• Improving America's Health Requires Community-Level Solutions: Folsom Revisited

    One Pagers | Aug 15, 2012
    The American Board of Family Medicine Young Leaders Advisory Group

    Amidst sweeping changes to health care in the 1960s, the broadly influential Folsom Commission report, Health is a Community Affair, never fully achieved its vision of galvanizing the creation of Communities of Solution, which were empowered to improve health at the local level. Passage of health care reform, and persistent concern over poor health outcomes despite runaway spending, contemporizes Folsom’s call for nationally supported and evaluated, but community-driven, solutions to the nation’s health care challenges.

    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 moved to the forefront of national attention. In response, Eastman-Kodak Chief Executive Officer Marion Folsom and 32 prominent commissioners representing medicine, business, health advocacy, and government spent three years researching health service needs in 21 selected communities across the United States. The Folsom Commission report, Health Is a Community Affair, recommended a wide range of reforms, including the delivery of community health services in Communities of Solution rather than by political jurisdiction, the provision of every individual with a personal physician as the central integration point for every patient’s medical services, volunteer action, and community-level action planning.1

    Although it is clear that the Folsom report stimulated many positive changes and influenced the formation of family medicine as a discipline, its vision of effective community action to improve health was never fully realized. However, with a current reform act that includes community-centric opportunities such as the formation of Accountable Care Organizations, patient-centered medical home pilots, and a Medicare Center for Innovation, the time is right for policy makers, primary care advocates, and public health leaders to revisit and revitalize Communities of Solution.2

    We propose an updated list of Grand Challenges required to meet Folsom’s vision in a new era of health reform:

    • Create a national network of community partnerships that engages and activates the citizenry to self-define Communities of Solution to develop and sustain communitytailored health programs at the local level, aimed at matching local health needs with integrated health services. 
    • Foster the ongoing development of integrated comprehensive care practices (patient-centered medical homes) accessible for all groups in a community—through the creation of explicit partnerships with public health professionals and Communities of Solution. 
    • Provide every individual in the United States with the opportunity to form a partnership with a personal physician and a team of health professionals utilizing integrated community health services in Communities of Solution. 
    • Engage individuals in Communities of Solution in the creation of healthy environments, eliminating existing barriers to community-tailored strategies. 
    • Endorse and implement a global conception of environmental health encompassing all physical, chemical, and biological factors external to a person that can potentially affect health.
    • Engage Communities of Solution to recognize and address injuries as a main preventable source of global human death and disability, especially for children.
    • Sustain and improve family planning as an integral part of community health services.
    • Engage with community partnerships to coordinate with municipal authorities to design and build healthy living environments.
    • Enhance health literacy to empower individuals within Communities of Solution to be active participants in promoting their own health and the health of their communities.
    • Create a health workforce to serve the needs of U.S. communities.
    • Integrate health services—aligning hospital, ambulatory, and community care—across settings to promote quality and create value.
    • Transform the roles of relevant federal, state, and local agencies by bridging public health and medicine to be effective partners in Communities of Solution.
    • Engage and support a citizen volunteer network formed by Communities of Solution to educate, motivate, and collaborate for strategic local, regional, and national resource allocation that is informed by credible and actionable data.

    The American Board of Family Medicine Young Leaders Advisory Group (“The Folsom Group”): Andrew Bazemore, MD, MPH, The Robert Graham Center for Policy Studies in Family Medicine and Primary Care; Sean P. David, MD, SM, DPhil, Stanford University School of Medicine; Marguerite Duane, MD, MHA, Georgetown University School of Medicine; Kimberly Griswold, MD, MPH, University at Buffalo SUNY School of Medicine and Biomedical Sciences; Sarah Lesko MD, MPH, Seattle, Washington; Thomas Morgan, MD, Vanderbilt School of Medicine; John M. Westfall, MD, MPH, University of Colorado School of Medicine; Larry Green, MD, University of Colorado School of Medicine and The American Board of Family Medicine; James Puffer, MD, The American Board of Family Medicine; Betsy Garrett, MD, University of Missouri School of Medicine.


    1. Health Is a Community Affair—Report of the National Commission on Community Health Services. Cambridge, Mass.: Harvard University Press; 1967.
    2. The Folsom Group. Communities of Solution: The Folsom Report Revisited. Ann Fam Med. 2012;10(3):250-260.

    The information and opinions contained in research from the Graham Center do not necessarily reflect the views or the policy of the AAFP. 

    Published in American Family Physician, Aug 15, 2012. Am Fam Physician. 2012;86(4):online. This series is coordinated by Sumi Sexton, MD, AFP Associate Medical Editor.