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The Milbank Memorial Fund is an endowed operating foundation that publishes The Milbank Quarterly, commissions projects, and convenes state health policy decision makers on issues they identify as important to population health.
February 10, 2021
Primary Care Transformation Population Health Social Determinants of Health COVID-19
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Read a companion blog post: H. Jack Geiger and the Power of Health Care to Transform Lives and Communities
In Central Falls, Rhode Island — the city with the highest COVID-19 infection rate in the state — 20 city residents regularly walk the streets decked out in bright orange hoodies, orange watch caps, and face shields; passing out masks; explaining the benefits of vaccination; and encouraging to sign up for vaccinations. These Health Ambassadors for the city are doing this work because of H. Jack Geiger, MD, and how he thought about health, health care, and health services. Community and health as well as community and health services, are as inextricably intertwined, Dr. Geiger knew, as dancer and dance. Health is of, by, and for each community. Health therefore flows from relationships and is not a commodity. And health services promote democracy by giving everyone a more equal place at the table, helping to address the health impacts of centuries of institutional racism while providing the residents of underserved communities with jobs, new professions, and new agency over their lives.
When Dr. Geiger came to Mound Bayou, Miss., to co-found the new Tufts Delta Health Center and began working with Dr. John Hatch, a social worker and community organizer, and Dr. Andrew James, the first Black sanitarian to work in Mississippi, they focused on hiring local people whenever possible. They demonstrated that environment, employment, and self-determination are critical factors in helping communities become and stay healthy. It’s a lesson we’ve tried to put to use in Central Falls.
Central Falls is Rhode Island’s smallest, poorest, most densely populated, and most Latinx city. Twenty thousand people live on 1.3 square miles in old wood frame triple-deckers. It is a city without much open land and with many undocumented residents, but it is also a city with unbridled grit and determination. It entered bankruptcy in 2011 but emerged in 2013 with a new mayor and city council. Many young people who had grown up in the city returned after college to give back to their communities. Known as the Comeback City, Central Falls has been innovating for years, finding its way to better education, better health care, a better economy, and a better future.
COVID-19 found opportunity to spread when working people living in poverty in Central Falls had to go out to work every day and come home to families living in densely packed houses. Dr. Geiger knew that medical care alone is never enough. For Dr. Geiger, a “community health center …[is] an instrument of social change” allowing for “intervention in the social, biological, and physical environments” using the tools of “community organization and community empowerment.” He understood that health outcomes don’t improve without community organization, and that health care alone is insufficient to protect and improve the public’s health.
Central Falls is the home of the first Neighborhood Health Station in the United States, which is a single clinical enterprise designed to provide primary medical, dental, behavioral health care and other services to the entire population of the city. In fact, community development focused on health is now a whole-city enterprise in Central Falls, inspired by Dr. Geiger’s example. Thanks to the vision of an engaged mayor, James Diossa, his visionary successor, Maria Rivera, and a supportive city council, the city took the notion of community-based primary care and transformed it, so the city government, and not just the health center, has become the locus of community organization and empowerment. The city uses its Parks and Recreation Department to engage people in physical activity. It studies data from its Emergency Medical Services to find opportunities to better deploy primary care and to address the needs of its most vulnerable people using a team of health care and social service workers, an expanded version of the health care teams that Dr. Geiger developed.
When COVID-19 struck city residents, about half of who had no access to primary care, the city stepped to the plate, and organized isolation, testing, and family support, by and for people who lived in the city and were most impacted by the spread of COVID-19. Now, it is the city that has organized a vast immunization program, and Central Falls is on track to becoming one of the most effectively immunized places in the United States if vaccine supply holds out.
In addition to understanding the transformative power of people from different communities working together to build a more just society, how health care in general and primary care in particular can help us address dignity and community, and to calling upon the moral responsibility of health care leaders, Dr. Geiger had a vision of the critical nature and integrity of communities themselves. His ability to recognize communities as central to health, and to strengthen communities so they could nurture all of us, lives on in Central Falls and in thousands of communities across the nation and the world. Dr. Geiger’s vision, his courage, and his commitment to community lives on and brings dignity to health care and health care workers as we struggle together to keep the nation and its democracy intact.
1Ward, TJ. Geiger HJ. Out in the Rural: A Mississippi Health Center and Its War on Poverty. New York: Oxford University Press; 2017.
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