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Background
The health care environment in the United States has changed dramatically over the past decade. Many of these changes have been documented and are described in detail in the report Medicine and Public Health: The Power of Collaboration by Dr. Roz Lasker and the Committee on Medicine and Public Health. Changes in patient populations, shifts in clinical services, changing perspectives, shifts in funding streams and economic and performance pressures have all raised the need for public health and medical organizations to identify where their missions overlap, and to develop the skills and resources to collaborate to improve the health of our communities. In California, the size and diversity of our population heighten the need for this collaboration.

Until recently, there have been few incentives for medical and public health organizations in California to discuss the future of public health and medical care. Given the different perspectives of the two professions, medicine and public health leaders have often held different, and sometimes opposing, positions on statewide health policies and programmatic directions. The result is that state health policies and programs have not met the needs of California's communities as effectively or efficiently as they could if public health and medical leaders were better informed and cooperative.

Early in 1998, the California Conference of Local Health Officers (CCLHO) and the California Medical Association (CMA) began a series of leadership meetings that provided the groundwork for more broad-based collaboration. In the summer of 1998, the Integrating Medicine and Public Health Program was established as a joint program of the California Department of Health Services and the University of California, San Francisco with partial funding provided by the Centers for Disease Control and Prevention.

In the fall of 1998, the Cooperative Actions for Health Program (CAHP) -- a joint initiative of the American Public Health Association and the American Medical Association, funded by the Robert Wood Johnson Foundation -- made funding available for state public health associations to join with medical associations to foster collaboration between these two disciplines. The California Public Health Association-North responded to the request for applications, and together with the CMA, CCLHO, the CMA Foundation, the Public Health Institute (PHI) and the Southern California Public Health Association (SCPHA) submitted a proposal to support implementation of some of the ideas generated during the earlier discussions between CCLHO and the CMA. On October 1, 1998 the Cooperative Actions for Health Program awarded CPHA-N $15,000 to launch the California Medicine and Public Health Initiative. California was one of 19 states selected to participate in this first year of the CAHP program.

Overview
During the first quarter of this initiative, the Steering Committee expanded to include 17 statewide organizations and associations representing medicine, public health and community perspectives. The common element among all of these groups was the desire to identify arenas where collaboration could strengthen the capacity of medicine and public health organizations to improve community health. The immediate Past- Presidents from both the CMA and CPHA-N were selected to co-chair the group, and decisions were made primarily by consensus.

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