title: Community, service, and policy strategies to improve health care access in the changing urban environment.
abstract: Urban communities continue to face formidable historic challenges to improving public health. However, reinvestment initiatives, changing demographics, and growth in urban areas are creating changes that offer new opportunities for improving health while requiring that health systems be adapted to residents' health needs. This commentary suggests that health care improvement in metropolitan areas will require setting local, state, and national agendas around 3 priorities. First, health care must reorient around powerful population dynamics, in particular, cultural diversity, growing numbers of elderly, those in welfare-workplace transition, and those unable to negotiate an increasingly complex health system. Second, communities and governments must assess the consequences of health professional shortages, safety net provider closures and conversions, and new marketplace pressures in terms of their effects on access to care for vulnerable urban populations; they must also weigh the potential value of emerging models for improving those populations' care. Finally, governments at all levels should use their influence through accreditation, standards, tobacco settlements, and other financing streams to educate and guide urban providers in directions that respond to urban communities' health care needs.
authors.affiliation: State University of New York Health Science Center/Brooklyn, Department of Preventive Medicine and Community Health 11203, USA. dandrulis@netmail.hscbklyn.edu
authors.forename: D P
authors.initials: DP
authors.lastname: Andrulis
mesh_terms: D000368:Aged; D002648:Child; D002662:Child Health Services; D003153:Community Health Services; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006299:Health Services for the Aged; D006801:Humans; D011640:Public Policy; D014481:United States; D014504:Urban Health / Q000639:trends*