Communities of solution: the Folsom Report revisited

Abstract

Efforts to address the current fragmented US health care structure, including controversial federal reform, cannot succeed without a reinvigoration of community-centered health systems. A blueprint for systematic implementation of community services exists in the 1967 Folsom Report--calling for "communities of solution." We propose an updated vision of the Folsom Report for integrated and effective services, incorporating the principles of community-oriented primary care. The 21st century primary care physician must be a true public health professional, forming partnerships and assisting data sharing with community organizations to facilitate healthy changes. Current policy reform efforts should build upon Folsom Report's goal of transforming personal and population health.

Figure 1

One city’s communities of solution. Note: Political boundaries, shown in solid lines, often bear little relation to a community’s problem-sheds or its medical trade area. Reproduced and adapted with permission from: Folsom M. Health is a Community Affair: Report of the National Commission on Community Health Service. Cambridge, MA: Harvard University Press; 1967:3, Fig 1.

Figure 2

Health workforce changes 1960 to 2000. Note: Segments represent the proportion of the total health professional workforce, composed of allied health professionals (eg, dietitians, clinical laboratory workers, physical therapists, emergency medical technicians, etc); physicians (allopathic, osteopathic), dentists, and pharmacists; and registered nurses from 1960, 1970 and 2000. Sources of data: Health Resources & Services Administration, Bureau of Health Professions, National Center for Health Workforce Analysis (all except for allied health: http://bhpr.hrsa.gov/healthworkforce/; allied health: http://bhpr.hrsa.gov/healthworkforce/).

Figure 2

Health workforce changes 1960 to 2000. Note: Segments represent the proportion of the total health professional workforce, composed of allied health professionals (eg, dietitians, clinical laboratory workers, physical therapists, emergency medical technicians, etc); physicians (allopathic, osteopathic), dentists, and pharmacists; and registered nurses from 1960, 1970 and 2000. Sources of data: Health Resources & Services Administration, Bureau of Health Professions, National Center for Health Workforce Analysis (all except for allied health: http://bhpr.hrsa.gov/healthworkforce/; allied health: http://bhpr.hrsa.gov/healthworkforce/).

Figure 2

Health workforce changes 1960 to 2000. Note: Segments represent the proportion of the total health professional workforce, composed of allied health professionals (eg, dietitians, clinical laboratory workers, physical therapists, emergency medical technicians, etc); physicians (allopathic, osteopathic), dentists, and pharmacists; and registered nurses from 1960, 1970 and 2000. Sources of data: Health Resources & Services Administration, Bureau of Health Professions, National Center for Health Workforce Analysis (all except for allied health: http://bhpr.hrsa.gov/healthworkforce/; allied health: http://bhpr.hrsa.gov/healthworkforce/).