Primary care in public housing: voices of clinicians.

T Public Housing Primary Care (PHPC) Program, created under the Disadvantaged Minority Health Improvement Act of 1990 and administered by the Department of Health and Human Services’ Health Resources and Services Administration (HRSA), enables 40 community health centers across the country to expand their primary care services to residents of public housing. These health centers are located on the premises of public housing, or at locations immediately accessible to residents. Public Housing Primary Care programs utilize partnerships with public housing authorities and resident/tenant organizations to facilitate the delivery of services, including collaboration with state and local managed care systems. Residents are actively involved in the design of services and program governance, and are routinely trained or employed as outreach workers and case managers. The goal of these partnerships is to have increased selfmanagement skills in disease prevention and health promotion. People living in public housing face complex social, economic, and physical stressors, and general safety concerns, which affect employment and educational opportunities, and contribute to the multiple health challenge. Carlos Manjarrez, a senior researcher at the Urban Institute, has looked at issues of neighborhoods and health outcomes and found that residents of public housing often keep children inside the home instead of taking them to a park for exercise and recreation due to personal safety concerns.1 Such individual decisions can contribute to a reduction in physical activity and, thus, to obesity and related disease processes. Additionally, limited access to fresh fruit and vegetables, and the proliferation of small stores stocking processed foods, can contribute to poor health behaviors and outcomes.2 The majority of the 2 million residents in public housing fall below the federal