Community Voices: Health Care for the Underserved

A little over 20 years ago, Margaret Heckler, Secretary of the Department for Health and Human Services, released the Secretary's Report on the Status of Black and Minority Health.¹ This national study brought into center stage the health disparities between Black and other ethnic minorities and their White majority counterparts across age groups and disease entities. This report noted an annual 60,000 "excess deaths" among the nation's Black and ethnic minority group populations. Three years later in 1988, the Centers for Disease Control and Prevention estimated that the annual number of "excess deaths" among these groups had grown to 75,000.² While documentation of heath disparities (infant mortality, longevity, and quality of life) between racial/ethnic minorities and Whites pre-dates these reports by 50 years or more, these reports relit the spark that ignited a national flame focusing attention on health disparities.

Concomitantly, several foundations launched intervention programs to address the abysmal national disgrace politicized by the gaps in health between racial and ethnic minorities and non-minority groups. The Kellogg Foundation embraced the challenge of working with the uninsured and underinsured as well as those unable to access comprehensive primary health care that included mental health and oral health care and funded the largest single initiative to improve primary health care access and strengthen fragile safety net institutions in this nation's history. More recently, national and local public health associations, federal agencies, and professional and scientific societies, including the Institute of Medicine, have drawn attention to the mounting and daunting health disparities in the most advanced nation in the hemisphere.

This special issue of JHCPU highlights efforts aimed at addressing health disparities using education, outreach, interventions, and policy initiatives. The articles present snapshots of the work that is conducted through the Community Voices (CV) Initiative supported by the W.K. Kellogg Foundation in Battle Creek, Michigan. Community Voices was launched in 1998, and now has its national program office headquartered at the Louis W. Sullivan National Center for Primary Care at Morehouse School of Medicine. The mission of the National Center for Primary Care is to promote excellence in community oriented primary health care and optimal health outcomes for all Americans, with a special emphasis on eliminating health disparities and on serving the underserved. The Center opened officially on November 1, 2002, with Dr. David Satcher (16^th U.S. Surgeon General) as Director. Articles on tobacco highlight work that was conducted as part of the Legacy/Community Voices Tobacco Initiative funded jointly by the W.K. Kellogg Foundation and the American Legacy Foundation or were supported though Legacy's HBCU Tobacco Initiative.

Community Voices (CV) involves 8 communities (originally 13) across the United States dedicated to improving access to health services for underserved populations, including low-income groups, racial and ethnic minorities, the under- and uninsured, immigrants, and other vulnerable populations such as ex-offenders, the incarcerated and the homeless. The eight CV sites span the U.S.: in the West (California), in the Rocky Mountain region (Colorado), in the Southwest (New Mexico), in the Midwest (Michigan), in the Southeast (North Carolina, Florida), and in the Northeast (Maryland, New York). These projects work to make sustainable improvements in access to care through policy change and systems change at local, state, and national levels. CV employs community intelligence to identify and address gaps in health services, particularly for those who have been voiceless and overlooked. Using community intelligence as the basis for change, CV sites seek to address service gaps by leveraging community assets and resources in combination with state and federal support. Use of community intelligence is a strategy for recognizing that the methods of delivering and reaching the disenfranchised can be as simple as showing genuine respect and gathering information from the client populations on what approaches work best for them, as it relates to programmatic offerings.

The work of Community Voices focuses on identifying gaps in services for those who are not well served by existing health systems; improving the way services are delivered; seeking...