Community health centers in the United States

A Community health center in the United States is a Community health center (CHC) in the United States.

Community Health Centers are unique in that at least 51 percent of all Governing Board Members must be patients at the CHC. Access to care is improved by decreasing the cost of care with a sliding fee scale based on income. Grant programs are typically available to provide the broadest opportunity for health care.

Integration of health care services is a major focus. Administrative and health care personnel sit down regularly to focus on location health care needs. Multiple services are provided that vary depending upon the site including primary care, dental care, counseling services, women's health, health promotion and education, podiatry, physiotherapy, case management, advocacy and intervention. The mission of Community Health Centers depends upon creating collaborative relationships with industry, government, hospitals and other health services.

Community Health Centers that receive federal funding through the Health Resources and Services Administration, HHS, are also called "Federally Qualified Health Centers." Today, there are more than 1250 federally-supported community health centers with more than 8000 service delivery sites. They are community health centers, migrant health centers, health care for the homeless centers and public housing primary care centers that deliver quality primary and preventive health care to more than 20 million people in all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, and the Pacific Basin. Through the years, health centers have built an impressive track record delivering high quality prevention and primary care to millions of low-income residents in inner cities and isolated rural areas.

In 2002, President Bush launched the Health Centers Initiative to significantly increase access to primary health care services in 1,200 communities through new or expanded health center sites. Between 2001 and 2006, the number of patients treated at health centers has increased by over 4.7 million, representing a nearly 50 percent increase in just five years. In 2006 the number of patients served topped the 15 million mark for the first time. By 2010, with the help of funding received through the American Recovery and Reinvestment Act (ARRA, or the "stimulus" law), health centers had expandede to serve more than 18 million people. and with new funding provided through the Affordable Care Act of 2010 (aka, health reform law), health ceners will grow to serve almost 40 million people by 2015 [National Association of Community Health Centers, www.nachc.org].

Approximately two-thirds of health center patients are minorities, and 9 out of 10 have incomes below 200 percent of the federal poverty line. Four in 10 health center patients have no health insurance.

The health center program’s annual federal funding has grown from $1.16 billion in fiscal year 2001 to $2.59 billion in fiscal year 2011 [House Appropriations Committee, www.house.gov/appropriations].

A large number of Community Health Centers also exist in Canada, although they are planned at the provincial level currently.

History

The concept of community health centers in the United States, according to historian John Duffy, can be traced to infant milk stations in New York City in 1901. In November, 1914, the first district health center in New York was established by the city at 206 Madison Avenue, serving 35,000 residents of Manhattan's lower east side. The staff consisted of one medical inspector and three nurses stationed permanently in the district who through a house card system developed a complete health record of each family.^[1] The system was expanded to Queens in 1915 with four district centers. Wartime and political pressures brought this development in New York City to an end, but privately-funded clinics through the New York Association for Improving the Condition of the Poor were started in 1916 (Bowling Green Neighborhood Association), 1917 (Columbus Hill Health Center), 1918 (Mulberry Street Health Center) and in 1921 the Judson Health Center founded by Eleanor A. Campbell in Greenwich Village, which became by 1924 the largest health center in the U.S.

Under the modern definition, the first community health center in the United States was the Columbia Point Health Center in Dorchester, Massachusetts. It was opened in December 1965 and served mostly the massive Columbia Point public housing complex adjoining it. It was founded by two medical doctors, Jack Geiger who had been on the faculty of Harvard University then later at Tufts University and Count Gibson from Tufts University.^[2][3][4] Geiger had previously studied the first community health centers and the principles of Community Oriented Primary Care with Sidney Kark ^[5] and colleagues while serving as a medical student in rural Natal, South Africa.^[6] The Columbia Point Health Center was funded by the federal government's Office of Economic Opportunity (OEO) and was needed to serve the community living in the Columbia Point Public Housing Projects which was on the isolated peninsula far away from Boston City Hospital.^[7] It is still in operation and was rededicated on its twenty-fifth anniversary in 1990 as the Geiger-Gibson Community Health Center.^[7][8]

At about the same time, Geiger and Gibson also had set up a rural community health center, The Delta Health Center, which was located in Mound Bayou, Bolivar County, Mississippi serving Bolivar, Coahoma, Sunflower, and Washington counties, where poverty was widespread.^[9][10] It was also set up in conjunction with Tufts University and with a grant from the OEO. It was a rural model whereas the Columbia Point center was an urban setting.^[3]

Newer developments in Community Health Centers include integration of health professional education with CHC sites for training. Numerous liaisons have been developed across the nation. New models also exist. The National Association of Community Health Centers encouraged the development of the physician assistant, dental, and osteopathic medical student training with A.T. Still University at the Arizona campus. Those with experience working with CHCs are encouraged to pursue Hometown status to improve probability of admission.

See also

• Eula Hall, Founder of the Mud Creek Clinic
• Clinic
• Community Health
• Federally Qualified Health Center
• Free clinic

References

1. ^ "A History of Public Health in New York City 1866-1966" by John Duffy, New York, Russell Sage Foundation 1974 p.268
2. ^ Delta Health Center Records, 1966-1987 in the Southern Historical Collection at the University of North Carolina at Chapel Hill.
3. ^ ^{a b} Sargent Shriver, "Remarks of Mr. Shriver at Comprehensive Health Services Press Conference. June 1, 1967". Cf. p.5: "Grantee: Tufts University School Of Medicine, Medford, Massachusetts; Operating Institution: Tufts University School of Medicine-Department of Preventive Medicine; Project Director: Count Gibson, M.D., H. Jack Geiger, M.D., Professors of Preventative Medicine, Tufts University; Location: Columbia Point, Boston, Mass. and Bolivar County, Mississippi; Items of Special Interest: One of the original demonstration programs to contrast a model of a northern urban center with a southern rural one; Amount: $1,168,099, $138,888, $281,685, $3,417,630; Date Approved: 6/24/65, 8/65, 3/30/66, 1/15/67"
4. ^ Dr. Count Gibson's biography at George Washington University, School of Public Health and Health Services
5. ^ Brown, Theodore M., and Fee, Elizabeth, "VOICES FROM THE PAST: Sidney Kark and John Cassel : Social Medicine Pioneers and South African Emigrés", American Journal of Public Health, November 2002, Vol 92, No. 11, 1744-1745
6. ^ Dr. Jack Geiger's biography page at George Washington University,School of Public Health and Health Services
7. ^ ^{a b} Roessner, Jane. "A Decent Place to Live: from Columbia Point to Harbor Point - A Community History", Boston: Northeastern University Press, c2000. Cf. p.80, "The Columbia Point Health Center: The First Community Health Center in the Country".
8. ^ "1965 Columbia Point Health Center" - Boston History and Innovation Collaborative
9. ^ Chu, Carolyn, “Out in the Rural: A Health Center in Mississippi”, in Social Medicine, Vol 1, No 2 (2006)
10. ^ "Preliminary Inventory of the Delta Health Center Records, 1966-1987. Collection Number 4613", Library of the University of North Carolina at Chapel Hill, Manuscripts Department

External links

• Health Center Program, U.S. Health Resources and Services Administration, HHS
• National Association of Community Health Centers
• Community Health Centers of the Central Coast
• Community Health Center Association of Connecticut
• Community Health Centers