Repairing the Social Contract by Adopting AAMC’s Fourth Mission of Embracing Community Collaboration

October 8, 2022

The Association of American Medical Colleges (AAMC) recently called for academic medicine to adopt “embracing community collaboration” as its fourth mission and for it to prioritize racial justice for healthcare. Health disparities are a longstanding and growing injustice that starkly affect communities of color. An article published in Academic Medicine, Academic Medicine’s Fourth Mission: Building on Community Oriented Primary Care to Achieve Community Engaged Health Care, describes successful models for community collaborations that can inform and guide this fourth mission.

“The AAMC’s “fourth pillar” of teaching hospitals is an important commitment to the communities they serve. Community Engaged Health Care offers a tested model for community engagement that improves health and trust,” said Robert L. Phillips, Jr, MD, MSPH, co-author and Founding Executive Director of the Center for Professionalism and Value in Health Care. Located in Washington, DC, the Center engages the broader health care community to consider the state of the social contract – the professional agreements between health care and people we serve – as well as professionalism and value and how to measure, align, and improve them. Community engagement and improvement is core to honoring the social contract.

Community Oriented Primary Care (COPC) is an eighty-year-old, well tested community collaboration mode that emphasizes community organizing and local partnership with healthcare professionals in developing solutions to community health problems. Each step of the COPC process includes community engagement. Dozens of academic health centers used the COPC as a training model in the 1970’s and 1980’s and notable academic health centers built on COPC to achieve Community Engaged Health Care (CEHC), offering robust examples of what the AAMC aims to achieve.

The University of New Mexico Health Sciences Center, Montefiore and Albert Einstein College of Medicine, and Morehouse School of Medicine all use the CEHC or COPC model in their programs. The AAMC has an opportunity as a leader and convenor to help academic health centers employ CEHC as viable solutions to the erosion of trust in the health professions and its institutions. The AAMC says that the fourth mission, “means working with community-based organization in true partnership to identity and address needs, and jointly develop, test, and implement solutions… to build a strong network of collaborators across public and population health, government, community groups, and the private sector, and to [weave] community collaborations consistently throughout research, medical education, and clinical care.” CEHC is a proven solution to these intentions. Health inequities were only widened by the global pandemic.

Commitment to community collaboration and health equity as a fourth mission, utilizing the recent National Academies of Science, Engineering, and Medicine (NASEM) report, Implementing High-Quality Primary Care, and peer institutions providing guidance, offers an important and strategic design for improving equity, building trust, and rehabilitating the social contract for healthcare.