Table 1.

Grand Challenges for Integrating Community Health Services

Folsom Report Recommendations 1967Folsom at 50: Grand Challenges*Funded Provisions from the American Recovery & Reinvestment Act of 2009, Children's Health Insurance Program Reauthorization Act of 2009, and Patient Protection & Affordable Care Act of 2010
A. Organization and delivery of community health services “community of solution” by relevant administrative area, not by political (city, county, state) jurisdictionsGrand challenge 1: Create a national network of community partnerships that engages and activates the citizenry to self-define Communities of Solution in order to develop and sustain community-tailored health programs at the local level aimed at matching local health needs with integrated health services.PPACA: Community-based Collaborative Care Network Program; National Prevention, Health Promotion & Public health Council, chaired by the U.S. Surgeon General, to coordinate federal prevention, wellness, and public health activities and to “elevate and coordinate prevention activities and design a focused National Prevention and Health Promotion Strategy in conjunction with communities across the country to promote the nation's health. The Strategy will take a community health approach to prevention and well-being—identifying and prioritizing actions across government and between sectors”; Community Transformation Grants
B. Provision of high-quality comprehensive personal health services to all people in each communityGrand challenge 2: Foster the ongoing development of integrated comprehensive care practices (patient-centered medical homes) accessible for all groups in a community—through the creation of explicit partnerships with public health professionals and Communities of Solution.ARRA: Increased funding for CHCs, military hospitals, Veterans Administration, Indian reservations, NHSC, and Consolidation Omnibus Budget Reconciliation Act (COBRA) subsidies CHIPRA: Coverage of additional 4.1 million children PPACA: Patient-centered medical home demonstration project within the Centers for Medicare & Medicaid Services; Medicaid parity with Medicare; increased insurance access
C. Every individual should have a personal physician who is the central point for integration and continuity of all medical and related services to the patientGrand challenge 3: Provide every individual in the United States the opportunity to form a partnership with a personal physician and a team of health professionals utilizing integrated community health services in Communities of Solution.ARRA: Funding for wellness and prevention CHIPRA: Funding for outreach, translation, interpretation; demonstrations to combat obesity PPACA: Preventive health care coverage mandate; $250 million Prevention and Public Health Fund to community programs (including National Healthy Weight Collaborative); interagency council headed by surgeon general with focus on prevention and public health
D. Prospective planning and management of comprehensive environmental health services; includes water, air, food, hygienic housing, activity, and recreationGrand challenge 4: Engage individuals in Communities of Solution in the creation of healthy environments, eliminating existing barriers to community-tailored strategies; and endorse and implement a global conception of environmental health encompassing all physical, chemical, and biological factors external to a person that can potentially affect health.PPACA: Community Preventive Services Task Force
E. Ensure control of water and air pollution, biological and chemical product safety, radioactive material safety Grand challenge 5: Engage Communities of Solution to recognize and address injuries as a main preventable source of global human death and disability—especially for children.
F. Accident prevention:
  • State health departments should develop accident prevention programs.

  • U.S. Public Health Service should establish a national accident prevention, research, training, service, and information facility analogous to the present communicable disease center.

G. Family planning should be an integral part of community health servicesGrand challenge 6: Sustain and improve family planning as an integral part of community health services.PPACA: State eligibility option for family planning services
H. Coordinate land use, transportation, economic development, and city planning to provide most effective and space use for urban populationsGrand challenge 7: Engage with community partnerships to coordinate with municipal authorities to design and build healthy living environments.PPACA: Community Preventive Services Task Force
I. Education for health:
  • The community has a responsibility for developing an organized and continuing education concerning health resources for its residents.

  • Each individual has a personal responsibility for making full use of available health resources.

Grand challenge 8: Enhance health literacy to empower individuals within Communities of Solution to be active participants in promoting their own health and the health of their communities.PPACA: Health care quality improvement programs; health care delivery system research; funding available for health literacy research
J. Health manpower: effective utilization of available health personnel will reduce the current manpower shortage, and continuous evaluation of the use of manpower, accompanied by necessary changes and retraining, will provide additional manpower for existing new health servicesGrand challenge 9: Create a health workforce to serve the needs of U.S. communities.ARRA: NHSC expansion PPACA: Teaching health centers; Primary Care Extension Service; revisions to GME to favor nonhospital training; national healthcare workforce commission to align federal workforce resources with needs; preference of primary care for reallocation of unused graduate medical education slots
K. Hospital care: further increases in hospital costs must not be accepted complacently, but that a wide range of vigorous and persistent actions must be taken by all parties concerned to moderate the costs of hospital care without adverse effects on qualityGrand challenge 10: Integrate health services—aligning hospital, ambulatory, and community care—across settings to promote quality and create value.PPACA: Establishment of accountable care organization pilots to manage patient populations comprehensively across settings
L. Every state should have a single, strong, well-financed, professionally staffed, official health agency with sufficient authority and funds to carry out its responsibilities/ assure every community of coverage by an official health agency and access to a complete range of community health servicesGrand challenge 11: Transform the roles of the relevant federal, state, and local agencies by bridging public health and medicine to be effective partners in communities of solution.PPACA: Research on optimizing the delivery of public health services; Prevention and Public Health Fund Title IV, Prevention of Chronic Diseases and Improving Public Health
M. Voluntary citizen participation: a central factor in the growth and development of |Po personal and community health has been the participation of individuals and voluntary associations through dedicated leadership, financial support, and personal serviceGrand challenge 12: Engage and support a citizen volunteer network formed by Communities of Solutions to educate, motivate and collaborate for strategic local, regional, and national resource allocation informed by credible and actionable data.
N. Action planning for community health services: planning is an action process and is basic to development and maintenance of quality community health services Grand challenge 13: Utilize health information technology and emerging data-sharing innovative networks that enable the flow of relevant knowledge (public health, environmental, educational, legal, etc.) to the Communities of Solution. ARRA: Beacon Community Cooperative Agreement Program PPACA: National Prevention, Health Promotion & Public Health Council (see above); implementation of activities to improve patient safety and reduce medical errors through the appropriate use of best clinical practices, evidence-based medicine, and health information technology
  • * The grand challenges address each of the major recommendations from “Health is a Community Affair” and overlapping provisions from recent legislation.

  • CHC, community health centers; GME, graduate medical education; NHSC, National Health Service Corps.

  • Adapted or reprinted with permission from Stange KC. In this issue: from communities of solution to joy. Ann Fam Med. 2012;10(3):194–195. The Folsom Group. Communities of solution: the Folsom Report revisited. Ann Fam Med. 2012;10(3):250–260., July/August, 2012, Vol 10, No 4, Annals of Family Medicine, ©2012 American Academy of Family Physicians. All Rights Reserved.