Politics in the Development of a Migrant Health Center: A Pilgrim's Progress from Idealism to Pragmatism

New methods of health-care delivery have been recommended to correct the inequities in the distribution of health services to rural and urban poor. A migrant health center developed in 1970 to accomplish this aim illustrated the many attendant problems. The award of the grant to an outside consumer group rather than to the county health department resulted in political pressures during the center's development. Other factors isolated the center. These included categorical funding specifically directed to a community's ethnic minority and the lack of a regional network of health care. Confusion was created when legitimate spokesmen of the target group, other segments of the local community or interested private and governmental agencies were not defined. Although a program for curative and preventive medicine was established for a minority, the center was less successful in becoming self-supporting and in affecting the social and economic determinants of health. (N Engl J Med 292: 890–895, 1975), HEALTH care in America has been the subject of many thoughtful reviews.