Bioethics in Community Health

The World Health Organization defines community health as the environmental, social, and economic resources people need for their physical and emotional wellbeing in the place where they live.

As a form of health care, community health focuses on primary care, disease prevention, and services that support wellbeing and access to health care. In the U.S., community health centers are nonprofit organizations that provide patient care at the neighborhood level, tailored to the needs of local populations. Ambulatory clinics run by hospitals and public health systems are also part of community health, as are community-based organizations that help immigrants and refugees, migrant farmworkers, and other vulnerable populations navigate health care systems and meet health-related needs.

Ensuring that health care practitioners can communicate in patients’ preferred languages, helping patients with health-related needs such as access to transportation or affordable housing, and providing primary care to rural, unhoused, migrant worker, uninsured, or other populations who face barriers to health care, are typical activities for community health center practitioners. These practitioners include physicians, nurse-practitioners, physician-assistants, registered nurses, social workers, and community health workers, among others.

Research in community health focuses on delivering high quality primary and preventive health care and understanding and mitigating health disparities across diverse patient populations. Community health centers are strongly focused on health equity for the communities they serve, and research participation by a community health center tends to reflect health equity goals.

Bioethics concerns what it means to be human, and a member of society, in relation to experiences of health, wellbeing, and flourishing. Access to health care, the trustworthiness of health care practitioners and organizations, how a person’s environment supports or undermines their health, and how to mitigate place-based health disparities are examples of ethically resonant dimensions of community health. Yet ethical challenges in community health are rarely the focus of bioethics teaching, research, and practice, which tend to be based in academic medical centers and hospitals.

Ethical challenges in community health arise when practitioners and administrators directly confront the health consequences of social inequalities affecting communities. Patients who face barriers to health care due to low income, lack of insurance, immigration status, low literacy, or other factors may also lack affordable housing, good jobs, Internet access, and educational opportunities.

The Hastings Center’s research in community health aims to understand and support community health practitioners in their roles as providers, investigators, educators, and advocates, and to explore and respond to the ethical challenges these practitioners face in providing high-quality health care in disadvantaged communities.

Sources: Institute for Community Health, National Association of Community Health Centers (NACHC), World Health Organization (WHO)

Federally Qualified Health Centers (FQHCs) are a major provider of community health services in the United States. FQHCs are non-profit organizations that provide primary care to medically underserved areas or populations, including uninsured and underinsured patients. These community health centers are financed by the federal Health Resources and Services Administration (HRSA).

In 2019, The Hastings Center launched ​a new line of research focused on FQHCs and the populations they serve, aligned with the Center’s longstanding work on immigrant health. Click to learn more about each research project.

• All of Us Motivations Study
• Motivations Study Supplement
• Covid VACCS

In 2011, The Hastings Center launched Undocumented Patients, a series of grant-funded projects on health care access for low-income populations excluded from federally funded health-related programs and facing other barriers to health care access due to immigration status. This initiative has included public health convenings, policy recommendations adopted by the nation’s largest public health system, and toolkits for researchers and practitioners. In 2022, the Undocumented Patients website was incorporated into Bioethics in Community Health, reflecting the community health orientation of immigrant health research, practice, and policy. Click to learn more about The Hastings Center’s work on immigrant health.

• Immigrant Health (incorporating Undocumented Patients website archive, 2011-21) 

Contact us if you would like more information about our work.

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