Health Care Reform Must Be Local, Despite Federal Legislative Efforts

“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.”

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.”

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.”

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.

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.”