History of Community Pediatrics.

T he community is the setting where the many determinants of childhood health, which include biologic, physical, economic, and social factors, exert much of their impact. 1 The American Academy of Pediatrics (AAP) has defined Community Pediatrics as a perspective that enlarges the pediatrician's focus from one child to all in the community and includes advocacy, especially for those who face barriers to health care because of social or economic conditions. 2 The pediatricians who established Pediatrics as a specialty in the late 19th century believed correctly that if they ignored the community , pediatricians ultimately would fall short in its efforts to improve child health. 2 The history of Community Access to Child Health (CATCH) by Hutchins and colleagues 3 in this supplement details the dramatic CATCH story and adds a chapter to the history of Community Pediatrics. Today, CATCH is well-established as part of the new AAP Department of Community Pediatrics. 2 The CATCH evaluation contains two major findings that have their origin in Community Pediatrics. The first is the pivotal role of early educational experiences in preparing a pediatrician for his/her community-based activities. The second is that established practitioners as volunteers can impact on the important health problems of his or her community. For more than 100 years, medical education consistently has sought ways of educating both medical students and residents in community settings. 4 In the mid-19th century, community-based generalists provided medical care to their communities, and physicians were educated primarily through preceptor-ships and apprenticeships. With the introduction of the full-time university post-Flexner model (1910), education for practice shifted to the university and its teaching hospitals. 5 Although Flexner emphasized the importance of social and preventive medicine, the Flexner Report established the full-time biomed-ical model of medical education based in academic medical centers and set the stage for the decline in the importance of community-based medical education. A few educators recognized the risks in deempha-sizing community care. 4 To balance the move away from community education, programs were developed in the 1920s and 1930s that included home visits (Johns Hopkins, Tufts, Boston University) and social clinics (Boston City Hospital). For most of these programs, the community was the hospital outpatient department. In eastern Baltimore in the late 1930s, Robinson suggested a hospital might have a responsibility for a defined community. The Committee on Medical Costs in the 1930s included, among its remarkable recommendations, not only national …