This is Our Lane: A Pilot Study Examining the Surgeon's Role in Social Justice Advocacy.

BACKGROUND: Despite the importance of social justice advocacy, surgeon attitudes toward individual involvement vary. We hypothesized that the majority of surgeons in this study, regardless of gender or training level, believe that surgeons should be involved in social justice movements. METHODS: A survey was distributed to surgical faculty and trainees at three academic tertiary care centers. Participation was anonymous with 123 respondents. Chi-square and Fisher's exact test were used for analysis with significance accepted when p < 0.05. Thematic analysis was performed on free responses. RESULTS: The response rate was 46%. Compared to men, women were more likely to state that surgeons should be involved (86% vs 64%, p = 0.01) and were personally involved in social justice advocacy (86% vs 51%, p = 0.0002). Social justice issues reported as most important to surgeons differed significantly by gender (p = 0.008). Generated themes for why certain types of advocacy involvement were inappropriate were personal choices, professionalism and relationships. CONCLUSIONS: Social justice advocacy is important to most surgeons in this study, especially women. This emphasizes the need to incorporate advocacy into surgical practice.

A 10-Year Social Media Analysis Exploring Hospital Online Support of Black Lives Matter and the Black Community.

Importance: Tensions around COVID-19 and systemic racism have raised the question: are hospitals advocating for equity for their Black patients? It is imperative for hospitals to be supportive of the Black community and acknowledge themselves as safe spaces, run by clinicians and staff who care about social justice issues that impact the health of the Black community; without the expression of support, Black patients may perceive hospitals as uncaring and unsafe, potentially delaying or avoiding treatment, which can result in serious complications and death for those with COVID-19. Objective: To explore how hospitals showed public-facing support for the Black community as measured through tweets about social equity or the Black Lives Matter (BLM) movement. Design, Setting, and Participants: Using a retrospective longitudinal cohort study design, tweets from the top 100 ranked hospitals were collected, starting with the most recent over a 10-year span, from May 3, 2009, to June 26, 2020. The date of the George Floyd killing, May 25, 2020, was investigated as a point of interest. Data were analyzed from June 11 to December 4, 2020. Main Outcomes and Measures: Tweets were manually identified based on 4 categories: BLM, associated with the BLM movement; Black support, expressed support for Black population within the hospital's community; Black health, pertained to health concerns specific to and the creation of health care for the Black community; or social justice, associated with general social justice terms that were too general to label as Black. If a tweet did not contain any hashtags from these categories, it remained unlabeled. Results: A total of 281 850 tweets from 90 unique social media accounts were collected. Each handle returned at least 1279 tweets, with 85 handles (94.4%) returning at least 3000 tweets. Tweet publication dates ranged from 2009 to 2020. A total of 274 tweets (0.097%) from 67 handles (74.4%) used a hashtag to support the BLM movement. Among the tweets labeled BLM, the first tweet was published in 2018 and only 4 tweets (1.5%) predated the killing of George Floyd. A similar trend of low signal observed was detected for the other categories (Black support: 244 tweets [0.086%] from 42 handles [46.7%] starting in 2013; Black health: 28 tweets [0.0099%] from 15 handles [16.7%] starting in 2018; social justice: 40 tweets [0.014%] from 21 handles [23.3%] starting in 2015). Conclusions and Relevance: These findings reflect the low signal of tweets regarding the Black community and social justice in a generalized way across approximately 10 years of tweets for all the hospital handles within the data set. From 2009 to 2020, hospitals rarely engaged in issues pertaining to the Black community and if so, only within the last half of this time period. These later entrances into these discussions indicate that these discussions are relatively recent.

Commercial determinants of health: an ethical exploration.

OBJECTIVES: This paper seeks to contribute toward a better understanding of commercial determinants of health by proposing a set of ethical principles that can be used by researchers and other health actors in understanding and addressing Commercial Determinants of Health (CDoH). METHODS: The paper is mainly based on a systematic review and qualitative analysis of the existing literature on CDoH and public health ethics frameworks. We conducted searches using selected search engines (Google Scholar and Pubmed). For ethical challenges relating to CDOH, our searches in Google Scholar yielded 17 papers that discussed ethical challenges that affect CDoH. For ethical frameworks relevant for CDOH, our searches in Google Scholar and Pubmed yielded 15 papers that clearly described bioethical models including relevant ethical principles. Additionally, we consulted eight experts working on CDoH. Through these two methods, we were able to identify ethical challenges as well as norms and values related to CDoH that we offer as candidates to comprise a foundational ethics framework for CDoH. RESULTS: Discussing risk factors associated with CDH frequently brings public health into conflict with the interests of industry actors in the food, automobile, beverage, alcohol, ammunition, gaming and tobacco industries including conflict between profit-making and public health. We propose the following candidate ethical principles that can be used in addressing CDoH: moral responsibility, nonmaleficence, social justice and equity, consumer sovereignty, evidence-informed actions, responsiveness, accountability, appropriateness, transparency, beneficence and holism. CONCLUSIONS: We hope that this set of guiding principles will generate wider global debate on CDoH and help inform ethical analyses of corporate actions that contribute to ill health and policies aimed at addressing CDoH. These candidate principles can guide researchers and health actors including corporations in addressing CDoH.

Examining the distributional equity of urban tree canopy cover and ecosystem services across United States cities.

Examining the distributional equity of urban tree canopy cover (UTCC) has increasingly become an important interdisciplinary focus of ecologists and social scientists working within the field of environmental justice. However, while UTCC may serve as a useful proxy for the benefits provided by the urban forest, it is ultimately not a direct measure. In this study, we quantified the monetary value of multiple ecosystem services (ESD) provisioned by urban forests across nine U.S. cities. Next, we examined the distributional equity of UTCC and ESD using a number of commonly investigated socioeconomic variables. Based on trends in the literature, we predicted that UTCC and ESD would be positively associated with the variables median income and percent with an undergraduate degree and negatively associated with the variables percent minority, percent poverty, percent without a high school degree, percent renters, median year home built, and population density. We also predicted that there would be differences in the relationships between each response variable (UTCC and ESD) and the suite of socioeconomic predictor variables examined because of differences in how each response variable is derived. We utilized methods promoted within the environmental justice literature, including a multi-city comparative analysis, the incorporation of high-resolution social and environmental datasets, and the use of spatially explicit models. Patterns between the socioeconomic variables and UTCC and ESD did not consistently support our predictions, highlighting that inequities are generally not universal but rather context dependent. Our results also illustrated that although the variables UTCC and ESD had largely similar relationships with the predictor variables, differences did occur between them. Future distributional equity research should move beyond the use of proxies for environmental amenities when possible while making sure to consider that the use of ecosystem service estimates may result in different patterns with socioeconomic variables of interest. Based on our findings, we conclude that understanding and remedying the challenges associated with inequities requires an understanding of the local social-ecological system if larger sustainability goals are to be achieved.

An examination of the influence of procedurally just strategies on legal cynicism among urban youth experiencing police contact.

Adolescents experience more police-initiated contacts resulting from relatively minor infractions than any other group, and often these interactions do not result in notable legal consequences. However, such interactions may have long-term consequences for adolescent perceptions of the justice system. Using data from the age 15 wave of the Fragile Families and Child Wellbeing Study, our study examines associations between situational and process features of police contact and legal cynicism in adolescence, accounting for demographic characteristics, self-reported delinquency, neighborhood context, and stop outcome. Relative to youth who experienced only vicarious police contact, youth who had direct or both direct and vicarious police contact reported higher levels of legal cynicism. Youth perceptions of procedural justice were associated with lower legal cynicism. Situational features of police contact such as harsh language and frisking were related to higher legal cynicism. Directions for future research, including the need for longitudinal research on this topic, are discussed.

Neighborhood cohesion and procedural justice in policing among Black adults: The moderating role of cultural race-related stress.

AIMS: This study explored how neighborhood cohesion is related to perceptions of procedural justice in policing, and the moderating role of cultural race-related stress among Black adults. METHODS: We conducted hierarchical regression analyses of a US sample of Black adults (N = 604) to examine if neighborhood cohesion and cultural race-related stress relate to global procedural justice in policing and procedural justice during a critical police stop. Moderation analyses were conducted to determine if cultural race-related stress strengthens or weakens the relationship between neighborhood cohesion and procedural justice in policing. RESULTS: Neighborhood cohesion was positively related to procedural justice at critical stops. For participants with above average stress from cultural racism, positive neighborhood cohesion was related to greater global perceptions of procedural justice in policing. CONCLUSIONS: Altogether, these findings highlight how structural and local environmental factors can influence perceptions of police among Black adults in the US.

Distributional Environmental Injustices for a Minority Group without Minority Status: Arab Americans and Residential Exposure to Carcinogenic Air Pollution in the US.

Distributional environmental injustices in residential exposure to air pollution in Arab American enclaves have not been examined. We conducted our investigation at the census tract-level across the continental United States using a set of socio-demographic variables to predict cancer risk from hazardous air pollutant (HAP) exposure. Arab enclaves had a mean cancer risk score of 44.08, as compared to 40.02 in non-enclave tracts. In terms of the specific origin groups, Moroccan enclaves had the highest cancer risk score (46.93), followed by Egyptian (45.33), Iraqi (43.13), Jordanian (41.67), and Lebanese (40.65). In generalized estimating equations controlling for geographic clustering and other covariates, Arab enclaves had significantly higher cancer risks due to HAPs (p < 0.001) than non-enclaves. When looking at specific ethnic origins, Iraqi, Palestinian, and Lebanese enclaves had significantly higher cancer risks due to HAPs (all p < 0.01) than non-enclaves. Results reveal significant environmental injustices for Arab American enclaves that should be examined in future studies. Results suggest that environmental injustice may be another way in which Arab Americans are disadvantaged as a racialized minority group without minority status.

Police contact and health among urban adolescents: The role of perceived injustice.

This research evaluates whether personal and vicarious police contact are related to self and caregiver-reports of teen health and to what extent these associations vary by perceptions of procedural injustice. We analyzed longitudinal health data collected from adolescents in the Fragile Families and Child Wellbeing Study (N = 3435), alongside teen self-reports of whether they were stopped by the police or experienced vicarious police contact, and if so, their perceptions of procedural injustice in these encounters. We estimated regression models with lagged dependent variables and a propensity score weighting approach. Our analysis yielded four important results. First, participants who reported personal or vicarious police stops had worse self-reported health in adolescence than their counterparts with no contact. Second, both types of police contact were unrelated to caregiver reports of adolescent health and inconsistently related to somatic symptoms. Third, procedural injustice exacerbated the relationship between both personal and vicarious contact and diminished self-reported health. Finally, the associations between police contact and self-reported health were stronger among black and Hispanic adolescents than white ones. Our results highlight personal and vicarious police contact, particularly instances viewed as procedurally unjust, as commonly experienced adverse health events among urban adolescents.

"Social justice is a dream": Tensions and contradictions in nursing education.

OBJECTIVE: The purpose of this study was to explore nurse educators' conceptualizations of social justice in theory courses. The findings contextualize the role of nurse educators in promoting social justice among future health care providers and the relevance of their perspectives on social justice. DESIGN: This descriptive qualitative study was completed utilizing constructivist grounded theory methods. SAMPLE AND MEASUREMENTS: I interviewed 28 nurse educators teaching theory courses in Baccalaureate nursing programs on the West coast of the United States. Initial and focused codes were constructed from interview transcripts to understand and contextualize statements about social justice. RESULTS: Participants' conceptualizations of social justice include equity, equality, self-awareness, withholding judgment, and taking action. CONCLUSIONS: Notable differences emerged along racial lines and, less so, in relation to educational background and nursing specialty. This study highlights areas of concern with respect to how nurse educators enact the claim that social justice is a core professional nursing value. The findings call attention to tensions and contradictions as individuals navigate the landscape of nursing with limited structural and institutional effort.

State of the Profession: The Landscape of Disability Justice, Health Inequities, and Access for Patients With Disabilities.

The nursing profession can both perpetuate inequities and elevate the discourse around disability. Our article uses an intersectional lens to discuss the scope, magnitude, and determinants of health inequities that people with disabilities experience and the ways in which theoretical models of disability used in nursing education can further contribute to inequities. Our article makes the case for an intersectional social justice approach to nursing education by contextualizing the current state of affairs within historical and contemporary models of disability. This has the potential to be a revolutionary leap toward promoting health equity and upholding the Code of Ethics.

A Global Exploratory Analysis of Men Participating in Gender-Based Violence Prevention.

Organizations addressing gender-based violence (GBV) increasingly include men as partners in prevention efforts. However, little is known about men who get involved in those efforts and what specific actions they take. We present analyses of data from an international sample of men involved in gender-based prevention work that aimed to describe (a) the nature of participants' involvement in prevention efforts, in both formal programming and in their daily lives; (b) characteristics of engaged men, including gender and bystander-related attitudes and beliefs, and social networks; and (c) factors that sustain men's involvement in GBV movements over time. Comparisons across global regions for these variables were also conducted. A total of 379 male-identified participants above 18 who had attended a GBV event in the past year completed an online survey (available in English, French, and Spanish). Respondents represented all continents except Antarctica, although North America was over-represented in the sample. Overall, respondents scored well above North American norms for men on support for gender equality and recognition of male privilege, and this was true across all geographic regions. Men in all regions reported moderate support from friends and somewhat less support from male relatives for their involvement in GBV prevention. Respondents in all regions reported high levels of active bystander and violence-preventive behavior. The most commonly reported motivations for involvement in GBV prevention included concern for related social justice issues, exposure to the issue of violence through work, hearing a moving story, or disclosures about domestic or sexual violence. Results were mainly similar across regions, but when regional differences emerge, they tended to be contrasts between the global north and global south, highlighting the importance of cross-fertilization across regions and a willingness to adapt critical learnings in new geographic settings.

Wood Waste and Race: The Industrialization of Biomass Energy Technologies and Environmental Justice.

In the 1980s, engineers developed new ways to use one of humanity's oldest fuel sources-wood-to create electrical power. This article uses envirotechnical analysis to examine the development of a wood-burning power plant in Flint, Michigan, and argues that when public officials began working with major energy corporations to build industrial biomass facilities in the 1980s and 1990s, new energy technologies designed to run on renewable fuels became part of an entrenched fossil fuel-based power structure that maintained deep historical inequalities. Like other examples of environmental injustice, the burdens of industrial-scale biomass power systems tended to fall on poor, nonwhite communities. By exploring the creation of the Genesee Power Station as part of an envirotechnical regime in Flint, this research seeks to develop conceptual bridges between the history of technology, environmental history, and environmental justice, and demonstrates the use of history to inform contemporary debates about sustainability.

Social justice, access and quality of healthcare in an age of austerity: users' perspective from rural Iceland.

Iceland is sparsely populated but social justice and equity has been emphasised within healthcare. The aim of the study is to examine healthcare services in Fjallabyggð, in rural northern Iceland, from users' perspective and evaluate social justice, access and quality of healthcare in an age of austerity. Mixed-method approach with transformative design was used. First, data were collected with questionnaires (response rate of 53% [N=732] in 2009 and 30% [N=415] in 2012), and analysed statistically, followed by 10 interviews with healthcare users (2009 and 2014). The results were integrated and interpreted within Bronfenbrenner's Ecological Model. There was significantly less satisfaction with accessibility and variety of healthcare services in 2012 after services downsizing. Solid primary healthcare, good local elderly care, some freedom in healthcare choice and reliable emergency services were considered fundamental for life in a rural area. Equal access to healthcare is part of a fundamental human right. In times of economic downturn, people in rural areas, who are already vulnerable, may become even more vulnerable and disadvantaged, seriously threatening social justice and equity. With severe cutbacks in vitally important healthcare services people may eventually choose to self-migrate.

Language from police body camera footage shows racial disparities in officer respect.

Using footage from body-worn cameras, we analyze the respectfulness of police officer language toward white and black community members during routine traffic stops. We develop computational linguistic methods that extract levels of respect automatically from transcripts, informed by a thin-slicing study of participant ratings of officer utterances. We find that officers speak with consistently less respect toward black versus white community members, even after controlling for the race of the officer, the severity of the infraction, the location of the stop, and the outcome of the stop. Such disparities in common, everyday interactions between police and the communities they serve have important implications for procedural justice and the building of police-community trust.

Perspective: Hope for Health Equity.

Times like these test the soul. We are now working for health equity in a time of overt, aggressive opposition. Yet, hope in the face of overwhelming obstacles is the force that has driven most of the world's progress toward equity and justice. Operationalizing real-world hope requires an affirmative vision, an expectation of success, broad coalitions taking action cohesively, and frequent measures of collective impact to drive rapid-cycle improvement.

Physicians' responses to financial and social incentives: A medically framed real effort experiment.

Because compensation policies have critical implications for the provision of health care, and evidence of their effects is limited and difficult to study in the real world, laboratory experiments may be a valuable methodology to study the behavioural responses of health care providers. With this experiment undertaken in 2013, we add to this new literature by designing a new medically framed real effort task to test the effects of different remuneration schemes in a multi-tasking context. We assess the impact of different incentives on the quantity (productivity) and quality of outputs of 132 participants. We also test whether the existence of benefits to patients influences effort. The results show that salary yields the lowest quantity of output, and fee-for-service the highest. By contrast, we find that the highest quality is achieved when participants are paid by salary, followed by capitation. We also find a lot of heterogeneity in behaviour, with intrinsically motivated individuals hardly sensitive to financial incentives. Finally, we find that when work quality benefits patients directly, subjects improve the quality of their output, while maintaining the same levels of productivity. This paper adds to a nascent literature by providing a new approach to studying remuneration schemes and modelling the medical decision making environment in the lab.

Perils of police action: a cautionary tale from US data sets.

OBJECTIVE: To count and characterise injuries resulting from legal intervention by US law enforcement personnel and injury ratios per 10 000 arrests or police stops, thus expanding discussion of excessive force by police beyond fatalities. DESIGN: Ecological. POPULATION: Those injured during US legal police intervention as recorded in 2012 Vital Statistics mortality census, 2012 Healthcare Cost and Utilization Project nationwide inpatient and emergency department samples, and two 2015 newspaper censuses of deaths. EXPOSURE: 2012 and 2014 arrests from Federal Bureau of Investigation data adjusted for non-reporting jurisdictions; street stops and traffic stops that involved vehicle or occupant searches, without arrest, from the 2011 Police Public Contact Survey (PPCS), with the percentage breakdown by race computed from pooled 2005, 2008 and 2011 PPCS surveys due to small case counts. RESULTS: US police killed or injured an estimated 55 400 people in 2012 (95% CI 47 050 to 63 740 for cases coded as police involved). Blacks, Native Americans and Hispanics had higher stop/arrest rates per 10 000 population than white non-Hispanics and Asians. On average, an estimated 1 in 291 stops/arrests resulted in hospital-treated injury or death of a suspect or bystander. Ratios of admitted and fatal injury due to legal police intervention per 10 000 stops/arrests did not differ significantly between racial/ethnic groups. Ratios rose with age, and were higher for men than women. CONCLUSIONS: Healthcare administrative data sets can inform public debate about injuries resulting from legal police intervention. Excess per capita death rates among blacks and youth at police hands are reflections of excess exposure. International Classification of Diseases legal intervention coding needs revision.