The hypotheses, studies, programs, and approaches discussed in this special edition are familiar to social workers in a variety of educational and practice settings. The respective helping professions and the Bureau of Primary Health Care (BPHC) have known and worked closely together with women from Native American, Hispanic American, African American, and Asian American and Pacific Islander backgrounds for decades. The bureau has recently developed a specialized program, Office of Minority and Women's Health (OMWH), to help address some of the unmet health care needs of women of color. Concomitantly, this new program and its conceptualization have been based on our mutual knowledge that women of color (particularly in the lowest income group) and their children have not received the level of access or quality of physical and mental health care that they require to sustain themselves (Adams, 1995; Bayne-Smith, 1996; Center for Health Economics Research, 1993; Salganicoff, 1997; Schoen, 1997; U.S. Department of Health and Human Services [HHS], 1985; Weaver, 1976; Weiss, 1997). The difficult task for the helping professions and for government has been to determine and agree on the most effective policies, services, and conceptual approaches to support and implement in this new and fluid managed health care environment. However, in the past several years, our knowledge of successful model programs that solve and prevent some health problems has increased significantly (BPHC, 1996a). A number of successful programs developed by BPHC have been based on a clearer understanding of the relationship between the culture of a community and its health status. At the close of the 20th century, we know more about how to assist medically underserved women than ever before in our history (Adams, 1995; Bayne-Smith, 1996). But the research challenge remains urgent to identify more specifically what works well and with which women, under what conditions and in what amounts, to prevent poor health, illness, and early deaths. These are critical issues in our current health care environment, where human and fiscal resources are limited and where access, cost, quality, and utilization are being managed by new processes (Mauer, Jarvis, Mockler, & Trabin, 1995).
The intent of this article is to describe the role of BPHC, OMWH, and their legislative mission to enhance the health status of underserved and vulnerable women and their children; to briefly review some of the background data on the medically underserved and the particular status of women of color within that population; to identify a series of questions to help frame the policy dialogue for developing services to medically underserved women of color; and to invite dialogue, feedback, and participation with social workers around a number of these key questions and issues that can help guide our collective vision and health care initiatives for the medically underserved over the next several years.
MISSION OF THE BUREAU OF PRIMARY HEALTH CARE
One of the most significant problems for underserved populations is their inability to obtain health care services in the marketplace. Where access is severely limited, "people use fewer health services and have worse health outcomes" (Center for Health Economics Research, 1993, p 6). The limited access of medically underserved and vulnerable populations is reflected in their higher mortality rates and increased rates of cancer, heart disease, strokes, and dental disease (Center for Health Economics Research, 1993).
The Bureau of Primary Health Care was developed by the Public Health Service to increase access to comprehensive primary and preventive health care and to improve the health status of populations defined as medically underserved (BPHC, 1996b). Generally, the medically underserved in the United States are defined as individuals and families who lack adequate "access to primary care" (Hawkins & Rosenbaum, 1993, p. …