COMMUNITY AND MIGRANT HEALTH CENTERS

Community Health Centers (CHCs) were first funded by the United States government as part of the War on Poverty in 1966 by Congress under Section 314 (e) of the Comprehensive Health Planning and Public Health Service Act. By the early 1970s, about one hundred neighborhood health centers had been established under the Economic Opportunity Act (OEO). These centers were designed to provide accessible, dignified personal health services to low-income families. The U.S. Public Health Service (PHS) began funding neighborhood health centers in 1969. With the phaseout of OEO in the early 1970s, the centers supported under this authority were transferred to the PHS. Currently, the CHC federal grant program is authorized under section 330 of the PHS Act and is administered by the U.S. Department of Health and Human Services, through its Health Resources and Services Administration's Bureau of Primary Health Care (BPHC).

BPHC's mission is to increase access to comprehensive primary and preventive health care and to improve the health status of underserved and vulnerable populations. CHCs exist in areas where economic, geographic, or cultural barriers limit access to primary health care for a substantial portion of the population; they tailor services to the needs of the community.

Section 330–funded programs include Community and Migrant Health Centers, Health Care for the Homeless projects, and Public Housing Primary Care programs. These programs build community-based primary care infrastructure and provide family-oriented, culturally competent primary care, which is also linked to social services in rural and urban medically underserved communities.

CHCs offer primary and preventive care, outreach, and dental care. Essential ancillary services such as laboratory tests and X-ray, environmental health, pharmacy, health education, transportation, translation, and prenatal services are provided or arranged for. Links to welfare, Medicaid, substance abuse treatment, Special Supplemental Food Program for Women, Infants, and Children, known as the WIC program, and related services are also provided. Personnel within the centers include physicians, advanced practice nurses, physician assistants, dentists, nurses, pharmacists, as well as administrators and supportive services staff such as medical records personnel, social workers, family health workers, laboratory technicians, and nutritionists.

In fiscal year (FY) 1996, the community and migrant health center appropriation was consolidated to include the homeless and public housing programs. Funding for CHCs represents approximately 85 percent of the consolidated appropriations:

• FY 1997 $802.0 million
• FY 1998 $825.0 million
• FY 1999 $925.0 million

Ten million of the nation's neediest people receive primary health care through the more than 3,000 primary-care delivery sites supported by the BPHC. These community-based programs emphasize prevention as well as early detection and timely intervention in health problems. The CHCs generate significant economic activity in financially depressed communities, but they are in fiscal trouble themselves. Per Mary McCrory of the Washington Post, "the CHCs, which take care of four out of every ten poor children in America, are up against it these days. Of the 650 in operation, 45 percent are in severe financial trouble; 7 percent have declared bankruptcy."

The U.S. health-care system is rapidly changing. The numbers of uninsured persons are increasing and disparities in health outcomes are widening. The BPHC has recognized that broad action is necessary if it is to fulfill its mission. In 1999, the BPHC declared that its aim was to achieve 100 percent access and zero disparities in health status so that every person in every underserved community would have access to primary and preventive care; and through improving the delivery of care and patient self-management of disease, there would be no disparities in health status related to race, ethnicity, or income. Since undertaking this endeavor, more than one hundred communities have committed to this 100 percent access zero disparity vision.

Rick Wilk

(see also: Decentralization of Community Health; Immigrants; Medicaid; Minority; Rural Health )

Bibliography

Hawkins, D., and Rosenblun, S. (1997). "The Challenges Facing Health Centers in a Changing Health Care System." In Access to Community Health Care: A National and State Data Book. Washington, DC: National Association of Community Health Centers, Inc.

McGrory, M. (1999). "The Corner on Caring." Washington Post, August 28.

Siegal, S. (1998). Access to Primary Health Care: Tracking the States. Washington, DC: National Conference of State Legislators.