Skip to main content

Main menu

  • Home
  • Content
    • Current Issue
    • Online First
    • Multimedia
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • The Issue in Brief (Plain Language Summaries)
    • Call for Papers
  • Info for
    • Authors
    • Reviewers
    • Media
    • Job Seekers
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
  • Contact
    • Feedback
    • Contact Us
  • Careers

User menu

  • My alerts

Search

  • Advanced search
Annals of Family Medicine
  • My alerts
Annals of Family Medicine

Advanced Search

  • Home
  • Content
    • Current Issue
    • Online First
    • Multimedia
    • Collections
    • Past Issues
    • Articles by Subject
    • Articles by Type
    • Supplements
    • The Issue in Brief (Plain Language Summaries)
    • Call for Papers
  • Info for
    • Authors
    • Reviewers
    • Media
    • Job Seekers
  • About
    • Annals of Family Medicine
    • Editorial Staff & Boards
    • Sponsoring Organizations
    • Copyrights & Permissions
    • Announcements
  • Engage
    • Engage
    • e-Letters (Comments)
    • Subscribe
    • RSS
    • Email Alerts
    • Journal Club
  • Contact
    • Feedback
    • Contact Us
  • Careers
  • Follow annalsfm on Twitter
  • Visit annalsfm on Facebook
DiscussionSpecial Reports

Communities of Solution: The Folsom Report Revisited

The Folsom Group
The Annals of Family Medicine May 2012, 10 (3) 250-260; DOI: https://doi.org/10.1370/afm.1350
  • Article
  • Figures & Data
  • Info & Metrics
  • eLetters
  • PDF
Loading

Article Figures & Data

Figures

  • Tables
  • Additional Files
  • Figure 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    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
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 2
    • Download figure
    • Open in new tab
    • Download powerpoint
    Figure 2
    • Download figure
    • Open in new tab
    • Download powerpoint
    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

  • Figures
  • Additional Files
    • View popup
    Table 1

    Grand Challenges for Integrating Community Health Services

    Folsom Report Recommendations 1967Folsom Report at 50: Grand ChallengesFunded 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) jurisdictionsGrand 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 servicesPPACA: 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 communityGrand 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 solutionARRA: 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 access
    C. Every individual should have a personal physician who is the central point for integration and continuity of all medical and related services to the patientGrand 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 solutionARRA: 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 health
    D. Prospective planning and management of comprehensive environmental health services, includes water, air, food, hygienic housing, activity, and recreationGrand 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 healthPPACA: 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 CenterGrand 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 servicesGrand challenge 6: Sustain and improve family planning as an integral part of community health servicesPPACA: 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 populationsGrand challenge 7: Engage with community partnerships to coordinate with municipal authorities to design and build healthy living environmentsPPACA: 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 resourcesGrand 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 communitiesPPACA: 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 servicesGrand challenge 9: Create a health workforce to serve the needs of US communities, including community health workersARRA: 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 slots
    K. 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 qualityGrand challenge 10: Integrate health services—aligning hospital, ambulatory, and community care—across settings to promote quality and create valuePPACA: 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 servicesGrand 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 solutionPPACA: Research on optimizing the delivery of public health services; Prevention and Public Health Fund
    Title IV, Prevention of Chronic Diseases and Improving Public Health
    M. 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 serviceGrand 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 servicesGrand 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 solutionARRA: 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.

    • Note: Grand challenges addressing each of the major recommendations from the Folsom Report10 and overlapping provisions from recent legislation.

Additional Files

  • Figures
  • Tables
  • 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

    1. 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
    2. 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.
    3. Donaldson MS, Yordy KD, Lohr KN, Vanselow NA, eds. Primary Care: America's Health in a New Era. Washington, DC: National Academies Press; 1996.
    4. Thomas P. Integrating Primary Health Care: Leading, Managing, Facilitating. Oxford, UK: Radcliffe Publishing; 2006.

PreviousNext
Back to top

In this issue

The Annals of Family Medicine: 10 (3)
The Annals of Family Medicine: 10 (3)
Vol. 10, Issue 3
May/June 2012
  • Table of Contents
  • Index by author
  • In Brief
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on Annals of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Communities of Solution: The Folsom Report Revisited
(Your Name) has sent you a message from Annals of Family Medicine
(Your Name) thought you would like to see the Annals of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
4 + 15 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Communities of Solution: The Folsom Report Revisited
The Folsom Group
The Annals of Family Medicine May 2012, 10 (3) 250-260; DOI: 10.1370/afm.1350

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Get Permissions
Share
Communities of Solution: The Folsom Report Revisited
The Folsom Group
The Annals of Family Medicine May 2012, 10 (3) 250-260; DOI: 10.1370/afm.1350
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

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
  • Info & Metrics
  • eLetters
  • PDF

Related Articles

  • CORRECTIONS
  • PubMed
  • Google Scholar

Cited By...

  • Shared Language for Shared Work in Population Health
  • A Review of 50-Years of International Literature on the Internal Environment of Building Practice-Based Research Networks (PBRNs)
  • Retrieving Family Medicine's Lost Literature: The Journal of Family Practice 1974-1999 Archive
  • Primary Care in the COVID-19 Pandemic: Essential, and Inspiring
  • Uniting Public Health and Primary Care for Healthy Communities in the COVID-19 Era and Beyond
  • A Sustainable Model for Preventive Services in Rural Counties: The Healthier Together Study
  • Recruiting, Educating, and Taking Primary Care to Rural Communities
  • Shaping Keystones in a Time of Transformation: ABFM's Efforts to Advance Leadership & Scholarship in Family Medicine
  • Integrating Family Medicine and Community Pharmacy to Improve Patient Access to Quality Primary Care and Enhance Health Outcomes
  • Reducing Cardiovascular Disparities Through Community-Engaged Implementation Research: A National Heart, Lung, and Blood Institute Workshop Report
  • In This Issue: Tools to Help Focus on What is Valuable
  • Practice-based Research Networks (PBRNs) Bridging the Gaps between Communities, Funders, and Policymakers
  • Changing Places: Where Will We Be with Our Patients? A Perspective from the Keystone IV Conference
  • Holding On and Letting Go: A Perspective from the Keystone IV Conference
  • Achieving Value in Primary Care: The Primary Care Value Model
  • Child Health Disparities: What Can a Clinician Do?
  • Perspectives in Primary Care: The Foundational Urgent Importance of a Shared Primary Care Data Model
  • Back to the Future: Reflections on the History of the Future of Family Medicine
  • Praxis-based Research Networks: An Emerging Paradigm for Research That is Rigorous, Relevant, and Inclusive
  • Who Will Establish a Proper Data Model for Family Medicine and Primary Care?
  • The Future Role of the Family Physician in the United States: A Rigorous Exercise in Definition
  • "My approach to this job is ... one person at a time": Perceived discordance between population-level quality targets and patient-centred care
  • The Future of Family Medicine Version 2.0: Reflections from Pisacano Scholars
  • Response: Re: Journal of the American Board of Family Medicine Issue on Communities of Solution
  • NAPCRG 2012: reflections from across the pond
  • A Primary Care-Public Health Partnership Addressing Homelessness, Serious Mental Illness, and Health Disparities
  • HeartBeat Connections: A Rural Community of Solution for Cardiovascular Health
  • Cold-Spotting: Linking Primary Care and Public Health to Create Communities of Solution
  • Community of Solution for the U.S. Health Care System: Lessons from the U.S. Educational System
  • Boot Camp Translation: A Method For Building a Community of Solution
  • The OCHIN Community Information Network: Bringing Together Community Health Centers, Information Technology, and Data to Support a Patient-Centered Medical Village
  • Advanced Primary Care in San Antonio: Linking Practice and Community Strategies to Improve Health
  • Communities of Solution: Partnerships for Population Health
  • Early Lessons and Challenges from the Healthy Mendocino Community of Solution
  • Increasing Access to Care for Brazos Valley, Texas: A Rural Community of Solution
  • The Military Health System: A Community of Solutions for Medical Education, Health Care Delivery, and Public Health
  • In This Issue: From Communities of Solution to Joy
  • Communities of Solution
  • Google Scholar

More in this TOC Section

  • Let’s Not Reinvent the Wheel: Using Communities of Learning and Practice to Address SDOH and Advance Health Equity
  • Supporting Mental Health and Psychological Resilience Among the Health Care Workforce: Gaps in the Evidence and Urgency for Action
  • Revolutionizing Health Professions Admissions to Achieve an Inclusive Workforce
Show more Special Reports

Similar Articles

Subjects

  • Domains of illness & health:
    • Chronic illness
  • Person groups:
    • Community / population health
  • Other research types:
    • Health policy
  • Other topics:
    • Health informatics

Content

  • Current Issue
  • Past Issues
  • Past Issues in Brief
  • Multimedia
  • Articles by Type
  • Articles by Subject
  • Multimedia
  • Supplements
  • Online First
  • Calls for Papers

Info for

  • Authors
  • Reviewers
  • Media
  • Job Seekers

Engage

  • E-mail Alerts
  • e-Letters (Comments)
  • RSS
  • Journal Club
  • Submit a Manuscript
  • Subscribe
  • Family Medicine Careers

About

  • About Us
  • Editorial Board & Staff
  • Sponsoring Organizations
  • Copyrights & Permissions
  • Contact Us
  • eLetter/Comments Policy

© 2023 Annals of Family Medicine