Access to Care and Community Pediatrics in the 1980s

By: Francis Rushton, Jr, MD, FAAP

The 1980s were a period of both consolidation of gains in community pediatrics and a shift in the political winds. Since the civil rights struggles of the 1960s, there had been steady gains for marginalized populations including poor and minority children. Lyndon Johnson's Great Society had launched Medicare, Medicaid, dramatically decreased both senior and childhood poverty and launched the community health care movement. The first community health center was led by Dr. Jack Geiger in Mound Bayou, MS and became a prototype for more. In 1980 opportunities for pediatricians (including myself) in the National Health Service Corps and the Indian Health Service were opening up. 

But in 1980 there was a change in political direction. Ronald Reagan was elected president and new fiscal pressure was placed on existing health initiatives as political priorities shifted. There were significant losses in some of the gains and political resistance to War on Poverty programs from both the left and the right. The Office for Economic Opportunity, a chief driver in the Great Society, was closed in 1981. Much of the medical community, pediatricians included, were wary of the new Medicaid program. Leadership for improving access to care became led instead by not- for- profit organizations and child advocacy organizations like the American Academy of Pediatrics (AAP). 

The Committee on Community Health Services (COCHS) was founded as a sub-committee of the Council on Practice in 1967 and became a full committee in 1970. Some remember COCHS in the 1980s as the conscience of the Academy, forcing a continued emphasis on vulnerable populations such as Native American and rural children.  Funding for pediatric health care was a concern, but the AAP recognized that there were multiple barriers to care. In 1986 the AAP launched Partnerships for Children (PFC), a program designed to ensure healthier outcomes through advocacy, education, public outreach and community action. As part of the emphasis on community action the Academy partnered with state chapters, local organizations, and practitioners.

And pediatricians at the local level responded. Dr Phil Porter in Cambridge, MA developed a system of school health clinics in the Boston area. Dr F. Edwards Rushton (my father) initially became involved with migrant health clinics inland from his practice in Sarasota. He rapidly realized that most of the children coming to the migrant clinics weren't migrants at all, but poor children from the local community. This realization triggered partnerships between local pediatricians, the Catholic church and the local health department to provide medical services for those with no access. Dr Rushton also was concerned about the lack of appropriate services for children with complex medical needs and left practice for a short time to help organize Children's Medical Services in Florida and mental health programs at the federal level. Returning to practice, but in Maine, he became concerned about the lack of adequate childcare for local children and devoted his energy to a community partnership working on this issue.    

In 1983 Dr Porter expanded his on efforts with the program, Healthy Children, emphasizing training to help develop pediatricians as community leaders, catalysts, and technical advisors.  Porter believed leadership in the community required 3 steps: First the generation of good ideas to improve community level help, second the development of a social strategy to enact the idea and third the marshalling of social support and political will. As Healthy Children grew, in 1988 Dr Phil Porter received a grant from the Robert Wood Johnson Foundation (RWJ) to promote and support community pediatricians.  In 1988 as part of its Access to Care work, the Academy entered a relationship with the federal government Maternal and Child Health Bureau to fund Healthy Tomorrows. Healthy Tomorrows provided significant funding for "community-based solutions to community-based programs" and became one of the most successful initiatives of the Academy. 

There was a realization that Porter's Healthy Children needed an institutional structure also. Both the AAP and Dr. Porter felt Healthy Children meshed well with the academy's Access to Care focus. Originally funded by RWJ for two years, Healthy Children became an AAP program in 1989 as program direction shifted from the charismatic Dr. Porter to a staff-based model at the Academy. RWJ provided a second grant to expand Healthy Children into more communities requiring more staff. Dr. Ed Rushton was then hired and brought to the Academy for the birth of what we now know as CATCH (Community Access to Child Health). CATCH has epitomized one of Dr. Rushton's favorite sayings ever since: "One pediatrician can make a difference. "And today CATCH participants continue to show that they can make that difference.

 ©2020, American Academy of Pediatrics

This article was prepared by Dr Rushton on behalf of the AAP Council on Community Pediatrics and CATCH Program.