| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH |
|
|
|
|||||||
|
|||||||||
TRACK to:
|
|
Electronic letters published:
![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
A Model for Us All
Kaufman et al. The Health Commons
|
|
|||
|
Gene A. Kallenberg, San Diego, CA Chief, Division of Family Medicine, UCSD
Send response to journal:
|
Kaufman’s article, “The Health Commons and Care of New Mexico’s Uninsured” offers a comprehensive roadmap for how to begin to solve some of the most challenging health and social problems facing the country’s uninsured, high risk and left-behind populations. Weaving a complex but highly focused, coordinated web of diverse social, medical and economic/employment development services out of the usually disjointed and unconnected hodge-podge of pre-existing programs, this paper shows us what could be done all across the country. This work draws on several successful models that have each partially addressed separate pieces of the puzzle: the service-learning movement that marries community-based learning opportunities for health professional trainees with much-needed service provision to populations in need; the community health worker movement that has provided the translational connection between needed services and populations who don’t know how to or have difficulty accessing them; the K-12 health professionals career development efforts of the long-standing national AHEC Program; the one-stop shopping concepts of the 60’s community health and law centers; the neighborhood economic development zone concept; and finally the use of more recent technologies of hotlines and the Web to connect people with resources. By putting these all in place together the “Health Commons” concept offers the opportunity to really move the bar of accomplishment a significant distance. The concept, as demonstrated in the four examples Kaufman includes, is flexible enough to be molded by local community preferences, economic circumstances, available funders and professional helping resources, while remaining constant enough in all the needed elements to be successful. In reading the description I can already see multiple useful applications to my own local situation in San Diego both from multiple perspectives of connecting many of the existing “dots” in our local safety net, of enhancing our health professions training programs and of educating our own Dean and AHC leadership about how they can collaborate with the local communities in need to produce mutually beneficial outcomes. I plan to share it with several of our local academic and community medicine leaders. This is a call for AHCs to engage again in their historic role of playing a major facilitating role in the nation’s safety net but in a totally informed, partnering and modern fashion. Competing interests: None declared |
|||
|
|
|||
|
John J. Frey III, MD, Madison, WI, USA Professor, University of Wisconsin School of Medicine and Public Health
Send response to journal:
|
In their article in this issue, Kaufman and his colleagues assert that family medicine should “catalyze the Health Commons of the Future”. They believe bringing together those who are broadly interested in the health of communities should be the model of care that informs clinical practice. While most of us may not work in a Health Commons, we can work toward communities of care that reflect a similar purpose and share similar values. This article is a metaphor for returning to the historic roots of the discipline by partnering with the communities we serve. Doctors connected to their communities have always been able to find hope and sustain optimism in both patients and providers.(1) In an era of discouragement for family medicine, this may be one of the best outcomes of the process described as a Health Commons. However, Kaufman and his colleagues also remind us that work in communities is hard, requiring patience, intellectual humility, listening, and moving beyond long held feelings of suspicion and distrust. We have always known that, while the family is the most important social system that affects human health, that same family can also be a source of health problems and illness. Similarly, most of the literature in social epidemiology has shown that strong communities and neighborhoods create an environment of health and social capital.(2) However, those same communities can also add to the burden of already marginalized individuals in very destructive ways and amplify physical and emotional illness.(3) The challenge for family medicine in academic medicine is to use our hard won role as believable witnesses and advocates for our communities to bring people together, indeed, in a Commons, of thought and action. This, of course, can’t be achieved solely by family medicine. What Kaufman and colleagues describe in this article is how the Health Commons they developed transformed the AHC at the University of New Mexico to put its resources and diverse clinical and research talent into innovative public-public partnership with the State, local health departments and with private sector insurers and employers. Managing such a transformation over time requires continuing trust, mutual respect, and recognition of mutual benefit. Sustaining this transformation, particularly in a State like New Mexico, with its large burden of uninsured and medical assistance patients and its rural/urban disparities, would be an achievement that should - and, I predict, will - inspire other states, other medical schools and academic health centers and, most importantly, family medicine to create a Health Commons for all. In the past two decades, universities have championed the idea of entrepreneurial partnering with industry, usually in the for-profit market. What Kaufman and colleagues describe is the opportunity for the transformation of Academic Health Centers into intellectual engines of innovation, collaboration and public partnerships, not with a new start up company, but with the society in which they live and work. Citizenship is an old word. But it is good citizenship that the Health Commons advocate and our leadership in that process has the possibility of making both us and our communities healthier. 1. Cutchin MP. Physician retention in rural communities: the perspective of experiential place integration. Health Place. 1997 Mar;3(1):25-41 2. Sellstrom E, Bremberg S. The significance of neighbourhood context to child and adolescent health and well-being: A systematic review of multilevel studies. Scand J Public Health. 2006;34(5):544-54. 3. Marmot M. Social determinants of health inequalities. Lancet. 2005 Mar 19-25;365(9464):1099-104. Competing interests: None declared |
|||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH |
TRACK: