I. Introduction

Background

In 1998, the Congress of the United States, recognizing the beneficial impact that interdisciplinary community-based linkages can have upon the quality and availability of health care services to populations that have traditionally been underserved or are otherwise medically vulnerable, adopted legislation authorizing grant funds to support the development of such linkages. The legislation, set forth in Title VII, Part D, of the Public Health Service Act ("the Act"), identified five sets of programs, all with the central mission of training and education, deemed to be particularly endowed with the potential for beneficial linkages of this nature. The programs were as follows:

• Area Health Education Centers (Section 751);
• Health Education and Training Centers (Section 752);
• Geriatric Education and Training Programs (Section 753);
• Quentin N. Burdick Program for Rural Interdisciplinary Training (Section 754); and
• Entities engaged in education and training for the Allied Health professions and other disciplines (Section 755).

Although these programs differ in detail, they share a common element: each has the potential for fostering the development and application of interdisciplinary, community-based linkages. This occurs in areas where such linkages are most urgently needed, on health care delivery issues of greatest concern from a community standpoint, and it targets populations that are especially vulnerable or underserved.

The mission of Part D, Interdisciplinary, Community-based Linkages of Title VII, Health Professions Education, is to assure that there is a workforce that can meet the health needs of state, local, and rural populations of the nation, especially those with unserved, underserved, vulnerable, and disadvantaged populations; a workforce that can respond effectively to new and demanding health priorities. "Interdisciplinary" and "community-based" training are two educational strategies that help to prepare health professionals who are both knowledgeable of and sensitive to the needs of these populations because they worked with and for them in the course of their education. These initiatives are effective ways to ensure that there will be an adequate health workforce to meet the needs of communities, particularly those with at-risk populations.

Thus, an important component of Part D, Title VII is to integrate "interdisciplinary" and "community-based" concepts into the training of health professionals. Given the diversity of the health care workforce, incentives for these professionals to work together in teams have become imperative. Moreover, these incentives should target education in community-based settings to optimize the delivery of the public's health care and to minimize health care needs based on the goals and priorities established by Healthy People 2010. Also, by using interdisciplinary educational strategies, the quality of interactions among the professionals, quality of communications with the patient, and quality of actual services delivered will improve.

Compelling Need for Interdisciplinary Community-based Linkages Programs

These Interdisciplinary Community-based Linkages Programs (ICBLP), by virtue of their mission, prepare the future health professions workforce to meet the current and future health needs in our society. These programs are unique as the education and clinical training of the future health workforce is targeted on the care of this country's growing vulnerable and underserved populations in community settings. These populations include: the poor, homeless, frail elderly, ethnically and racially diverse, migrant, immigrants, rural, and incarcerated groups. Using preventive, primary care and population-based approaches to health care, these programs educate the future generation of health professionals to deliver culturally competent, clinical and public health services in underserved communities. The integration of interdisciplinary and community-based concepts into the training of health professionals through these programs has demonstrated its efficacy in preparing a diverse national health workforce to provide culturally competent, high-quality care to these populations. The public's health is enhanced through the population-based services delivered by these health professions learners and faculty, ultimately expanding the capacity of the current health workforce.

Population projections predict that the U.S. will almost double its older population to 70 million people by the year 2030 and increase its very-old population five-fold to 19 million in 2050.

Without Title VII Part D programs, interdisciplinary health professions education would be severely restricted and access to care for underserved and vulnerable populations would be reduced. Furthermore, the anticipated growth in these populations is expected to stretch health professions education and training resources well-beyond current and future capacity. Health professions' schools, deluged by these demands, are limited by the lack of available institutional resources targeted at institutionalizing service to communities. In addition, the distribution and diversity of the health workforce in these community-based settings frequently is not well-matched to the populations it serves, further limiting access to care. This combination of factors mandates the critical need for Federal and State support for these interdisciplinary, community-based programs.

These looming projections have been exacerbated in the wake of September 11, 2001. The health care concerns associated with bioterrorism, emergent infections and epidemics require collaboration across public health and primary care as well as interdisciplinary teamwork. As examples, the increased incidence of West Nile Virus, anthrax, and terrorist activities over the past year, calls for higher levels of collaboration across systems of public health and primary care. These real threats to human health could be addressed through the efficient integration of existing Interdisciplinary Community—based Linkages Programs mobilizing academic/community partners to use population-based approaches to health. Through teamwork among health care providers, partnerships with public health and communities, and innovative education and clinical training programs, can expand new and existing programs in a cost-effective manner, avoiding duplication and fragmentation.

Community Benefits of Interdisciplinary, Community-Based Linkages Programs

The ICBLP offer real world experiences for community-based primary care education and training for health professionals, students, faculty, and community health workers. The value and benefits of each of the ICBLP are described in Chapter 2. Community benefits and outcomes that exemplify the overall annual impact of these programs are described below:

• Since 1972, interdisciplinary community- based linkages programs have provided education and training to develop and expand the Nation's health workforce, thereby improving access to care for this country's most vulnerable populations.
• Federal investment in interdisciplinary community-based programs has developed more than 180 academic/community partnerships.
• Interdisciplinary community-based programs link naturally with 530 Community Health or Migrant Health Centers and 170 National Health Service Corps training sites.
• More than 40,305 health professions students are educated and clinically trained through the interdisciplinary community-based linkages programs.
• More than 340,000 students from K-12 participated in health professions career recruitment programs.
• More that 194,000 health professionals participated in Continuing Education Programs.
• More than 70,800 individuals benefited from the delivery of health promotion programs provided by trainees.

Formation of the Advisory Committee for Interdisciplinary, Community-Based Linkages

In addition to the programs identified in Sections 751 through 755 of the Act, Section 756 authorized establishment of a committee, termed the Advisory Committee on Interdisciplinary, Community-Based Linkages, to which it assigned the following duties and responsibilities:

• Provide advice and recommendations to the Secretary concerning policy and program development and other matters of significance concerning the activities under this part; and
• Not later than 3 years after the date of enactment of this section, and annually thereafter, prepare and submit to the Secretary, and the Committee on Labor and Human Resources of the Senate, and the Committee on Commerce of the House of Representatives, a report describing the activities of the Committee, including findings and recommendations made by the Committee concerning the activities under this part.

Section 756 further directed that:

• Appointments to the Committee be made from among individuals who are health professionals associated with schools of the types described in Sections 751 through 755;
• A fair balance be maintained among the health professions, with at least 75 percent of the appointees being health professionals;
• Broad geographic representation and a balance between urban and rural members be maintained; and
• Adequate representation of women and minorities.

A 21-member committee meeting these requirements was appointed by the Secretary and assigned a charter with an effective date of March 24, 1999. The charter was subsequently renewed on March 22, 2001 and March 23, 2003.