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Folsom Redux: Revisiting the relationship between public health and primary care



By the late 1960s, in the wake of rapid advances in medical technology and increased medical costs despite widespread unmet needs, the efficient provision of health services had “risen to the top of the national consciousness.” In response, the National Commission of Community Health Services – chaired by Eastman Kodak Director Marion B. Folsom and comprised of thirty-two prominent commissioners from the fields of medicine, business, health advocacy, and government – spent 3 years researching health service needs in 21 selected communities across the United States and formulating a rational action plan. The result was the broadly influential Folsom Report entitled, "Health is a Community Affair." While it is clear that the Folsom Report stimulated many positive changes, including the formation of the American Board of Family Medicine (ABFM), its vision of effective community action to improve health was never fully realized. National concern about health services has recently peaked again, with the passage of the health care reform bill in 2010, and the time is right to explore the lessons of the Folsom Report and consider its contemporary relevance.

The ABFM convened a dynamic working group of family physicians to discuss the future success of the discipline at yet another time of major change in our health care system. Its members include: Andrew Bazemore, from the Robert Graham Center; Margeurite Duane, from Georgetown University; Sarah Lesko, from the University of Washington; Jack Westfall, from the University of Colorado; Kim Griswold, from the University at Buffalo, The State University of New York; Tom Morgan, from Vanderbilt University; and Sean P. David, from Stanford University. The group developed a set of "Grand Challenges" for leaders in public health and medicine building on the Folsom Report.

These Grand Challenges were presented at a Robert Graham Center Primary Care Forum, held at the Washington Court Hotel the morning of October 5, 2010. The presentations were attended by 30 policy makers, opinion leaders and students from Health Resources and Services Administration (HRSA), National Committee for Quality Assurance (NCQA), American Academy of Family Physicians (AAFP), and other agencies and institutions, including George Washington University and Georgetown University. On this page, the working group offers this summary of Folsom for reconsideration, and a vision for integrating community health services to inform health policy.

Communities of Solution: The Folsom Report Revisited - The Folsom Group. Communities of Solution: The Folsom Report Revisited. Ann Fam Med. 2012;10(3):250-60.

Health Is a Community Affair: Preview of the Final Report of the National Commission on Community Health Services - Roberts DW. JAMA. 1966;196(4):332-3.


Folsom MB, American Public Health Association and National Health Council. Health is a community affair. Report of the National Commission on Community Health Services. Boston, MA: Harvard University Press; 1967.

October 2010