The great need for family medicine and primary care research in the United States is highlighted by a report from the Institute of Medicine's (IOM) Committee on the Future of Primary Care (Institute of Medicine. Primary Care: America's Health in a New Era, Washington, DC: National Academy Press, 1996):
Expanded research in this area is timely because of the accelerating movement toward a variety of managed care and integrated delivery systems, most of which will rely increasingly on primary care models and clinicians.
Through their respective research initiatives, the American Academy of Family Physicians, the Society of Teachers of Family Medicine, and the North American Primary Care Research Group have responded to the IOM's call for support to increase infrastructure in family medicine and primary care research.
Although the IOM focused on managed care and systems of care, primary care research has had a more profound impact through its examination of the disparity in the delivery of health services, and the effect of social, structural, and personal barriers on health (Starfield, B. Primary Care: Balancing Health Needs, Services, and Technology, New York: Oxford University Press, 1998). The investigation of social and behavioral determinants of health, illness, and well-being, which is a focal area for the researchers in the Department of Family Medicine, is also congruent with this primary care impetus, and is an explicit goal of Healthy People 2010 (U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health. Washington DC: Government Printing Office, 2000).
The second goal of Healthy People 2010 is to eliminate health disparities among different segments of the population. These include differences that occur by gender, race, or ethnicity, education, or income, disability, living in rural localities, or sexual orientation.
The state of Kansas has undertaken a series of community health assessments in different regions through a program known as Community Health Assessment Partnerships (CHAPS). In 1996 Wyandotte County, the county where the University of Kansas Medical Center is situated, conducted its own community health assessment with assistance from the Kansas Department of Health and Environment. Five priorities were reported for this economically depressed area: (1) reduce the prevalence of modifiable health risks associated with heart disease; (2) increase the percentage of healthy pregnancies and healthy babies in the county and reduce the incidence of teenage pregnancy; (3) reduce the incidence of cancer; (4) increase the availability and accessibility of primary care for community members and; (5) reduce the prevalence of violent crime in the county.
These findings are consistent with a 1998 report from the Kansas Health Institute entitled, Health and Social Factors in Kansas. This report found that Wyandotte County was one of four counties that had the lowest level of health in the state, and the highest mortality. The report went further to outline important differences in various measures of health status among subpopulations across Kansas which were influenced by social determinants. The conclusions reached by the report regarding the overall health of Kansas echo the goal set by Healthy People 2010 regarding health disparities among different populations (Singh GK, Wilkinson AV, Song FF, et.al. Health and Social Factors in Kansas: A Data and Chartbook, 1997-98. Kansas Health Institute, Topeka, KS. Allen Press, Lawrence, Kansas, 1998):
Despite the overall improvement [in health], important differences in health remain for various socioeconomic and demographic groups and geographic areas.
The University of Kansas Medical Center has embarked on an ambitious endeavor to increase its research enterprise as part of the Kansas City Life Sciences initiative. This collaborative community effort is oriented around a genetic and molecular orientation to the diagnosis and treatment of disease. Investigators in our department redress the biomedical approach taken in this initiative by examining the effects of social, structural, and personal barriers on health and well-being.
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