Health Policy Arena Research Articles

Primary health care and the local health department: the North Carolina experience.

The emergence of access to primary care as a major public health priority constitutes one of the most important health policy developments of the past two decades. As underserved populations found their political voice and began participating in the health policy arena, serious questions arose challenging the legitimacy of public policies which over the years placed increasing emphasis on medical specialization and high cost technology at the expense of equitable distribution of and access to basic health care services. Coupled with this challenge came a call for the re-examination of the roles of federal, state, and local governments in the delivery of basic personal health services. For if, in society's redefinition, universal entitlement to health care is considered more a function of need than of ability to pay,4 then the problem of inadequate access lies at least partially outside the reach of the public and private pocketbook and must be addressed strategically by the community as a whole through the mechanisms available to it-including its government. Recent experiences with primary care in local health departments in North Carolina underscore at once the urgency and the complexity of addressing this public problem.