Faculty Development for Education for Sustainable Health Care: A University System-Wide Initiative to Transform Health Professional Education.

Health professionals (HPs) are increasingly called upon to care for patients experiencing the health impacts of climate change, while working in the high eco-footprint health care system, which is starting to embrace a culture of sustainability. HPs are uniquely positioned to drive health care culture toward ecological responsibility and, consequently, improve patient care, health equity, and public health. Education for sustainable health care (ESHC or ESH) is the first step in developing health care practitioners able to think critically about and act upon the health impacts of the climate crisis. University of California Education for Sustainable Healthcare (UC-ESH) Faculty Development Initiative was developed to address the following goals: educate faculty on eco-medical literacy, empower faculty to build community and lead ESH at their institutions, and expand coverage of ESH to reach students beyond those for whom sustainability is already a focus. The initiative provided training to faculty across health professions and 6 health science campuses to integrate ESH into their courses using the train-the-trainer model, key knowledge and pedagogical skills, and longitudinal guidance and networking opportunities. Using a survey, questionnaire, and interviews, the initiative was evaluated using the process/elements and product/outcomes steps of the Context, Input, Process, and Product evaluation model. The UC-ESH educated over 100 faculty members and led to ESH integration into 99 existing and new courses that subsequently reached over 7,000 learners. The UC-ESH increased empowerment, awareness, and knowledge about the climate crisis, and built an ESH community of practice. Initiative elements that contributed to these outcomes included engaging training; creation of supportive group dynamics; helpful resources and activities; ongoing support; and integration approaches to ESH. This university-system-wide initiative provides a transferable model to institutions, schools, and departments seeking to develop eco-medical literate faculty who educate their students about the climate, ecosystem, and health crisis.

Racialized legal status as a social determinant of health.

This article advances the concept of racialized legal status (RLS) as an overlooked dimension of social stratification with implications for racial/ethnic health disparities. We define RLS as a social position based on an ostensibly race-neutral legal classification that disproportionately impacts racial/ethnic minorities. To illustrate the implications of RLS for health and health disparities in the United States, we spotlight existing research on two cases: criminal status and immigration status. We offer a conceptual framework that outlines how RLS shapes disparities through (1) primary effects on those who hold a legal status and (2) spillover effects on racial/ethnic in-group members, regardless of these individuals' own legal status. Primary effects of RLS operate by marking an individual for material and symbolic exclusion. Spillover effects result from the vicarious experiences of those with social proximity to marked individuals, as well as the discredited meanings that RLS constructs around racial/ethnic group members. We conclude by suggesting multiple avenues for future research that considers RLS as a mechanism of social inequality with fundamental effects on health.

Destigmatization and health: Cultural constructions and the long-term reduction of stigma.

Research on the societal-level causes and consequences of stigma has rarely considered the social conditions that account for destigmatization, the process by which a group's worth and status improve. Destigmatization has important implications for the health of stigmatized groups. Building on a robust line of stigma reduction literature in psychology, we develop a sociological framework for understanding how new cultural constructions that draw equivalences and remove blame shape public and structural stigma over time. We examine historical transformations of cultural constructions surrounding three stigmatized groups in the United States: people living with HIV/AIDS, African Americans, and people labeled as obese. By tracing this process across cases, we find that the conditions that account for destigmatization include the credibility of new constructions, the status and visibility of actors carrying these constructions, the conclusiveness of expert knowledge about stigmatized groups, the interaction between new constructions and existing cultural ideologies, and the perceived linked fate of the stigmatized and dominant groups. We also find that the reduction of structural and public forms of stigma often depend on distinct processes and constructions. To conclude, we propose a framework for the comparative study of destigmatization as an essential component of promoting a culture of health.