I am pleased to have the opportunity to comment on Dr Smith's article. He has shared with us collaborative approaches to the organization and delivery of health care that have been used in the Dallas inner city to break down structural and cultural barriers to health care at the community level. In the June 1994 issue of Pediatrics, Albert Scheiner points out that "Ninety-five percent of pediatric health care is provided in the community .... All community practice settings are home ground for the family and the child and provide opportunities for a continuity of care experience that is family-centered and that includes such concepts as child advocacy, disease prevention, and health promotion."1
Dr Smith aptly points out that rapidly evolving changes in the health care system and health care financing can provide an opportunity to accomplish many of the positive changes for children that pediatricians long have sought. I would like to share some thoughts about how we create the health care, education, and research components of the new community pediatrics. New kinds of collaboration will be critical to developing these components, and such collaboration will challenge all of us to partner with institutions and individuals with whom in the past we may have been unfamiliar or even uncomfortable.
Because it is always good to define our terms, let us take as a starting point Haggerty's definition of community pediatrics,2 which captures the essence of the Dallas program. Says Haggerty:
Community pediatrics seeks to provide a far more realistic and complete clinical picture by taking responsibility for all children in a community, providing preventive and curative services, and understanding the determinants and consequences of child health and illness, as well as the effectiveness of services provided.