How Is Access to Legal Resources and Advocacy Foundational to Health Justice?

Health justice as a movement incorporates research about how to more effectively leverage law, policy, and institutions to dismantle inequitable power distributions and accompanying patterns of marginalization that are root causes of health inequity. Legal advocacy is key to health justice because it addresses patients' health-harming legal needs in housing, public benefits, employment, education, immigration, domestic violence, and other areas of law. In medical-legal partnerships, lawyers and clinicians are uniquely positioned to jointly identify and remove legal barriers to patients' health, advocate for structural reform, and build community power.

Can Medical-Legal Partnerships Do More to Advance Reproductive Justice After Dobbs?

The medical-legal partnership (MLP) and reproductive justice (RJ) movements both seek to solve complex problems, serve diverse populations with intersectional challenges, and resolve community conditions that impact people's ability to reach their highest health potential. Yet MLPs have been overlooked as a strategy to advance reproductive health and justice. MLP has distinct advantages for advancing RJ, and many MLPs might already be doing RJ work without referring to it by name. By intentionally adopting an RJ strategy and explicitly addressing the unmet social and legal needs that limit people's ability to plan their reproductive futures, MLPs can better serve their clients and contribute to the movement to combat reproductive oppression.

[Obesity as structural injustice: towards a radically different social contract for a healthier society]. / Obesitas als structureel onrecht.

The prevalence of obesity in the Netherlands has been on the rise for decades and recent preventive efforts of government and other societal actors appear insufficient to reverse this trend. The development of food technologies neutralizing the impact of fat and sugar, and medicines that might help individuals losing weight could be seen as part of a solution. We argue however that these also reinforce three fundamental societal problems underlying the obesity crisis: a vicious market cycle, the framing of overweight as a problem of individuals, and an epistemological dilemma in science. Together these problems constitute a vicious circle that is especially harmful for socioeconomically disadvantaged groups. Many societal actors are involved in these problems and share moral responsibility for taking away the causes of injustice, including food industry, retailers, health care, and government. Effective prevention of obesity may require developing avenues to legally enforce these responsibilities.

Access to medicines, the Unified Health System, and intersectional injustices.

OBJECTIVE: To estimate the prevalence of general and public access to prescription drugs in the Brazilian population aged 15 or older in 2019, and to identify inequities in access, according to intersections of gender, color/race, socioeconomic level, and territory. METHODS: We analyzed data from the 2019 National Health Survey with respondents aged 15 years or older who had been prescribed a medication in a healthcare service in the two weeks prior to the interview (n = 19,819). The outcome variable was access to medicines, subdivided into general access (public, private and mixed), public access (via the Unified Health System - SUS) for those treated by the SUS, and public access (via the SUS) for those not treated by the SUS. The study's independent variables were used to represent axes of marginalization: gender, color/race, socioeconomic level, and territory. The prevalence of general and public access in the different groups analyzed was calculated and the association of the outcomes with the aforementioned axes was estimated with odds ratios (OR) using logistic regression models. RESULTS: There was a high prevalence of general access (84.9%), when all sources of access were considered, favoring more privileged segments of the population, such as men, white, and those of high socioeconomic status. When only the medicines prescribed in the SUS were considered, there was a low prevalence (30.4% access) that otherwise benefited marginalized population segments, such as women, black, and people from low socioeconomic backgrounds. CONCLUSIONS: Access to medicines through the SUS proves to be an instrument for combating intersectional inequities, lending credence to the idea that the SUS is an efficient public policy for promoting social justice.

Advancing Equity and Justice in Academic Nursing Through Trauma-Informed Education Practice.

BACKGROUND: As educators and schools redouble their efforts to support and graduate a diverse and highly competent student body, there is an urgent need to adopt an academic framework to understand the effects of trauma on student learning, ground equity and justice in nursing education, and underpin policy development. METHOD: This article explicates the use of equity-centered trauma-informed education practice (TIEP) as a framework for examining, scrutinizing, and eliminating the influences and effects of racism, including explicit, implicit, systematic, and microaggressions, as well as inequitable approaches in practices, pedagogy, and policy. RESULTS: Five key strategies were identified: (1) bias and antiracist work; (2) safety and trust; (3) culturally responsive pedagogy; (4) wellness and balance and (5) community-building. CONCLUSION: Transforming nursing education requires a paradigm shift, with changes occurring from an individual to a system level. TIEP ensures changes are equity-centered and justice-focused. [J Nurs Educ. 2024;63(8):507-514.].

Science should save all, not just some.

Discussions around global equity and justice in science typically emphasize the lack of diversity in the editorial boards of scientific journals, inequities in authorship, "parachute research," dominance of the English language, or scientific awards garnered predominantly by Global North scientists. These inequities are pervasive and must be redressed. But there is a bigger problem. The legacy of colonialism in scientific research includes an intellectual property system that favors Global North countries and the big corporations they support. This unfairness shows up in who gets access to the fruits of science and raises the question of who science is designed to serve or save.

The Impact of Procedural Justice and Trust on Customers' Continuity Intention Toward Healthcare Providers.

As life has become noticeably more comfortable compared to the past, there is a mounting interest in various service sectors, such as healthcare, where growing demand has led to an increase in the number facilities that supply products essential to service provision. Enhancing the service quality is critical to gaining an advantage in the fiercely competitive healthcare environment and is especially important as the outcomes encompass not only the treatment of disease but also patients' emotional and experiential satisfaction. This study presents procedural justice and two dimensions of trust as factors related to physician and patient relationship, investigating their effects on patients' intention to continue the relationship with their healthcare providers. We found that procedural justice had a positive effect on the two dimensions of trust, and the latter had a significant positive effect on the continuity intention. As this study verifies the necessity of procedural justice and trust for patients to continuously experience medical services, it is imperative for the healthcare industry to understand and incorporate these factors into their practices.

The relationship between workplace justice and self-evaluated nonfatal occupational accidents among healthcare employees in Taiwan: An observational study.

The relationship between workplace justice and nonfatal occupational accidents in a single-payer healthcare system has rarely been explored. As countries strive to achieve and sustain universal health coverage, healthcare workers' occupational safety and health require greater concerns. We used the data from a national survey conducted on randomly sampled Taiwanese workers. One hundred forty eight males and 567 females, with a total of 715 healthcare workers aged 20 to 65, were analyzed. The workplace scale consisted of 4 subcomponents, including distributive justice, interpersonal justice, information justice, and procedural justice, and was dichotomized into low and high groups in each dimension. Logistic regression models examined the relationship between workplace justice and self-evaluated occupational accidents among healthcare employees. The prevalence of self-evaluated occupational accidents in healthcare employees was 15.54% and 11.64% for men and women, respectively. After adjusting variables such as sociodemographic variables, physical job demands, shift work status, work contract, and psychological job demands, regression analyses indicated that health employees with lower distributive justice, interpersonal justice, information justice, and procedural justice were significantly associated with self-evaluated occupational accidents both in males and females. Expanding the study to include healthcare systems in different countries could enhance the generalizability of the findings. Offering specific recommendations for policymakers and healthcare administrators to improve workplace justice and reduce occupational accidents.

Affirmative action and employment equity in the professions: Backlash fueled by individualism and meritocracy.

In the 40 years since federal employment equity initiatives were launched in Canada, they have faced persistent backlash. This backlash is grounded in and fueled by conceptualizations of justice and equality that are rooted in ideologies of individualism and meritocracy. Here we draw on 140 qualitative interviews with members of six professions from across Canada, who self-identify as Indigenous, Black or racialized, ethnic minority, disabled, 2SLGBTQ+, and/or from working-class origins, to explore tensions between concepts of justice grounded in group-based oppressions and those grounded in individual egalitarianism. Though affirmative action and employment equity opened up opportunities, people were still left to fight for individual rights. This push to individualism was intensified by persistent hostile misperceptions that people are less qualified and in receipt of 'unfair advantages.' Through discursive misdirection, potential for transformative institutional change is undermined by liberal discourses of individualism and meritocracy.

Au cours des 40 années depuis le lancement des initiatives fédérales d'équité en matière d'emploi au Canada, celles­ci ont été confrontées à des réactions négatives persistantes. Cette réaction est fondée et alimentée par des conceptualisations de la justice et de l'égalité enracinées dans des idéologies d'individualisme et de méritocratie. Nous nous appuyons ici sur 140 entretiens qualitatifs avec des membres de six professions à travers le Canada, qui s'identifient comme autochtones, noirs ou racialisés, membres de minorités ethniques, handicapés, 2SLGBTQ+ et/ou issus de la classe ouvrière, pour explorer les tensions entre les concepts de justice fondés sur les oppressions de groupe et ceux fondés sur l'égalitarisme individuel. Bien que l'action positive et l'équité en matière d'emploi aient ouvert des perspectives, les gens devaient encore se battre pour leurs droits individuels. Cette poussée vers l'individualisme a été intensifiée par des perceptions hostiles persistantes selon lesquelles les personnes sont moins qualifiées et bénéficient d'« avantages injustes ¼. Les discours libéraux sur l'individualisme et la méritocratie sapent le potentiel de changement institutionnel transformateur par une mauvaise orientation discursive.

Introduction to Topical Collection: Changing Values and Energy Systems.

This paper is the introduction to a topical collection on "Changing Values and Energy Systems" that consists of six contributions that examine instances of value change regarding the design, use and operation of energy systems. This introduction discusses the need to consider values in the energy transition. It examines conceptions of value and value change and how values can be addressed in the design of energy systems. Value change in the context of energy and energy systems is a topic that has recently gained traction. Current, and past, energy transitions often focus on a limited range of values, such as sustainability, while leaving other salient values, such as energy democracy, or energy justice, out of the picture. Furthermore, these values become entrenched in the design of these systems: it is hard for stakeholders to address new concerns and values in the use and operation of these systems, leading to further costly transitions and systems' overhaul. To remedy this issue, value change in the context of energy systems needs to be better understood. We also need to think about further requirements for the governance, institutional and engineering design of energy systems to accommodate future value change. Openness, transparency, adaptiveness, flexibility and modularity emerge as new requirements within the current energy transition that need further exploration and scrutiny.

Methods to advance health equity and social justice in healthcare: Protocol for a scoping review on the utilisation of routinely collected data.

BACKGROUND: Many areas of healthcare are impacted by a paucity of research that is translatable to clinical practice. Research utilising real-world data, such as routinely collected patient data, may be one option to efficiently create evidence to inform practice and service delivery. Such studies are also valuable for exploring (in)equity of services and outcomes, and benefit from using non-selected samples representing the diversity of the populations served in the 'real world'. This scoping review aims to identify and map the published research which utilises routinely collected clinical healthcare data. A secondary aim is to explore the extent to which this literature supports the pursuit of social justice in health, including health inequities and intersectional approaches. METHOD: This review utilises Arksey and O'Malley's methodological framework for scoping reviews and draws on the recommended enhancements of this framework to promote a team-based and mixed methods approach. This includes searching electronic databases and screening papers based on a pre-specified inclusion and exclusion criteria. Data relevant to the research aims will be extracted from included papers, including the clinical/professional area of the topic, the source of data that was used, and whether it addresses elements of social justice. All screening and reviewing will be collaborative and iterative, drawing on strengths of the research team and responsive changes to challenges will be made. Quantitative data will be analysed descriptively, and conceptual content analysis will be utilised to understand qualitative data. These will be collectively synthesised in alignment to the research aims. CONCLUSION: Our findings will highlight the extent to which such research is being conducted and published, including gaps and make recommendations for future endeavours for real-world data studies. The findings from this scoping review will be relevant for practitioners and researchers, as well as health service managers, commissioners, and research funders.

Building Successful Partnerships Between State Health Departments and Attorney General Offices: The Minnesota Example.

In recent years, the Minnesota Attorney General's Office and the Minnesota Department of Health have cultivated a productive partnership to strengthen the state's multidisciplinary response to overlapping health equity and social justice issues. This article describes shared efforts in three areas: post-conviction justice, drug overdose, and human trafficking/exploitation.

The Pregnant Workers Fairness Act Leaves Agricultural Workers Behind.

The new federal Pregnant Workers Fairness Act advances important protections for pregnant workers, but leaves behind agricultural workers, who are overrepresented in hazardous occupational environments. This article highlights the connection between workplace pregnancy discrimination and health inequities. It concludes with a discussion of immigrant-led advocacy efforts to eliminate health inequities and advance health justice.

What Would Equitable Harm Reduction Look Like?

Structural determinants of health frameworks must express antiracism to be effective, but racial and ethnic inequities are widely documented, even in harm reduction programs that focus on person-centered interventions. Harm reduction strategies should express social justice and health equity, resist stigma and discrimination, and mitigate marginalization experiences among people who use drugs (PWUD). To do so, government and organizational policies that promote harm reduction must acknowledge historical and ongoing patterns of racializing drug use. This article gives examples of such racialization and offers recommendations about how harm reduction programming can most easily and effectively motivate equitable, antiracist care for PWUD.

"My Health, My Right:" There Is More to It than Meets the Eye.

The WHO's World Health Day 2024 slogan, "My health, my right," has been unpacked through the lens of an evolving social epidemiological understanding. The operative part of the theme merely reiterates international positions that have been established for a long and is unable to adequately incorporate advances in the understanding of the central role that structural determinants play in the production of ill-health. Given the urgency of addressing Sustainable Development Goal and Universal Health Coverage goals, the reduction of health inequities through the promotion of social justice is as much a governance imperative as moral.

Dehumanization and Minimization of Informal Caregivers Suffering: The Legitimizing Role of Justice Perceptions.

Informal caregivers, who provide unpaid care work to individuals with disabilities, are devalued despite their important contributions to society. Identifying the factors contributing to their devaluation is crucial for recognizing and valuing their work. In two experimental studies, we examined (a) whether informal caregivers are dehumanized; (b) the moderating impact of belief in a just world (BJW) on this process; and (c) the predictive impact of BJW and the dehumanization of informal caregivers on the perception of informal caregivers' suffering. In Study 1 (N = 180), a 2 (informal caregiver vs. non-caregiver) X 2 (female vs. male) between-participants design was used; in Study 2 (N = 205), there were two experimental conditions: female informal caregiver vs. male informal caregiver. Participants were randomly assigned to one description of a target and were asked to complete measures assessing the dehumanization of the target (Studies 1 and 2), the perception of the suffering of the target (Study 2), and a measure of BJW referring to themselves (Study 2). Results showed the expected dehumanization effect, such that participants attributed fewer uniquely human emotions to informal caregivers compared to non-caregivers, regardless of their gender (Studies 1 and 2). However, this effect was observed only among participants with higher BJW (Study 2). Furthermore, BJW and the dehumanization of informal caregivers predicted the minimization of the perception of informal caregivers' suffering (Study 2). These results establish a theoretical relationship between these research areas and offer insights for practical implications and future research.