Abstract
The first community health centers were established 40 years ago, with roots in the civil rights and social justice movements of the 1960s. As part of the federal War on Poverty, the centers combined preventive and primary care, social and support services, and consumer involvement. While most observers gave them little chance for survival, health centers beat back repeated efforts to cut funds or eliminate the program, grew exponentially, and were selected for further expansion. Possible reasons include provision of concrete, essential services, community ownership, bipartisan political support, interested and involved officials, unusually committed leadership, persistent need, and a record of effectiveness, quality, and cultural sensitivity.