers has helped improve health care
at the local level. The paper suggests that primary care physicians
should consider as one option using community health workers and
health educators in their practices.
Formidable barriers also exist in inner-city communities for
growing numbers of immigrants and legally re-settled refugees. At
Buffalo's Neighborhood Health Center, for example, Griswold and
colleagues provide care to refugees from various countries. In one
case, she notes, a Burmese translator was needed, but they needed
someone who could speak one of the 14 Burmese dialects, making the
challenge of finding someone even more significant.
That's the type of situation that requires what the Folsom Group
calls "communities of solution," where problems, such as language
or transportation barriers, are managed and solutions are delivered
to the communities that need them, regardless of artificial
boundaries, such as political or geographic communities.
"The nation has done this beautifully with disaster response,"
says Griswold, "where first responders in a region all respond
immediately without regard to which jurisdiction it is. That's what
we need for health care."
Griswold notes that the publication of the report this year
followed the release in March of an Institute of Medicine Report on
the "Integration of Primary Care and Public Health" (http://iom.edu/Reports/2012/Primary-Care-and-Public-Health.aspx).
In addition to Griswold, the Folsom Group consists of these
family physicians: Sarah Lesko of the Center for Researching Health
Outcomes; Sean P. David of Stanford University School of Medicine;
Andrew W. Bazemore of the Robert Graham Center for Policy Studies
in Family Medicine and Primary Care; Margaret Duane of the Spanish
Catholic Center of Catholic Charities; Thomas Morgan of Vanderbilt
School of Medicine; C. Everett Koop of the C. Everett Koop
Institute at Dartmouth; Betsy Garrett of the University of Missouri
School of Medicine; and Larry Green of the American Board of Family
Medicine and the University of Colorado School of Medicine.