Public hospitals have long been a major site for the training of Blacks in the health care profession. They have also provided opportunities for research into a broad array of health, social, and economic determinants of disease and dysfunction in the Black community. Their emphasis on community-oriented primary care has encouraged the larger national community to pay attention to the social, economic, and environmental factors that increase disease and morbidity in the poor and underserved population. And they have been instrumental in providing technical assistance to Black community health projects such as lead poisoning prevention, injury prevention, substance abuse, violence prevention, and hypertension and diabetes education.
The academic-public hospital partnership has provided the Black community with the training and resources to become effective advocates for improved quality health care and related social services. In many communities, public hospitals have created new models of interaction among health care professionals, institutions of higher education, and community organizations. This partnership has enriched the medical and health sciences education.
However, the teaching, research, and service activities of public hospitals are being affected by dynamic changes that are currently taking place in the health care system. These changes could well limit the opportunities for Black students to gain firsthand experience relevant to their health career goals and objectives.
Given the popularity of privatizing services and the apparent growth of so many forms of health care, some may wonder why it is worth preserving public hospitals at all. Can't the rest of the health care system pick up the slack, including training for health and medical students?
It would be nice if that were possible, but the facts prove otherwise. Tears in the public safety net are already creating a new health care crisis of its own. Between 1981 and 1993 the number of public hospitals decreased by 25 percent nationally. If we continue to lose these hospitals, many Blacks and other minorities stand to lose their last certain access to medical care, and an important site for medical training and research will be substantially eroded.
The fragile state of public hospitals is brought into sharper focus bv the increased number of the uninsured. …