crisis in health care, to perceive this crisis as insignificant or inevitable...to this extent the nation is living in denial that the crisis in health care will bankrupt us socially, as well as economically." The defenders of private medicine refuse to acknowledge that our health care system is no better than the least well-served of its citizens. We in the United States currently support a health care system which provides inadequate or no care for more than 20% of our population. The rest of us receive a graded level of provision based on our ability to pay. The medically indigent become the recipients of a compromised public health system, cared for by a small handful of grassroots community health care workers, advocates and institutions which receive little support, assistance or recognition from Capitol Hill. We live in a nation where the medical needs of the community are not provided for, and the right to health care is not respected. To the extent that we have all turned a blind eye upon the health care needs of our own citizens ...to this extent has our humanity diminished. However, there are now over 800 community health centers nation-wide refusing to look the other way. When asked why he stayed with community-based medicine for all these years, Morgan responded, "Well, I. guess you could call it an honest day's work...simply because it's the right thing to do." With a stronger community, less people fall through the safety net and more people will see a healthier tomorrow. Westside Clinic (now called Planned Parenthood) is located in Santa Cruz, California. Phone (408) 426-1994. Eric Bellfort is a Santa Cruz community activist. Resources -Books Connor, Eileen. Community Oriented Primary Care. Washington, DC: National Academy, 1983. Perhaps this is one of the all-time important works having to do with the theory behind community medicine. Connor clearly spells out why there is a need for increased recognition for community oriented primary care. Kark, Sidney. The Practice of Community Oriented Primary Health Care. New York: Appleton-Century-Crofts, 1981. This is the "how to" manual of implementing community oriented primary care. What is so useful in this text is the wide variety of models Kark uses, so that the reader can apply whatever context works best for their local community. Knox, E.G. Epidemiology in Health Care Planning. Oxford, England: Oxford University, 1979. Never underestimate the importance of epidemiology in creating community medicine with and for the local population. Traditionally defined, epidemiology is the study of trends in disease. Knox found this definition to be too limiting for COJTimunity-oriented primary care. He advocates for epidemiology to include the study of the health care system itself, as well as the barriers to care for local populations. Churchill, Larry. Rationing Health Care in America. Notre Dame, IN: University of Notre Dame, 1987. Churchill brings up some very challenging ethical questions for both health care planners and providers alike. How are needs defined? Who should define them? And should they be prioritized? He questions (and in the end praises) the existence of community health centers, and asks us if indeed they are not slapping a bandaid on one of America's greater social illnesses. Articles Bigelow, Victoria and Carolyn B. Trees. "A Model for Primary Care Delivery to a Widely Dispersed Medically Indigent Population." JAMA 266.4 (24/31 July 1991 ): 563-564. This is a piece similar to the article on the Westside . 1 Community Health Center, except that it applies more to an innercity environment. Bigelow's approach to increasing primary care for low-income inner city people is to create a partnership between private and public institutions. "Primary Health Care: The Chinese Experience." Report of an inter-regional seminar, World Health Organization, Geneva: 1983. Don't miss the Chinese Experience! This report is one of my favorites because it draws many comparisons between China's Barefoot Doctors and the Mid-Level Practitioners (Physician Assistants and Nurse Practitioners). Slater, Giuseppi R. "Reflections on Curative Health Care in Nicaragua." American Journal of Public Health 5 (May 1989): 648. This article reflects upon preventative medicine within an international perspective. It covers a lot of what community-based clinics similarly do here in the US, but in the context of a socialized medi~al system. Siegler, Mark. "A Physician's Perspective on a Right to Health Care." JAMA 244 (October 3, 1980): 1591-1596. RAIN Summer 1996 Volume XV, Number 1 Page 11
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