The Conference on Community Oriented Primary Care, held in March of 1982 under the auspices of the Institute of Medicine, represented an important historical point in the development of primary care in the United States. Set as it was against a backdrop of 20 years of vigorous efforts to provide more equitable health services to the entire population of the United States, it was nonetheless firmly rooted in the realities of the 1980s.

The antecedents of the conference were several. Large-scale federal commitment to the provision of medical care was one. That began in the 1960s with the OEO Neighborhood Health Centers, the Children and Youth and Maternal and Infant Care Programs, and the Migrant Health Program. It continued in the 1970s with the authorization and growth of the National Health Service Corps and its scholarship program. A second factor was the reemergence of general practice medicine in the form of family practice as called for in the Millis and Willard Reports, both published in 1966.^* The family medicine movement grew apace from the sentiments that these documents articulated. By the late 1970s some 13 percent of American medical graduates were pursuing careers in family medicine—many practicing in rural and traditionally underserved areas.

Finally, during the 1970s, the concept of primary care gained prominence and acceptance as an anchor against the subspecialty drift of the major medical disciplines. Not only was family practice included in the concept of primary care, but general internal medicine and general pediatrics and some elements of psychiatry and obstetrics and gynecology were included as well. The Institute of Medicine (IOM) helped to solidify the concept with its 1978 publication, A Manpower Policy for Primary Health Care, which clearly defined the field and made specific policy recommendations pertinent to it.

All these developments had taken place in an environment of greater community participation. From the civil rights movement of earlier years to the consumerism of the 1970s, the role of the community and the patient had become more prominent in the delivery of health services. Departments of community and social medicine had grown up in medical schools, and increasing numbers of medical students and young health professionals sought career opportunities in community-responsive practice settings.

The conference occurred at a time when the difficult economic, social, and political circumstances of the 1980s were being experienced for the first time in all sectors. The nation's economy was hard-pressed. Serious cutbacks in governmental support for health care were a reality. The energetic efforts of medical schools in previous years had succeeded in producing a vastly expanded pool of physician graduates whose availability was unquestionable but whose ultimate place and type of practice was uncertain.

The historical trends in health service delivery, set against the political and economic realities of 1982, provided the backdrop for the meeting.

The National Academy of Sciences supplied a small program initiation fund that enabled the Institute of Medicine to assemble a planning committee to examine issues emerging out of these events. This group met for 2 days in June 1981 and then continued to deliberate by phone, letter, and subcommittee meeting for the balance of the year. The planning committee played an important role in formulating the questions for the conference and supplying a format for the answers. They selected the term “community oriented primary care” (COPC) over a number of other possibilities because they felt it represented an amalgam of the main themes of their deliberations. The term itself had been coined by Dr. Sidney Kark of Hadassah-Hebrew University in Jerusalem to describe his well-established program of training and research in the area of population medicine and primary care. Dr. Kark, who was visiting in the United States, served as a member of the planning committee and played an important part in framing the concept.

The committee further agreed on two important points that shaped the substance of the conference. The first was that, while COPC had major implications for health services delivery, its implementation would be impossible without education and training programs that would prepare physicians and other health providers for the demands of community practice. Therefore, any deliberations on the subject should recognize the issues of education as well as service. Second, there was a strong sense that the COPC discussion should not be limited to the United States because much could be gained from and exchanged with other nations who had undertaken similar approaches to the delivery of health services. Many committee members felt that the rapid developments of the previous years in the United States had taken place without the benefit of the experience of similar efforts around the world. Therefore, it was decided that the conference should attempt to incorporate representatives of community oriented programs in progress in other countries. The committee stated four goals for the conference:

• to refine the concepts and techniques of COPC and to trace its development in the United States in comparison with that of other nations;
• to examine the theories and practices that have been applied in COPC;
• to consider the means of incorporating the theory and practice of COPC into the education and training of health care providers; and
• to publish and disseminate the results of this conference in order to facilitate further developments in COPC.

In summary, the conference was intended as a forum in which the practice of community medicine in the United States could be reassessed, codified, and, as appropriate, redirected. This volume represents the record of that undertaking. It is our hope that it will be of assistance to health care practitioners, planners, and teachers in the decade to come.

And, finally, a word of thanks. Conference participants were drawn from many walks of professional and community life in an effort to provide broad and varied contributions to the deliberations. Although many participants raised their own funds to enable them to attend the conference, crucial financial assistance for others, as well as for the undertaking as a whole, was provided by the U.S. Public Health Service, the Commonwealth Fund, and the Henry J. Kaiser Family Foundation. The COPC committee wishes to thank them for their trust and their support.

FITZHUGH MULLAN