This is a compilation of proceedings from the first networking meeting of grantees from the 13 communities - or learning laboratories - who are playing the lead role in the W.K. Kellogg Foundation Initiative Community Voices: Healthcare for the Underserved. The meeting washeld August 2-6, 1998, at Stowe, Vermont. The presentations and answers to questions have been edited for clarity.The theme of the meeting was public policy and structural processes that strengthen the ability of providers of last resort to offer and sustain quality primary and preventive health care services.Community Voices is a five-year, $55 million initiative to improve health care access and quality. It is the largest start-up initiative in the Foundation's 68-year history and is the single largest philanthropic effort aimed at improving health care access and quality in the U.S.The Foundation is launching the Initiative to help ensure the survival of safety-net providers and to strengthen community support services given the unlikely prospect of achieving universal health coverage in the next five years. Building up from the community level, theInitiative will give the underserved a voice to help make health care access and quality part of the national debate. The Foundation is supporting 13 local learning laboratories with communications, research, and technical assistance to help educate the public andpolicymakers on the importance of improving health care to the 70 million Americans who are underserved in the best health care system in the world. Each learning laboratory will seek matching funds to greatly expand the reach of the Initiative.