Applying a strategic decision-making perspective on the economics of business, we suggest that a competitive locality in the health industry is one that, relative to other localities, is effective in: (1) providing the health care that enables everyone to participate fully in the democratic development of the locality; (2) providing the health care that is democratically identified as a direct objective of this development; (3) contributing through the health industry to any other democratically determined objectives of the locality’s development. The paper hypothesises that strategic decision-making in organisations is an especially significant determinant of the impacts of the health industry. We conclude that: (i) a locality that suffers concentration in the power to determine the objectives of its health industry could not be strictly competitive in that industry; (ii) the first best way to achieve competitiveness in the health industry would be to democratise its strategic decision-making. What this would entail in practice is discussed in some detail.