National Community Health Center Week 2021: An Advocacy Guide for Providers

Community health centers, which are also known as Federally-Qualified Health Centers (FQHCs) or community clinics, are a vital force for widening healthcare access, reducing inequality, and improving health equity in America. Their creation over 50 years ago was led by activists who built on the momentum of President Johnson’s War on Poverty and the Civil Rights Movement. They lobbied for a community-based healthcare model that would uplift the nation’s poorest citizens and the idea was simple: target the roots of poverty by combining community resources with federal funding to establish neighborhood health clinics, particularly in medically underserved areas (MUAs).

One of the key advocates in that initial effort was Dr. H. Jack Geiger, who, as a young doctor studying in South Africa, observed how a local, community-based health model improved health outcomes for those most in need. His work, along with the work of many others, led to the first two community health centers being funded in the US in 1965 and 1967.

Today, America’s community health centers are the primary medical home for over 30 million people across 13,000 rural and urban communities. These health centers provide affordable and highly efficient primary and preventive care to all residents of their communities, regardless of income level or insurance status, and now represent the backbone of America’s primary care health system.

Community health centers are a good investment: they save the healthcare system nearly $24 billion annually while still performing as well or better than other healthcare providers on 94 percent of quality measures.

At the same time, these health centers are tackling not only the symptoms of illness, but the environmental causes of health inequity, such as poverty, racism, food insecurity, mental illness, unemployment, and substance abuse. On the heels of the Covid-19 pandemic, and facing down a nationwide primary care crunch, community health centers have never been more important.

National (Community) Health Center Week has been celebrated for over 30 years; this year’s event takes place August 9-15, 2021. It’s an opportunity to shine a light on the health disparities that still exist in America today, and how a community-based healthcare model can help address those disparities.

Public support and federal funding are integral components of community health centers, and healthcare providers and civil rights activists are continually advocating for their expansion so that they can continue to grow a primary care health system that’s governed by (and working for) those who need it most.

To learn more about the importance of America’s community health centers, and how you can help advocate for them, read on.

“Community health centers are drivers of health equity,” Dr. Yee says. “Born in the 1960s out of America’s struggle for equality and social and economic justice, health centers have always worked to improve not only the health and well-being of underserved people but also to empower people to become actively involved in solving issues unique to their needs and communities. Increasing equity and reducing health disparities are not aspirations, but rather are daily practices.”

Community health centers are more than just ordinary medical clinics: they also connect patients to crucial resources related to education, transportation, translation, food, employment, housing, and mental health. And they provide care regardless of a patient’s ability to pay, charging on a sliding scale to ensure that the most vulnerable individuals and families receive the help they need. This communal approach even extends to the way that the health centers themselves are governed.

“To be a federally qualified health center (FQHC), you must have a board of directors which has full control over the health center program, and a majority of that board must be active patients of the community health center,” Dr. Flinter says. “It’s something that is fundamental to community health centers, and sounds so simple but is radical when you consider it. It means that community health centers, which serve an overwhelmingly low-income and very racially diverse population, are controlled by the people who have direct experience of needing and using their services.”

“The acronym (FQHC) doesn’t begin to describe such a vibrant, passionate, motivated, and I would dare to say noble, movement,” Dr. Flinter says. “It is a very mission-driven area, and the standards of care are high and explicit. The whole point is to make sure that the people who are most in need of care get it, and they not only get primary care—they get really outstanding, comprehensive primary care.”

FQHCs are required to provide a wide range of primary care services, broadly defined to include full scope preventive care, health promotion, chronic illness management, behavioral health, and oral health services. This is a comprehensive and collaborative work environment that brings together a wide array of different health professions: doctors (MDs), registered nurses (RNs), nurse practitioners (NPs), physician assistants (PAs), dentists (DDSs), pharmacists (PharmDs), medical assistants, dental assistants, and other certified health personnel.

Community health centers also play a significant role in health professions’ training, both by directly sponsoring residencies and fellowships but also through partnerships with colleges and universities. This is a strategic investment in health centers’ future workforce.

Health centers also are experts in removing obstacles to care for low-income and uninsured patients. They have sliding fee scales for all clinical services provided at their centers and also have systems in place to get prescriptions medicines, lab work, and diagnostic testing to their patients.

“It’s extremely frustrating to provide healthcare only to find out the people you’re providing it to cannot afford to go and get the prescription filled or get the lab test done, or do any of a host of other things,” Dr. Flinter says. “Community health centers are required to have solved many of those problems. You can’t solve every problem all the time, but there’s a strategy for helping people get medications filled and get necessary lab tests done. And as ideas develop within the health center world, I think there’s also a good sharing of best practices, and ways to help others develop those same strategies.”

Community health centers also partner with government entities, healthcare payers, the private sector, and entire health systems to help solve the most pressing public health crises of our time: the opioid crisis, maternal mortality rates, natural disasters, and pandemics.

“Health centers have been on the ground in force fighting the spread of Covid-19 in hard-to-reach communities, including communities of color and among special populations such as the elderly, the homeless, and agricultural workers,” Dr. Yee says. “They have tested, vaccinated, diverted non-acute cases from overwhelmed hospitals, and connected affected patients with housing, food, and critical services. What makes health centers especially unique right now is their critical role in the national strategy to ensure equity in vaccinations for Covid-19.”

For a significant portion of the pandemic, community health centers were under-resourced, and experienced challenges with financial reimbursement, vaccine storage capacity, and vaccine confidence amongst patients. They also experienced staff shortages and staff exhaustion; between April 2020 and April 2021, some 41,000 community health center workers tested positive for Covid-19.

Still, community health centers were instrumental in bringing about recovery, completing five million vaccinations in the first three months of their rollout—half of those vaccinated being people of color.

“I think community health centers can be really proud of the role they played during the pandemic, in keeping their doors open, in making rapid scale transitions to virtual health when that was required, and in managing people who had Covid,” Dr. Flinter says. “Doing anything throughout a pandemic is a challenge, but at community health centers, we’re used to challenges. Community health centers also stepped up in a major way to lead public health efforts in testing and vaccines during the Covid-19 pandemic. My own health center provided nearly 600,000 doses of vaccine in drive-through clinics, community clinics, and even through home visits”.

As organizations that serve low-income people, community health centers need a strong partnership with the federal government to do what they do. They don’t require a blank check, and the federal government doesn’t fully fund them, but as community health centers grow in size and scale, their funding needs to grow in tandem.

“We are caring for a population that across the board faces greater health challenges, but in addition, we care for many special populations including the homeless, agricultural workers, people living with HIV, and people with significant behavioral health or substance use disorders,” Dr. Flinter says. “Federal support is important not just to help offset the care we provide to uninsured people, but to help us invest in growth, expansion, new facilities, and new programs to address the most pressing needs in a community. On our end, we also need to be innovators and to constantly test out new ways of delivering high-quality care.”

Fortunately, and somewhat remarkably, health centers have enjoyed bipartisan support in the US: in the absence of a national health system, Congress seems to recognize that community health centers play a critical role in delivering healthcare to a significant portion of the population.

But community health centers are advocating for more than just their own federal authorizations. Expanded Medicaid coverage, increased infrastructure development, and boosted social services are all points of advocacy that benefit community health centers and the people they serve.

“A lot has evolved over the years, but much of what was laid out in the original authorizing legislation for community health centers is unassailable,” Dr. Flinter says. “The fundamental bedrocks, like a consumer-dominated board and a requirement to provide a full range of primary and preventive care services, are a lot of what has kept the community health center movement growing—growing in size and growing in its ability to meet its mission.”

“For the future, we’re taking a hard look at infrastructure needs to meet an anticipated ramped-up demand for quality, affordable primary care,” Dr. Yee says.

In the near term, the increased demand for primary care will come from patients who have been staying home during the pandemic but now need routine and preventive care. But in several areas, hospitals or clinics have closed, leaving residents without easy access to primary care providers. The expansion of community health centers will be crucial in addressing this increased need, and the needs of an increasingly aging population.

“Beyond Covid-19, there are wide health disparities we need to address—maternal mortality, cancer, diabetes, and hypertension—conditions which disproportionately affect minority and hard to reach populations, many of whom are our essential workers,” Dr. Yee says. “We anticipate that the demand for quality affordable primary care will ramp up after the pandemic is over.”

Going forward, community health centers will renew their commitment to equity and social justice, and place greater emphasis on strategies that address social determinants of health. They’ll build out an adaptive, skilled, and motivated workforce, which works with governing boards to develop broader and more meaningful partnerships. And they’ll continue to evolve through the adoption of innovative technology and emerging best practices that help meet the needs of the populations they serve.

“Community health centers have undergone many changes in their 54-year history,” Dr. Yee says. “Over the years, they have expanded services, adopted new quality standards, and implemented new technologies to meet the needs of their patients. Health centers will continue to be drivers of health equity, especially in times of crisis.”

Community health centers have never been more important. To learn more about how you can get involved with community health centers, and how you can help advocate for the community-based healthcare model, check out some of the resources below.

• Health Center Advocacy Network (HCAN): An initiative of the National Association of Community Health Centers (NACHC), HCAN represents a robust grassroots network of more than 175,000 advocates fighting for good policies and sustainable funding for America’s community health centers.
• National Association of Community Health Centers (NACHC): Founded in 1971 to promote efficient, high-quality, comprehensive healthcare that is accessible for all, NACHC serves as the leading national advocacy organization in support of community health centers.
• National (Community) Health Center Week: This year’s National Community Health Center Week takes place August 8-14, 2021, and the official website includes important information on focus days, advocacy tools, and event ideas.