Avoiding “Mission Shrink” at Health Centers

by Marc Wetherhorn; Project Director, Community Health Vote

Over a period of 15 years working for the National Association of Community Health Centers (NACHC), I went from not knowing what a health center was to becoming almost unbearably passionate about health centers. I never did the real work of delivering health care to people every day – of literally easing suffering and saving lives and changing communities so I was in many ways a cheerleader for what the people who work at health centers do. I took advocating for health centers very personally. I viewed every policy and legislative fight for health centers and their patients as a battle, not just a job, and I HATED TO LOSE. I am an advocate, not a policy expert or lobbyist. I am living proof of the old saying that if you are a hammer, the whole world looks like a nail and I operate on the theory that if at first you don’t succeed, get a bigger hammer!

During my time at NACHC, I often asked folks what they thought the mission of health centers is. Not surprisingly, I got different answers from different people – ranging from the narrow “to care for the medically underserved” to the broad “make the world and our communities a better place”. I am willing to concede that just as “When you have seen one health center — you have seen one health center”, the mission that each health center sees for itself may be a bit different at the margins, but at the core it is the same:

To eliminate disparities in our health care system by providing high quality, affordable health care for everyone who needs it (or as many people as we can), AND to be leaders in improving the life and well-being of our communities.

I am not old enough to have been involved in the early days of the health center movement, but I am old enough to remember the times in which the movement began. Over the years, I have had the privilege of hearing from, talking to and working with people who were there and who made it happen and it is clear to me that just as health centers grew out of the movement for civil rights and social justice in the 1960’s, you cannot have a mission for a health center today that does not include advocacy for your community and empowering your patients. Simply put, without powerful grassroots advocacy and the bi-partisan political support it earned, there would probably be few, if any, health centers as we know them today and the result would have been no “mission” at all.

More than a few times I have had health center leaders tell me that they are reluctant to make advocacy or voter engagement part of their work because they see that as “Mission Creep” or going beyond the real purpose of the health center. Yet, those who remember the early days of the program would say that if advocacy and civic engagement are not part of a health center’s work today, then that health center has actually suffered from Mission Shrink!

I have nothing but admiration for the people who lead and work at health centers today. I went to business school and understand the need to maximize staff productivity and to pay the bills. It is true that the challenges have never been greater and the political environment in which health centers have to face these challenges has never been more difficult. Yet, the mission of health centers has not changed and the importance of their achieving that mission – in its fullest sense – has never been more important. While Health Centers continue their work to shape a better health care system, they need to avoid allowing their mission to shrink so they can continue to help shape a healthier civic system as well.

Marc Wetherhorn  has over 30 years of political, organizing and advocacy leadership experience at the state and national levels. Marc served for 15 years as the National Advocacy Director and Senior Director of Advocacy and Civic Engagement for the National Association of Community Health Centers.

Voter Engagement at Community Health Centers: Continuing the Legacy of Freedom Summer

Fifty years ago, during Freedom Summer, Dr. Jack Geiger traveled to Mississippi as a field coordinator for the Medical Committee for Human Rights. Following directly from that experience, Dr. Geiger and Count Gibson, whom he met that summer, started the first federally funded health centers. They were, indeed the Fathers of the Health Center Movement.

In 2014, as America observes the 50th anniversary of that Freedom Summer and health centers prepare to celebrate the 50th Anniversary of the creation of the Community Health Center Program next year, the more than 1200 health centers in existence today have the chance to continue the legacy begun during Freedom Summer that connects Community Health Centers directly to the work to empower the communities they serve through the right to vote.

In 2012, blog post, Dr. Geiger spoke directly to the connection between voting and community health centers:

“Voting Rights—and Freedom Summer, in Mississippi in 1964—was a pathway to the creation of community health centers, for it brought to Mississippi, through the Medical Committee for Human Rights, so many of the people who would go on to create Community Health Centers. “ After telling a personal story of the power of civic engagement in Mississippi, Dr. Geiger closed by offering his slogan for Community Health Centers: “Voting is good for your health! Register Now! We can help!” Yes, we did. And yes, we can. “

Following Dr. Geiger’s admonition, over 200 health centers registered over 25,000 voters in 2012. An analysis of that effort showed that voters registered or reminded to vote by a health center turned out in number substantially higher than others in their demographic groups.  This is not news to many health centers because they have been encouraging and supporting their staff, patients and communities to vote for years.  Yet many health centers remain fearful of assisting their patients in registering to vote in the current politically charged environment.  This is a legitimate fear, but not one that should not deter health centers from continuing the work that helped give them birth.  Health centers can legally conduct voter engagement activities as long as they are done in an entirely non-partisan manner, consistent with the IRS guidelines. Our goal at Community Health Vote  is to help health centers and any other safety net health care provider, to do just that.

There remain many people who dispute the idea that empowering patients to vote is a part of the health center mission. If you believe Dr. Geiger and others who have been around the health center movement since its early years, not only is voter engagement a part of the mission, it is part of the very DNA of every health center that grew from that Freedom Summer 50 years ago. Just as health centers provide care to any patient who walks in the door, they should provide assistance to anyone who wants to register to vote or update their registration.

As you observe Freedom Summer and reflect on the legacy of America’s Health Centers since then, I urge you to do more than reflect. I urge you to reconnect to the fabric of the movement that began in 1964. Commit to empowering your patients and your community by offering non-partisan voter registration assistance to everyone at your health center. For information on how you can do it or help getting started, email me at