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What Can Tillery Tell Hillary? Tiny Town Reforms Its Own Health Care

Paul Cotton
JAMA. 1993;269(19):2485. doi:10.1001/jama.1993.03500190027005.
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THE OBSCURE, unincorporated rural hamlet of Tillery, NC, virtually ignored by the traditional health care delivery system, has put itself on the cutting edge of health care reform.

The effort can be traced to 1978 when residents successfully organized to save a local school. That done, they looked around to see what else they could do for their community of just under 1000 people, many of them poor, African American, elderly, or single parents.

The result today is a model comprehensive health program emphasizing prevention, individual responsibility, and empowerment that won Tillery the 1993 Healthier Communities Award, an international competition sponsored by the Healthcare Forum of San Francisco, Calif, and Marion Merrell Dow Inc.

"Tillery typifies the many rural crossroads communities in eastern North Carolina in which poverty, high unemployment, persistent racial inequities, and isolation create a very visible atmosphere of apathy and hopelessness," wrote residents in applying for the


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