Abstract

The concept of "community" as well as actual historical communities have received little critical attention in theories of justice for health care or in health policy. In this dissertation, I argue that health care is a social good, and specifically a community good, which is to say that sub-national affiliative, ascriptive, and geographic communities play critical roles in health and health care. These communities create meanings of health and health care; their physical and social environments importantly influence health; actual care often takes place in the context of community-based relationships and institutions; and these communities accrue the benefits of health-related activities. Analyses of these community dimensions over time in health policies associated with two health care institutions--community health centers and health maintenance organizations (and their precursor institutions--reveal the varied embodiments of "community" and the differing roles of actual communities. The concepts and theories of justice for health care offered by Norman Daniels, Daniel Callahan, Ezekiel J. Emanuel, as well as Catholic and Protestant perspectives are examined in light of their attention to these sub-national communities and their roles in justice. I show how these community dimensions have been neglected in Daniels's influential liberal theory and only partially addressed in the other, more "communitarian" concepts and theories of just health care. Given these analyses and the suggestive works of feminist and Catholic thinkers on social justice, I offer an initial vision of "district justice," a notion of community justice for health care which takes seriously the roles communities play in health and health care