Prevention - Prevention Through Community Health Centers

President Johnson's War on Poverty was the inspiration for the first federally funded community health centers (CHCs). Their aim, according to Johnson's 1965 State of the Union Address, was "to help the mentally ill and improve health care for school-age children from poor families, including services for the mentally retarded." Today CHCs aim to improve the health status of all underserved populations and provide access to health care services for the uninsured. Uninsured people numbered 38.9 million in 2001; 8.5 million of them were children (about 11.2% of children under age 18).

The CHCs are supported by Federal grants. The FY 2002 appropriation was $1.3 billion. The program coordinates cooperative agreements and grants with national, state, and regional health and primary care organizations. Those wishing to find such a center can begin by looking at http://www.bphc.hrsa.gov/databases/fqhc/default.htm.

In 2001, there were more than 1,000 CHCs in operation. The chart shows that they offered care at 3,307 delivery sites. The Department of Health and Human Services projects growth to 4,507 sites by 2006, an increase of 37%. There are CHCs in all 50 states, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands.

CHCs served some 11 million patients in 2001. It is estimated that an additional 6.1 million will be served by 2006, for a total of 17 million served. Well-known sites include St. Vincent's Hospital in New York, Cook County Hospital in Chicago, and COTS in Detroit. Because services are tailored to community needs, delivery sites have been established specifically for the homeless, for women, for migrants, for subsets of the population (Native Americans, for example), and others.

Why do we have CHCs? The Centers for Disease Control tells us: because society has an "interest in assuring conditions in which persons can be healthy." This falls under the heading of public health. According to CDC: "Public health engages both private and public organizations and individuals in accomplishing this mission. Responsibilities encompass preventing epidemics and the spread of disease, protecting against environmental hazards, preventing injuries, encouraging healthy behavior, helping communities to recover from disasters, and ensuring the quality and accessibility of health services."

A hundred years ago, major public health threats were infectious diseases associated with poor hygiene, sanitation, and nutrition; high infant and maternal death rates; and diseases or injuries associated with unsafe workplaces. Today, major threats to health are chronic diseases and risky behavior; these can be prevented. Because the health problems of untreated individuals can have far-reaching consequences, everyone must be cared for. And when preventive care is made available, Medicaid disbursements are lowered.

President George W. Bush's 2003 budget cites this evidence of the benefit of CHCs: "While health center patients typically have high blood pressure rates far exceeding that of comparable racial, ethnic and socioeconomic groups, they are more than three times as likely to report that their blood pressure is under control compared to non-health center patients." Untreated, high blood pressure can cause stroke, heart attack, kidney or eye problems, or death.

Not everyone agrees with the practices of community health centers. For example, some centers offer needle exchanges to prevent HIV, a practice that is supported by the CDC, the American Medical Association, and the National Institutes of Health. Critics contend that needle exchanges encourage drug use. There are those who argue that the confidentiality guaranteed to a child in a health center suspends parental rights and that the parent should be the only health educator.

What are emerging threats to public health? According to the Public Health Threats and Emergencies Act of 2000, they "may include new or resurgent infectious diseases, dangerous microbes resistant to antibiotics, or deliberate terrorist attacks using biological weapons." Vast numbers of uninsured people without access to health care would be a threat to public health in any of these dire events. Hence the need for more CHCs.

We will now take a look at the rising number of health care programs offered in schools.

Sources: Chart: The White House Office of Management and Budget, retrieved June 26, 2002, from http://www.whitehouse.gov/omb/budget/fy2003/bud15.html. CDC, "Achievements in Public Health, 1900-1999: Changes in the Public Health System," retrieved June 26, 2002, from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4850a1.htm. Lyndon Johnson's 1965 State of the Union Address, retrieved July 2, 2002, from http://lone-star.net/mall/jcitychamber/union65.htm.