A Note from the Editor

The final installment of our sixteenth volume, this issue is rich with papers on the themes associated with community-oriented primary care^1–3 and particularly with papers on chronic illness and the role of providers in delivering optimal care to medically underserved populations.

The issue comes with not one but two supplements, as well. The first, sponsored by the National Institutes of Health/National Institute on Drug Abuse (NIH/NIDA) and guest-edited by Dr. Lula Beatty, concerns the stratospheric rise of HIV/AIDS in the African American community and its relationship to disproportionate rates of incarceration and to drug abuse. The second, sponsored by the Historically Black Colleges and Universities (HBCU) Research Network and guest-edited by Drs. Eleanor Walker and Richard Bragg, includes papers emerging from a conference held at the National Center for Primary Care at Morehouse School of Medicine in September 2004 titled, "Racial Disparities in Health Outcomes: Research and Intervention Findings." We are very grateful to the sponsors for supporting these supplements and to the guest editors for their hard work creating them.

An important article by Cunningham and colleagues from UCLA dovetails with the topic of the NIH/NIDA supplement: Cunningham's team looked at the relationship between socioeconomic status (SES) and survival with HIV in a prospective cohort study of a national probability sample of nearly 3,000 people receiving HIV care. They found that those with no accumulated financial assets had an 89% greater risk of death and those with less than a high school education had a 53% greater risk of death than their counterparts. As they point out, the findings are of particularly great concern because of the disproportionate rates of HIV infection in low SES groups.

Like most of the papers in the HBCU Research Network supplement, several in this issue target a particular community, sometimes in a particular locality. In a broad sense, all of these papers concern community-oriented primary care (COPC), an approach to health care first articulated in the 1940s by Drs. Sidney and Emily Kark in South Africa and Israel, which has subsequently taken root in the United States, due in large part to the seminal efforts of Dr. Jack Geiger, the subject of the this issue's Heroes and Great Ideas Column.

Christensen and colleagues report on the overwhelming rates of trauma resulting from childhood abuse among a sample of over 70 people who were homeless, mentally ill and drug-addicted seen for psychiatric care in their Jacksonville, Florida clinic over the course of one year.

Crowell and colleagues studied treatment of toddlers (12 to 36 mos. old) for anemia at three ambulatory pediatric clinics in Hartford, Connecticut through a retrospective review of randomly selected medical charts and semi-structured interviews with clinicians. The team identified poverty and communication difficulties as two themes in the interviews with clinicians about the high rate of anemia (38% of charts reviewed) and the low rate of treatment (just under half of those with diagnosed anemia) that they found.

Schmaling and Hernandez also looked at a particular group in a particular location, specifically conducting a questionnaire study with just under 500 Mexican American primary care patients from high-poverty areas in two rural Texas communities. Comparing patients' self-reports of depressive symptoms with results of structured diagnostic interviews and with medical charts, they found a very high prevalence of depression (self-reports and diagnostic interviews agreeing most of the time), but poor correlation between diagnostic interviews and prior diagnosis for depression by providers. They discuss the importance of enhancing the detection of depression in primary care, especially among minority populations.

Farmer and her team studied cancer screening among members of the Lumbee Indian tribe in North Carolina, encouragingly finding that screening rates compare favorably with those of national samples.

In each of these four papers, we find that the overall societal and social contexts of the patients' lives, as well as their personal histories and health behaviors, enter into their medical make-up; as work in COPC would suggest, understanding and coping with these contexts is a critical part of delivering primary care to the...