Community Health Centers: A Movement and the People Who Made It Happen (review)

Much has been made of late about how the political and cultural wars of the 1960s have affected and, some would say, distorted the politics of the early twenty-first century. The War on Poverty and its attendant programs have been a central source of conflict and criticism from both the left and right. But, as Bonnie Lefkowitz makes clear in this important book, community health centers are one of the few institutions that were created during the 1960s that have not only survived but expanded and even won the support of the George W. Bush administration. Lefkowitz has not provided an analysis of the over nine hundred health centers that were established throughout the United States and several territories. Rather she has chosen to focus on five centers, and in doing so, she has placed them within their regional and historical contexts and provided in-depth analyses of their strengths and weaknesses.

In the early conception of the War on Poverty, health was neglected by federal bureaucrats, but local activists, and especially Jack Geiger, played crucial roles in convincing the Johnson administration that health care could and should play a significant role in fighting poverty. Though the health centers were initially funded as experimental programs, they were soon incorporated into the Office of Economic Opportunity Act in April 1967. While it might have been instructive to include more discussion of the antecedents of the “community oriented primary care concept,” Lefkowitz does provide some of this background and shows how “OEO was the first to bring the full-scale model to this country” (p. 9). In assessing why the health centers have survived, even flourished, through Democratic and Republican administrations and during liberal and conservative eras, Lefkowitz argues that part of the reason for their success was that “they offered specific, concrete services when and where they were needed” (p. 24) and also that local communities had the experience of ownership and control that other federal programs did not provide.

The author provides in-depth studies of centers in Boston, South Carolina, New York, and the Rio Grande Valley, but her analysis of the Tufts-Delta Health Center in Mound Bayou, Mississippi, offers the best insight into what made these centers so unique and successful. Through penetrating examinations of the social, political, economic, and health status of the South in the mid-twentieth century, and astute mini-biographies of critical actors, Lefkowitz provides a fascinating portrait of how community leaders and health center personnel were able build grassroots support for the center and to help administrators and community residents alike to understand “just how social science, environment and medical care all came together” (p. 38). Nutrition became such a critical part of the center’s program that the center’s director called Washington and told one official, “look, fellow, we’ve got to be able to write prescriptions for baby formula” (p. 38). The center was located in the third poorest county in the United States, and yet it was able to substantially improve the health of residents and also to be a catalyst for upward mobility for many residents, including five physicians, seven Ph.D.s, over a dozen registered nurses, and the first ten registered black sanitarians in Mississippi history. Lefkowitz points out, however, that rural health centers tended to have a more profound effect on both the health and social status of citizens than did urban centers.

The most significant lesson of the health center movement is that academics and policymakers alike make a crucial mistake when they focus their analyses and energies in trying to determine which of a variety of factors have the greatest influence on health. “People who live and work in communities know that these factors are inextricably linked. You cannot have a healthy society unless you pay attention...