Urban AHECs: a comparison with rural AHECs.

The first generation of projects in the Federal Area Health Education Center (AHEC) Program was funded in 1972. Those AHEC projects, located in predominantly rural areas, focused on problems that resulted from the geographic maldistribution of health professionals, especially primary care physicians. Education programs for health professionals, students, and practitioners were used to influence the geographic distribution of health professionals and to improve access to and quality of health care for underserved populations. In 1976, the Congress redrafted the law authorizing the expenditure of funds for AHECs and emphasized that improving access to health care in urban underserved areas also was to be addressed by the program. During the early years of urban AHEC development, it was not clear which lessons learned from rural AHEC experiences could be applied to urban communities and what would be the best focus for AHEC activities in the complex urban environment. Some said that urban areas were so different from rural areas--in economic, racial, and cultural terms and in the subtlety of barriers to health care--as to make the rural AHEC experience largely irrelevant. Others maintained that basic AHEC principles could be applied, regardless of setting, with changes only in tactics to address the problems of the urban inner city. Now that 18 of the total 53 AHECs nationally are urban, and a decade of experience in developing them has been accumulated, it is appropriate to compare the types of educational interventions supported by AHECs in urban and rural environments and the relative priorities of such programs. In this report we examine the experiences of the California AHEC System, which includes 17 urban and rural centers and the 9 medical schools with which they are affiliated. Although the AHEC Program concept was found to be equally applicable to both urban and rural settings, significant differences in implementation were noted. Those differences were evidenced both by relative budgets,such as the large expenditures for undergraduate medical education in urban areas and for nursing in rural areas, and by subtler differences in the types of programs developed within budget categories