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Community authority and management may be most important in altering the social conditions and prevention activities to promote health ---AND in the complex services needed for persons with serious, persistent, and progressive disabilities, mostly associated with aging. Both populations basically have to "make do" with the services that their community makes available. The populations "in the middle" with an acute or non-disabling chronic illness, if they have resources and interest, can examine the marketplace locally and at a distance and make choices. I wonder whether it is important to link the very sick and those who could be well - or whether they need different integrators and advocates, and a different set of community-based managers.

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