AMA Journal of Ethics^®

Abstract

Physicians play important roles in community development. They seek not only to increase patients’ overall well-being and the quality of care in clinical settings, but also to engage communities in health promotion and public health efforts. The AMA Code of Medical Ethics offers guidance to physicians developing community health initiatives, especially regarding health promotion, community development, and rural health care access.

Medicine and Public Health

The effects that health care organizations have on surrounding communities is recognized in the American Medical Association (AMA) Code of Medical Ethics¹ and in several policies put forth by the AMA.^2-4 By extending care beyond clinical encounters, physicians become integrated within a community with a goal of motivating positive health outcomes.

Health Promotion

Opinion 8.11 of the AMA Code, “Health Promotion and Preventive Care,” states that, alongside diagnosis and treatment, “physicians also have a professional commitment to prevent disease and promote health and well-being for their patients and the community.”¹ Physicians can promote healthy lifestyles by educating patients, helping them create and maintain a healthy lifestyle, and, “when appropriate, delegate[ing] health promotion activities to other professionals or other resources available in the community who can help counsel and educate patients.” Beyond clinical encounters, AMA policy “Healthy Living Behaviors,” H-170.984, “encourages all physicians to provide advocacy by working with parents, schools and community organizations to develop programs and services for the children and youth populations.”² That is, physicians should help both adults and children create healthy lifestyles to reduce health risks. Physicians are uniquely suited to use their medical knowledge and expertise in aiding the community in which they are situated. In doing so, the health of the entire community can be elevated.

Community Development

Physicians’ roles in a community’s health extend beyond diagnosis and treatment of individual patients. Physicians and health care organizations can help communities develop into healthier, safer environments. Because physicians are obligated to support patients’ well-being, Opinion 8.11 urges physicians to “advocate for community resources designed to promote health and provide access to preventive services.”¹ Resources and services offered might include vaccinations, screenings, or public health programs. Physicians should also appreciate the influence of social determinants of health and “encourage an open dialogue regarding circumstances that may make it difficult to manage chronic conditions or maintain a healthy lifestyle, such as transportation, work and home environments, and social support systems.”¹ Physicians are thus obligated to participate in upstream community-based public health campaigns to reduce risk of poor health status downstream. In short, this means that physicians should consider factors outside of the clinical setting when thinking about healthy lifestyles and be active in areas that are lacking in development.

Rural Health

The AMA has 2 notable policies pertaining to rural health and rural communities. The first of these, “Rural Health,” H-465.989, establishes the AMA’s obligation to closely monitor implementation of and compliance with state and federal legislation concerning hospital access and the quality of patient care.³ This policy also addresses clinical, professional, and social challenges faced by rural physicians in community practice. Nevertheless, the AMA describes the organization of rural community health networks as intertwinements of health systems and economies in a rural setting that should be managed by those directly affected by the actions of the network. The policy “Rural Community Health Networks,” H-465.980, states that “participation in rural community health networks should be voluntary, but open to all qualified rural physicians and other health care providers wishing to participate.”⁴ This policy also proposes scholarships and loan-repayment programs as solutions to rural physician shortages. Such proposals are designed to incentivize physicians to work in underserved areas. As more physicians become involved in these rural community health networks, the overall health of the rural community should improve.