Health Care Reform Must Be Local, Despite Federal Legislative Efforts
Published
August 15, 2012
Primary care physicians and local communities—not federal
legislation—will determine the path of true health care
reform, according to a policy paper co-written by Kim
S. Griswold, MD, MPH, associate professor of family
medicine.
“Communities
of Solution: The Folsom Report Revisited,” published
online in the May/June issue of Annals of Family Medicine,
calls for a closer alliance between pubic health and primary
care.
In that regard, it echoes the original Folsom Report published
in 1967.
“Nearly 50 years later, we’re calling for the same
thing,” says Griswold, the paper’s corresponding
author. “We need to inject—and maintain—the
public ingredient in medical care.”
Folsom Report Used to Explore Health Care Solutions
The first Folsom Report grew in part out of the social justice
movements of the 1960s and ’70s. It led to several important
advances, including the establishment of family medicine as a
specialty.
In 2010, the American Board of Family Medicine invited Griswold
and eight other family physicians across the U.S. to revisit the
seminal 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 Department of
Psychiatry and 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.”
Helping Patients Overcome Obstacles to Healthy Living
The authors recommend that physicians connect with public health
and other community health workers to develop or find resources
that overcome obstacles to a patient’s healthy lifestyle.
Such resources might include 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.
“I can provide the patient with medications, but I
can’t fix the neighborhood he or she lives in,”
Griswold says. “For that, I need the public health
perspective.”
Capitalizing on Skills of Community Health Workers
The report notes that fewer primary care physicians practice now
than in past decades, especially where they are most needed.
It suggests that primary care physicians consider using
community health workers and health educators in their
practices—a tactic that has improved local health care in
numerous cities, including Buffalo.
Formidable barriers exist in inner-city communities for growing
numbers of immigrants and legally resettled refugees, the report
states.
At Buffalo’s Neighborhood Health Center, for example,
Griswold and colleagues provide care to refugees from various
countries. In one case, physicians needed to find a translator who
could speak one of 14 Burmese dialects.
Delivering Integrated Care Regardless of Boundaries
The new Folsom Group calls for “communities of
solution” to deliver integrated health services and manage
problems, including language and transportation barriers,
regardless of artificial boundaries, such as political or
geographic lines.
“The nation has done this beautifully with disaster
response, where first responders in a region react immediately
without regard to which jurisdiction it is,” Griswold says.
“That’s what we need for health care.”
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