It turns out that retail medical clinics may not serve the underserved after all, according to a study published in the Archives of Internal Medicine (see reports). Of the 930 retail clinics mapped by researchers, only 123 were located in areas defined by the federal government as medically underserved. Clinics were typically found in neighborhoods with lower percentages of black and Hispanic residents, lower rates of poverty, higher rates of home ownership and higher median incomes.

Proponents contend, however, that the poor and uninsured do make their way to retail clinics. “People go out of their neighborhoods to work and shop,” says Margaret Laws, director of the California Healthcare Foundation’s Innovations for the Underserved program. “I don’t think we should make the assumption that they won’t go out of neighborhoods to seek health care if it offers customer service, better hours and transparent prices.”

But what about those without a car or public transportation or childcare or safe, walkable sidewalks? Will people overcome these and other barriers for good “customer service, better hours and transparent prices”?

Of course, all this misses a bigger issue. Defining “access” is not only a matter of proximity. The real question is: access to what? Will the CVS walk-in clinic three neighborhoods away speak my language? Will it offer culturally sensitive care? Integrated medicine? Indigenous healers?

Consider what happened at Southcentral Foundation, a community health system serving Alaska Native and American Indian people living in Anchorage and 60 rural villages. In 1982, Southcentral was turned over from the government to the very communities it serves, as part of the Alaska Native Claims Settlement Act by Congress.

Now owned by the Alaska Native and American Indian communities, there has been a total system-wide transformation, dramatically increasing quality of care for heart disease, diabetes, and cancer, which is the number one killer of Alaska Native people.

But here’s the amazing part. Southcentral has reached deeper into the sources of health of illness within these communities – with programs for domestic violence, child abuse, alcohol and drug abuse, and suicide. They run the school Head Start program. And community health education covers the basics, plus traditional healing, tribal relations, and economic wellness.

Southcentral’s vision: A Native Community that enjoys physical, mental, emotional and spiritual wellness.

This is a community that has come together to change from within. Where everyone has a voice and a role. Where building community is a natural extension of living in the community. And as a result, community members have a sense of control, shared purpose and contribution.

So, what might a “care clinic” look like in Las Vegas or Houston or Benton Harbor, Michigan? Are we willing to turn over design and control to the people who live there? Can we see care as the highest expression of community?