to be engaged. The committee notes that there are precedents for this kind of systematic strategy development and investment in national programs, such as the Hill-Burton program to build the nation’s hospital infrastructure, investment in the National Institutes of Health and its extramural programs to build the nation’s biomedical research infrastructure, and preferential funding for specialty medicine to build high-tech clinical capacity. There has never been an analogous comprehensive and sustained investment in the nation’s primary care and public health infrastructure.

•   While national leadership and prioritization will be needed if the necessary infrastructure is to be built, the committee believes that emerging organizational and funding models for the personal health care delivery system and unprecedented investment in public health and community-based prevention can be leveraged to promote the necessary alignment. However, no single best solution for achieving integration can be prescribed. Community-level application of the framework represented by the principles for integration identified by the committee will require substantial local adaptation and the development of specific structures, relationships, and processes.

•   Academic health centers often are well positioned to facilitate the integration of primary care and public health and the development of improved means of engagement and integration, as they are often located in communities of need and draw both their patients and their employees from these communities. As illustrated by several of the examples highlighted in Chapter 2, academic health centers can serve as effective partners with both health centers and local health departments in sharing data; aligning clinical, research, and educational programs; and sustaining integrated operations aimed at improving the health of the entire community. Some academic health centers appear to be actively engaged in this role; however, many are not. The evidence in this area is sparse, but the committee believes that creating an interface for the Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC) to work with academic health centers, their primary care programs, and their local health departments to promote the integration of primary care and public health is an opportunity that should be explored.

•   The committee believes that a starting point for catalyzing and promoting greater integration of primary care and public health is leveraging existing funds and policy initiatives. Table 4-1 in Chapter 4 highlights opportunities in the Patient Protection and Affordable Care Act (ACA) that HRSA and CDC can exploit for greater integration. Of particular note is the amendment to the Internal

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