Moral Uncertainty in Community Health 

Understanding Ethical Challenges of Community Health Center

Funder: Greenwall Foundation, Making A Difference Program

This national study of nonprofit community health centers in the United States will learn about and describe the nature and extent of ethical challenges arising in primary care clinics serving diverse low-income communities facing health care barriers. Community health providers have few places to turn for bioethical analysis and guidance on the practice challenges that keep them up at night. The project builds on prior Hastings Center research on ethical challenges in immigrant health and arising in Federal Qualified Health Centers (FQHCs) participating in genomics research and responding to Covid-19.

Through its engaged research process and its products, this new study will strengthen and inform ongoing bioethics-community health collaboration that supports community health providers and advances trustworthy health care, inclusive research, and equitable health policy.

The Hastings Center’s quantitative research partner in this project, the Institute for Community Health (ICH), is a nonprofit consulting organization with a mission to improve community health through planning and assessment, participatory evaluation, applied research, and data services. ICH’s Leah Zallman Center for Immigrant Health Research was established in memory of the late Leah Zallman, a primary care physician and preeminent researcher on immigrant health.

The Hastings Center’s qualitative research partner, Johanna Crane, PhD, Professor in Albany Medical College’s Alden March Bioethics Institute, has collaborated with our Hastings Center team on each of our Bioethics in Community Health projects.

Methods

The study will use survey, interview, and analytical methods. It took place from September 1, 2022-August 31, 2024. 

Learn more about the Bioethics in Community Health project.

Project Team

• Carolyn Neuhaus, PhD, Principal Investigator; Research Scholar, The Hastings Center
• Nancy Berlinger, PhD, Co-Principal Investigator; Research Scholar, The Hastings Center
• Johanna Crane, PhD, Co-Investigator/Interview Director; Associate Professor, Alden March Bioethics Institute, Albany Medical College
• Onesky Aupont, MD, MPH, PhD, Co-Investigator/Survey Director; Senior Research and Evaluation Scientist, Institute for Community Health (ICH)
• Jessica Santos, PhD, Senior Advisor-Survey; Director, Leah Zallman Center for Immigrant Health Research, ICH
• Ranjani Paradise, PhD, Senior Advisor-Survey; Director of Evaluation, ICH
• Sofia Ladner, MPH, Project Manager-Survey; Research and Evaluation Project Manager, ICH
• Aashna Lal, BA, Project Manager; Project Manager & Research Assistant, The Hastings Center

Research Brief

Publications

Abstract: Started in the 1960s with a commitment to justice, the community health center (CHC) movement emphasized that everyone deserves respectful, quality health care and that addressing social drivers of health is within the remit of health-care organizations. Sixty years on, the network of federally funded community health centers that developed from this movement remain committed to serving vulnerable populations in America as they set the standard for high-quality, wraparound primary care services. This essay draws on the authors’ qualitative study of moral uncertainty in community health to show how CHC providers enact a commitment to justice as they both improve access to care and services and recognize their patients’ humanity in a society where too many of them are “chewed up and spit out.” CHCs’ ability to enact justice, however, is limited in the US’s fractured health-care system and profoundly unequal society, and their success and financial viability are not assured. In order for CHCs to fully enact their mission, it will take appreciating the key role they play in advancing health justice in America, and strong, savvy advocacy efforts.

Neuhaus, Carolyn. “Cultivating Peace and Health at Community Health Centers.” Hastings Center Report 53, no. 5 (2023). https:/doi/10.1002/hast.1399. 

Abstract: Founded on a commitment to social justice and health equity, community health centers in the United States provide high‐quality primary care to underserved populations and address social drivers of health disparities. Through an examination of two books on the history of community health centers, Peace & Health: How a Group of Small‐Town Activists and College Students Set Out to Change Healthcare, by Charles Barber, and Community Health Centers: A Movement and the People Who Made It Happen, by Bonnie Lefkowitz, this essay provides insight into what it takes to center social justice in community‐based health care organizations. As bioethics reorganizes itself around an emphasis on justice, scholars in bioethics have much to learn from colleagues in community health.

Berlinger, Nancy. “Bioethics in Community Health.” Hastings Center Report 52, no. 4 (2022). https:/doi/10.1002/hast.1399. 

Abstract: What keeps community health providers up at night? And how should bioethics evolve to meet the needs of these providers? Hastings Center research scholar Nancy Berlinger introduces a new project and line of research and public-facing work at The Hastings Center to explore ethical challenges that arise in primary and preventative health care for medically underserved communities, where ethical challenges often reflect the health consequences of social inequalities.

Download the article.