The Health Commons and Care of New Mexico’s Uninsured

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