Ethics

How health care organizations can best support communities they serve

Beyond delivering health care services, hospitals and physician practices are often major employers in their communities. The physical and psychological consequences of social inequalities experienced by patients are also confronted by physicians employed by these organizations. Because of this, health care delivery organizations need to be aware of the important roles they play in supporting the economic and social fabric of communities they serve.  

The March issue of the AMA Journal of Ethics® (@JournalofEthics) features numerous perspectives on health care organizations and community development and gives you an opportunity to earn CME credit. 

Articles include: 

How Should Health Care Professionals Address Social Determinants of Refugee Health?” This article considers social determinants of refugee health and the moral importance of freedom to achieve well-being. The capabilities framework is used to analyze this case because it offers an ethical framework for understanding and evaluating social determinants of refugee health that either promote or diminish freedom to achieve well-being. By using this framework to consider social isolation as a negative social determinant of refugee health, physicians and institutions can be caregivers as well as advocates for social justice, fulfilling two core ethical obligations to refugee communities. 

How Can Clinicians Catalyze Investments to Improve Community Health?” Where people live and work influences how long and how well they live. Physicians can help keep patients healthy by encouraging health care organizations to support community investments that improve conditions contributing to health risks, outcomes, and costs. These conditions—the social determinants of health—include housing, transportation, jobs, and educational opportunities. Hospitals and health systems have assets—financial capital, land, and expertise, for example—that can be used to help support community health. Physicians are uniquely positioned to collect data and ask questions in support of effective partnerships that address the root causes of poor health. 

How Should Health Care Organizations and Communities Work Together to Improve Neighborhood Conditions?” In the past few decades, scholars have begun to establish ethical principles for public health engagement. A key tension has been how to reconcile public health improvement with local autonomy in decision-making to express respect for community members’ on-the-ground experiences. This article describes the experience of one children’s hospital in learning to ethically engage a surrounding community in conversations about housing development in partnership with a local faith-based development organization. 

Hospitals’ Obligations to Address Social Determinants of Health.” Federal health care reform has expanded medical insurance to millions of people, altering the roles hospitals play in improving community health. However, current federal and state community benefit policy is an ineffective tool for ensuring that hospitals address social determinants of health in their communities. Policy shifts and other incentives that promote improved population health outcomes can encourage health care organizations to do the same. 

Listen and learn 

In the journal’s March podcast, guests include:  

  • Daniel Skinner, PhD, an assistant professor of health policy at the Ohio University Heritage College of Osteopathic Medicine in Dublin, Ohio, and a co-director of the Health Policy Fellowship, a program of the American Association of Colleges of Osteopathic Medicine. 
  • Berkeley Franz, PhD, a medical sociologist and an assistant professor of community-based health at the Ohio University Heritage College of Osteopathic Medicine in Athens, Ohio.  
  • Kelly Kelleher, MD, a professor of pediatrics at the Ohio State University College of Medicine. She is also director of the Center for Innovation in Pediatric Practice and the vice president of health services research at the Research Institute at Nationwide Children’s Hospital. 
  • Robin Hacke, MBA, the executive director and cofounder of the Center for Community Investment in Washington, D.C. 

In the episode, we explore key factors for successful partnerships among physicians, health care organizations and communities. Listen to previous episodes of the podcast, “Ethics Talk,” or subscribe in iTunes or other services. 

Submit manuscripts and artwork 

The journal’s editorial focus is on commentaries and articles that offer practical advice and insights for medical students and physicians. Submit a manuscript for publication. The journal also invites original photographs, graphics, cartoons, drawings and paintings that explore the ethical dimensions of health or health care. 

A look ahead 

Upcoming issues of the AMA Journal of Ethics will focus on innovating nanoethics and advanced cardiopulmonary care ethics. Sign up to receive email alerts when new issues are published.