This study traces the major policy shifts in medical care that have affected disadvantaged African-Americans and the response of this community's medical leadership to these changes. Since World War II policy has passed through three major phases. The first—engagement—ran from the mid-1960s through the mid-1970s. During this phase a community health policy orientation prevailed as national government targeted resources to health care programs for needy blacks and other poor Americans. From the late 1970s to the mid-1980s the period of submersion occurred: black community health professionals and political leaders experienced a newfound inclusion in health policy debate, but, at the same time, broader policy-making circles in government and health care reduced medical resources for the inner-city poor. Finally, in the third phase—crisis recognition—a network developed of community health advocates who seek to reorient the health system so that it addresses needs within urban America's “New Ghettos.”

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