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.

Correction to "Defining racial allies: A qualitative investigation of White allyship from the perspective of people of color" by Hinger et al. (2023).

Reports an error in "Defining racial allies: A qualitative investigation of White allyship from the perspective of people of color" by Cassandra L. Hinger, Cirleen DeBlaere, Rebecca Gwira, Michelle Aiello, Arash Punjwani, Laura Cobourne, Ngoc Tran, Madison Lord, Jordan Mike and Carlton Green (Journal of Counseling Psychology, 2023[Nov], Vol 70[6], 631-644). An additional citation was added for the structure of the definition of White allies in the second paragraph of the introduction. The online version of this article has been corrected. (The following abstract of the original article appeared in record 2024-23216-002.) While interdisciplinary scholars and activists urge White allies to engage in racial justice work led by the voices of Black, Indigenous, and people of color (BIPOC), to date, most research on racial allyship has centered exclusively on the perspective of White allies themselves. Thus, the purpose of this study was to create a framework of racial allyship from the perspective of BIPOC. Utilizing constructivist grounded theory (Charmaz, 2014), focus groups were conducted to understand how BIPOC describe the knowledge, skills, and actions of White allies. Participants across eight focus groups described allyship as an ongoing interpersonal process that included a lifelong commitment to (a) building trust, (b) engaging in antiracist action, (c) critical awareness, (d) sociopolitical knowledge, (e) accountability, and (f) communicating and disseminating information. The findings of this study point to several avenues through which White counseling psychologists can incorporate racial allyship in their research, training, clinical, and advocacy work that align with our field's emphasis on social justice, multiculturalism, and prevention. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

"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.

Aligning data with decisions to address the biodiversity crisis.

The planetary outlook for biodiversity is dire. A new collection of articles discusses the disconnect between the data we have and the data we need for more effective action on conservation, as well as how social justice and end-user viewpoints must be centered to ensure a more sustainable future for our planet.

Promoting equity and justice in school mental health.

Advancing equity and justice in school mental health can address inequities in school-based services and outcome disparities. The purpose of this special issue is to promote equitable and just systems and practices in school mental health to promote change in institutional practices that have produced and reproduced inequities over time. The four articles in this special issue clarify a process for advancing equity in school mental health by addressing justice-centered variables to promote connections across and within systems to realize a vision of comprehensive and integrated school mental health.

Reframing family-school partnerships to disrupt disenfranchisement of Black families and promote reciprocity in collaboration.

Research has long demonstrated the benefits of family-school partnerships. However, these benefits often fail to generalize to all families, especially Black families. A present and historical pattern of discrimination and exclusion has contributed to the lack of benefits yielded from Black family-school partnerships. A major contributing factor is the narrow way in which schools define family engagement. Such narrow definitions often marginalize families from non-dominant backgrounds, particularly Black families, and reinforce harmful narratives that Black parents and families are uninvolved in their children's education. The combination of continued discrimination and exclusion as well as harmful narratives has impacted Black family-school partnering. However, schools can work to repair harm and rebuild partnerships with Black families. In this article, we advance a framework for such work. After grounding the need for this framework in a historical context, we emphasize three essential components to forming equitable Black family-school partnerships: (a) grounding relationship building in social justice, (b) integrating reciprocity in family-school relationships, and (c) usage of multiple and non-dominant methods and modalities to build relationships.

Access to civil justice as a social determinant of health: a legal epidemiological cross-sectional study.

BACKGROUND: Although it is widely acknowledged that access to civil justice (ATJ) is a key social determinant of health (SDOH), the existing literature lacks empirical evidence supporting ATJ as a SDOH for specific dimensions of health. METHODS: A legal epidemiological, cross-sectional, postal survey was conducted on n = 908 randomly sampled participants in Hong Kong in March 2023. Data collected were perceptions of the civil justice system, health, and sociodemographics. Perceived ATJ was assessed using a modified version of the Inaccessibility of Justice scale (IOJ) and Perceived Inequality of Justice scale (PIJ), i.e. the "modified IOJ-PIJ", consisting of 12 of the original 13 items from both scales divided into two subdomains: "procedural fairness", and "outcome neutrality". For health data, quality of life was assessed using the Hong Kong version of the Abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-BREF(HK)), psychological distress (including symptoms of anxiety and depression) was assessed using the four-Item Patient Health Questionnaire (PHQ-4), and having comorbidities was assessed using Sangha's Self-Administered Comorbidity Questionnaire (SCQ). Structural equation modelling (SEM) was used to investigate the relationships between perceived ATJ and the measured health outcomes. RESULTS: SEM demonstrated that both subdomains for ATJ had significantly negative associations (B < 0; p < 0.05) with all quality-of-life subdomains, except for between outcome neutrality with social relationships; both subdomains for ATJ had significantly positive association (B > 0; p < 0.05) with both anxiety and depression; and, after adjusting for age, only "procedural fairness" had significantly positive association (B > 0; p < 0.05) with having comorbidities. CONCLUSION: This study provided empirical evidence that ATJ is a SDOH for specific dimensions of health. The results of this study encourage laws, policies, and initiatives aimed at improving ATJ, as well as collaborative efforts from the legal and health sectors through health-justice partnerships, and from the broader community, to safeguard and promote public health by strengthening ATJ.

Health Justice and Systems of Care: A Required Longitudinal Course for MD Students.

Problem & Background: Medical education has acknowledged the impact of structural societal factors on health, prompting the need for curricula seeking to eliminate health inequities upstream while simultaneously caring for downstream effects of existing inequities. The Keck School of Medicine of USC (KSOM) implemented one such comprehensive curriculum, Health Justice and Systems of Care (HJSC), integrating health systems science, structural competency, and service-learning in a required course spanning the pre-clerkship and clerkship phases with an optional post clerkship elective. Approach: The HJSC course addresses topics including racism in medicine, health inequities, and health systems science. Using transformative learning theory, it fosters critical consciousness and structural competency. Assessments include case analyses, reflections, team-based learning sessions, and group projects related to social justice in healthcare. The program aims to instill cultural humility and practical application, fostering a holistic approach to medical education that implores physicians to become advocates for health justice. Outcomes of the Innovation: Feedback from students indicated generally positive perceptions of the curriculum. Students provided overall positive comments about discussions with guest speakers. However, students expressed a desire for more concrete examples of how health inequities can be remedied. Some found small-group activities less engaging. Other challenges included providing students of different readiness levels with tailored experiences and seamlessly integrating HJSC content within basic and clinical sciences courses. Critical Reflection: Next steps include continuing to integrate content into the science curriculum and clerkships, improving opportunities for meaningful student interactions, and enhancing faculty development to address health justice concerns in clinical settings.

Centering relationships to place for more meaningful research and engagement.

Research has the potential to simultaneously generate new knowledge and contribute meaningful social-ecological benefits; however, research processes and outcomes can also perpetuate extractive patterns that have manifested the climate, biodiversity, and social justice crises. One approach to enhance the societal value of research processes is to strengthen relationships with places of study and the peoples of those places. Deepening relational engagement with the social-ecological context and history of a place can lead to more accurate results and improved public trust in the scientific process and is particularly important for natural scientists who work at the interface of nature and society. We provide three actionable pathways that range from individual to systemic change to enhance place-based relationships within research systems: 1) deepen reflection and communication about relationships with places and peoples; 2) strengthen collaboration among research teams and partners; and 3) transform systems of knowledge creation to foster place-based roots. Action on any of these proposed pathways, but especially action taken across all three, can build empathy and connections to place and people, strengthening the meaningful impact of research both locally and globally.

LGBTQ+ Sociopolitical Engagement: Examining the Role of House Ball Community Involvement and LGBTQ+ Community Connection.

Recent events such as the Black Lives Matter movement, COVID-19, and political elections have highlighted the power of a socially and politically engaged society. One under-researched cultural pillar at the core of sociopolitical resistance for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people of color (POC) has been the House Ball Community, a dynamic subculture made up of intricate social networks. This study uses data collected for the Social Justice Sexuality Project (N = 246) to examine LGBTQ+ community connection and House Ball Community involvement as predictors of LGBTQ+ and intersectional LGBTQ+ sociopolitical engagement. Two continuous variables, community connection and sociopolitical engagement (consisting of separate scales about LGBTQ+ individuals and LGBTQ+ POC), were included in the analysis. Multivariate linear regression analyses were performed to examine the relationships between these variables. While community connection was significantly associated with both scales of sociopolitical engagement, House Ball involvement was only associated with intersectional LGBTQ+ sociopolitical engagement. Relative to community connection, House Ball involvement was more strongly associated with intersectional LGBTQ+ sociopolitical engagement. Findings suggest that House Ball involvement may influence behavior for LGBTQ+ POC. Authors discuss implications for intersectionality in social movements and culturally responsive direct, community, and systems-level social work practice within the current U.S. sociopolitical landscape.

Advancing gender transformative intersectional science for health justice: An ecosocial analysis.

At a time when health-oriented institutions both globally and nationally are increasingly recognizing the need to support research, interventions and training that engage with analysis of how gendered social systems shape population health, independent of and in conjunction with sex-linked biology, it is essential that this work reject biological essentialism and instead embrace embodied integration. In this essay, guided by the ecosocial theory of disease distribution, I clarify connections and distinctions between biological versus social reproduction and inheritance, underscore the non-equivalence of the categories "sex" and "race," and offer a set of examples analyzing the production of gendered health inequities and who needs to do what to address them. The examples concern the worlds of work (sexual harassment; breastfeeding; sex work), ecologic environments (water access; fracking, sexually transmitted infections, & sexual violence); sexual reproduction and reproductive justice (gender stereotyping of reproductive biology; sterilization abuse and abortion bans); and (4) gender transformative initiatives (violence; health interventions). To advance gender transformative intersectional science for health justice, I offer recommendations regarding requirements for justifying data conceptualization, analysis and governance that can be implemented by institutions with the power to shape the funding, translation, and publication of science involving gender, sex-linked biology, and the people's health.

What Does Disability Justice Require of Antimicrobial Stewardship?

This commentary on a case argues that antimicrobial stewardship requires an intersectional disability justice approach if it is to be equitable, particularly for multiply marginalized patients with disabilities residing in nursing homes, who are more susceptible to antibiotic under- and overtreatment. Disability justice concepts emphasize resistance to structural and capitalist roots of ableism and prioritize leadership by disabled persons. A disability justice perspective on antimicrobial stewardship means prioritizing clarification of presumptive diagnoses of infection in vulnerable patients, clinician education led by disabled persons, and data collection.

Social Justice Education in CAATE-Accredited Post-Baccalaureate Athletic Training Programs.

Social justice education (SJE) prepares clinicians to provide patient-centered care. Our purpose was to assess SJE in CAATE-accredited, post-baccalaureate professional athletic training programs. We used a cross-sectional, online survey. Individuals (n=215) in their last year of post-baccalaureate professional education or those who were within 6 months post-graduation participated. The survey included closed and open-ended questions regarding types of education, topics of education, perceived confidence, and levels of agreement regarding identifying, addressing, and applying social justice concepts. Students from different cultural ethnicities reported having different educational experiences relative to their formal and informal instruction. Significant differences were identified between cultural ethnicity groups on perceptions of professors' knowledge (p<0.001), preceptors' knowledge (p<0.001), and agreement their program prepared them to address social justice issues (p<0.001). Two domains emerged from the open-ended responses: 1) social justice defined and 2) educational needs. Participants described social justice as equality, equity, and justice for minoritized people. Participants described SJE as not occurring or limited, and they expressed a desire for active practical experiences from heterogeneous and unbiased sources. As programs move to incorporate CAATE standards, more frequent and varied SJE is expected from minoritized students.

Now is the time for conservationists to stand up for social justice.

Existing power imbalances and injustices could be exacerbated by large flows of international funding for nature recovery. Conservationists are still grappling with what social justice means in practice; a major shift in mindset is required.