Article Figures & Data
Figures
- Figure 1
One city’s communities of solution.
Note: Political boundaries, shown in solid lines, often bear little relation to a community’s problem-sheds or its medical trade area.
Reproduced and adapted with permission from: Folsom M. Health is a Community Affair: Report of the National Commission on Community Health Service. Cambridge, MA: Harvard University Press; 1967:3, Fig 1.
- Figure 2
Health workforce changes 1960 to 2000.
Note: Segments represent the proportion of the total health professional workforce, composed of allied health professionals (eg, dietitians, clinical laboratory workers, physical therapists, emergency medical technicians, etc); physicians (allopathic, osteopathic), dentists, and pharmacists; and registered nurses from 1960, 1970 and 2000. Sources of data: Health Resources & Services Administration, Bureau of Health Professions, National Center for Health Workforce Analysis (all except for allied health: http://bhpr.hrsa.gov/healthworkforce/; allied health: http://bhpr.hrsa.gov/healthworkforce/).
Tables
Folsom Report Recommendations 1967 Folsom Report at 50: Grand Challenges Funded Provisions From ARRA, CHIPRA, and PPACA A. Organization and delivery of community health services community of solution by relevant administrative area, not by political (city, county, state) jurisdictions Grand challenge 1: Create a national network of community partnerships that engages and activates the citizenry to self-define communities of solution to develop and sustain community-tailored health programs at the local level aimed at matching local health needs with integrated health services PPACA: Community-based Collaborative Care Network Program; National Prevention, Health Promotion and Public Health Council, chaired by the US Surgeon General, to coordinate federal prevention, wellness, and public health activities and to “elevate and coordinate prevention activities and design the focused National Prevention Strategy in conjunction with communities across the country to promote the nation’s health. The strategy will take a community health approach to prevention and well-being, identifying and prioritizing actions across government and between sectors”; Community Transformation Grants B. Provision of high-quality comprehensive personal health services to all people in each community Grand challenge 2: Foster the ongoing development of integrated, comprehensive care practices (patient-centered medical homes), accessible for all groups in a community, through the creation of explicit partnerships with public health professionals and communities of solution ARRA: Increased funding for NIAMS CHCs, military hospitals, Veterans Administration, Indian reservations, NHSC, and COBRA subsidies
CHIPRA: Coverage of additional 4.1 million children
PPACA: Patient-centered medical home demonstration project within the Centers for Medicare & Medicaid Services; Medicaid parity with Medicare; increased insurance accessC. Every individual should have a personal physician who is the central point for integration and continuity of all medical and related services to the patient Grand challenge 3: Provide every individual in the United States the opportunity to form a partnership with a personal physician and a team of health professionals utilizing integrated community health services in communities of solution ARRA: Funding for wellness and prevention
CHIPRA: Funding for outreach, translation, interpretation; demonstrations to combat obesity
PPACA: Preventive health care coverage mandate; $250 million Prevention and Public Health Fund to community programs (including the HRSA Healthy Weight Collaborative); interagency council headed by Surgeon General, focus on prevention and public healthD. Prospective planning and management of comprehensive environmental health services, includes water, air, food, hygienic housing, activity, and recreation Grand challenge 4: Engage individuals in communities of solution in the creation of healthy environments, eliminating existing barriers to community-tailored strategies; endorse and implement a global conception of environmental health encompassing all physical, chemical, and biological factors external to a person that can potentially affect health PPACA: Community Preventive Services Task Force E. Ensure control of water and air pollution, biological and chemical product safety, radioactive material safety F. Accident prevention: State health departments should develop accident prevention programs. US Public Health Service should establish a national accident prevention, research, training, service, and information facility analogous to the present Communicable Disease Center Grand challenge 5: Engage communities of solution to recognize and address injuries as a main preventable source of global human death and disability, especially for children G. Family planning should be an integral part of community health services Grand challenge 6: Sustain and improve family planning as an integral part of community health services PPACA: State eligibility option for family planning services H. Coordinate land use, transportation, economic development, and city planning to provide most effective and space use for urban populations Grand challenge 7: Engage with community partnerships to coordinate with municipal authorities to design and build healthy living environments PPACA: Community Preventive Services Task Force I. Education for health: The community has a responsibility for developing an organized and continuing education concerning health resources for its residents; each individual has a personal responsibility for making full use of available health resources Grand challenge 8: Enhance health literacy to empower individuals within communities of solution to be active participants in promoting their own health and the health of their communities PPACA: Health care quality improvement programs; health care delivery system research; funding available for health literacy research J. Health manpower: Effective utilization of available health personnel will reduce the current manpower shortage, and continuous evaluation of the use of manpower, accompanied by necessary changes and retraining, will provide additional manpower for existing new health services Grand challenge 9: Create a health workforce to serve the needs of US communities, including community health workers ARRA: NHSC expansion
PPACA: Teaching Health Centers; Primary Care Extension Service; revisions to GME to favor nonhospital training; National Health Care Workforce Commission to align federal workforce resources with needs; preference of primary care for reallocation of unused GME slotsK. Hospital care: Further increases in hospital costs must not be accepted complacently; a wide range of vigorous and persistent actions must be taken by all parties concerned to moderate the costs of hospital care without adverse effects on quality Grand challenge 10: Integrate health services—aligning hospital, ambulatory, and community care—across settings to promote quality and create value PPACA: Establishment of accountable care organization pilot programs to comprehensively manage patient populations across settings L. Every state should have a single, strong, well-financed, professionally staffed, official health agency with sufficient authority and funds to carry out its responsibilities and to assure every community of coverage by an official health agency and access to a complete range of community health services Grand challenge 11: Transform the roles of the relevant federal, state, and local agencies by bridging public health and medicine to be effective partners in communities of solution PPACA: Research on optimizing the delivery of public health services; Prevention and Public Health Fund
Title IV, Prevention of Chronic Diseases and Improving Public HealthM. Voluntary citizen participation: A central factor in the growth and development of…personal and community health has been the participation of individuals and voluntary associations through dedicated leadership, financial support, and personal service Grand challenge 12: Engage and support a citizen volunteer network formed by communities of solutions to educate, motivate, and collaborate for strategic local, regional, and national resource allocation informed by credible and actionable data N. Action planning for community health services: Planning is an action process and is basic to development and maintenance of quality community health services Grand challenge 13: Utilize health information technology and emerging data-sharing innovative networks that enable the flow of relevant knowledge (public health, environmental, educational, legal, etc) to the communities of solution ARRA: Beacon Community Cooperative Agreement Program
PPACA: National Prevention, Health Promotion and Public Health Council; implementation of activities to improve patient safety and reduce medical errors through the appropriate use of best clinical practices, evidence-based medicine, and health information technology-
ARRA = American Recovery & Reinvestment Act of 2009; CHC = Community Health Center; CHIPRA = Children’s Health Insurance Program Reauthorization Act of 2009; COBRA = Consolidation Omnibus Budget Reconciliation Act; GME = graduate medical education; HRSA = Health Resurces and Services Administration; NIAMS=National Institute of Arthritis and Musculoskeletal and Skin Diseases; NHSC = National Health Service Corp; PPACA = Patient Protection and Affordable Care Act of 2010.
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Note: Grand challenges addressing each of the major recommendations from the Folsom Report10 and overlapping provisions from recent legislation.
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The Article in Brief
The Folsom Group
Background The fragmented US health system lacks a policy blueprint for systematic implementation of integrated, community health services. The 1967 Folsom Report, which called for more comprehensive health care, can help guide reform efforts and maximize the potential of health information technology.
What This Study Found The Folsom Report suggested that the boundaries of communities be those "within which a problem can be defined, dealt with, and solved" and referred to this concept as a Community of Solution. From the Folsom Report's original 14 positions, the authors have produced an updated series of 13 grand challenges to facilitate nationwide integrated patient-centered community health services. The renewal of the Folsom Report's Community of Solution concept serves as the anchor point for improving overall health, decreasing health costs, and focusing on local decision making.
Implications
- The authors call for health care professionals, public health organizations, community groups, and policy makers to actively partner with communities to transform personal and population health.
Annals Journal Club
May/Jun 2012: Communities of Solution
The Annals of Family Medicine encourages readers to develop a learning community of those seeking to improve health care and health through enhanced primary care. You can participate by conducting a RADICAL journal club and sharing the results of your discussions in the Annals online discussion for the featured articles. RADICAL is an acronym for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. The word radical also indicates the need to engage diverse participants in thinking critically about important issues affecting primary care and then acting on those discussions.1
HOW IT WORKS
In each issue, the Annals selects an article or articles and provides discussion tips and questions. We encourage you to take a RADICAL approach to these materials and to post a summary of your conversation in our online discussion. (Open the article online and click on "TRACK Comments: Submit a response.") You can find discussion questions and more information online at: http://www.AnnFamMed.org/site/AJC/.
CURRENT SELECTION
Article for Discussion
- The Folsom Group. Communities of solution: the Folsom Report revisited. Ann Fam Med. 2012;10(3):250-260.
Discussion Tips
This article provides an opportunity to reinvent the insights of an influential report to guide the actions of family physicians, community partners, policy makers, and others toward sustainably achieving healthy communities.
Discussion Questions
- What is the Folsom Report?2
- How are the challenges addressed by the Folsom Report in 1967 (providing more comprehensive health care, improving the social and environmental determinants of health, enhancing urban and rural life...) relevant today?
- What current forces favor acting now on the Community of Solution vision?
- What health problems are best addressed at the level of community?
- How can a community focus complement a focus on caring for individual patients to promote health?
- Discuss the current report's "grand challenges."
- How can activities and policies at the federal and state levels complement action at the local community level to promote health?
- Although the Institute of Medicine defines primary care as being provided "in the context of community,"3 does the Community of Solution concept give you a way of acting on this ideal?
- How can working toward communities of solution become part of your professional and personal identities? What training and support systems are needed to make this a reality?
- How might you begin working to create communities of solution where you live and work?4
References
- Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: It's time to get RADICAL. Ann Fam Med. 2006;4(3):196-197. http://annfammed.org/content/4/3/196.full
- Folsom MB. American Public Health Association and National Health Council. Health is a Community Affair. Report of the National Commission on Community Health Services. Boston, MA: Harvard University Press; 1967.
- Donaldson MS, Yordy KD, Lohr KN, Vanselow NA, eds. Primary Care: America's Health in a New Era. Washington, DC: National Academies Press; 1996.
- Thomas P. Integrating Primary Health Care: Leading, Managing, Facilitating. Oxford, UK: Radcliffe Publishing; 2006.
Jump to section
- Article
- Abstract
- INTRODUCTION
- THE PRESENT: OPPOSING FORCES OF COMMUNITY HEALTH AND HEALTH CARE AS A COMMODITY
- REINVIGORATION OF THE FOLSOM REPORT: WHY HOPE? WHY NOW?
- A CURRENT VIEW OF THE FOLSOM REPORT CHALLENGES
- PARALLEL TRANSFORMATION AND THE IMPORTANCE OF COMMUNITY-BASED SOLUTIONS
- THE MODERN PRIMARY CARE PHYSICIAN
- CONCLUSION
- Acknowledgments
- Footnotes
- References
- Figures & Data
- eLetters
- Info & Metrics
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