Gessert C, Jones C
Public Health Rep. 1986 Nov-Dec;101(6):637-43.
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
联邦地区健康教育中心（AHEC）项目的第一代项目于1972年获得资助。这些AHEC项目主要位于农村地区，关注的是卫生专业人员，尤其是初级保健医生地理分布不均所导致的问题。针对卫生专业人员、学生和从业者的教育项目被用于影响卫生专业人员的地理分布，并改善服务不足人群获得医疗保健的机会和医疗保健质量。1976年，国会重新起草了授权为AHEC项目拨款的法律，并强调该项目也应解决改善城市服务不足地区获得医疗保健服务的问题。在城市AHEC发展的早期，不清楚从农村AHEC经验中学到的哪些经验可以应用于城市社区，以及在复杂的城市环境中AHEC活动的最佳重点是什么。一些人说，城市地区在经济、种族和文化方面以及医疗保健障碍的微妙之处与农村地区如此不同，以至于农村AHEC的经验基本上不适用。另一些人则坚持认为，AHEC的基本原则可以应用，无论环境如何，只需改变策略以解决城市中心区的问题。鉴于全国53个AHEC中有18个是城市型的，并且已经积累了十年的发展经验，比较AHEC在城市和农村环境中支持的教育干预类型以及此类项目的相对优先事项是合适的。在本报告中，我们考察了加利福尼亚AHEC系统的经验，该系统包括17个城乡中心以及与之相关联的9所医学院。尽管发现AHEC项目理念同样适用于城市和农村环境，但在实施过程中仍存在显著差异。这些差异既体现在相对预算上，比如城市地区本科医学教育和农村地区护理方面的大量支出，也体现在预算类别内所开展项目类型的细微差异上。
