Public Health and Social Justice

Health equity, defined as the attainment of the highest level of health for all people, remains a fundamental goal of global public health. Despite notable scientific advances and increased attention to structural drivers of health disparities, profound inequities persist both within and between nations. Insights from the CMSS Encoding Equity and CCST Mental Health Conference, as well as the work of Dr. Lisa Cooper and others, offer a comprehensive framework for understanding and advancing health equity through research, community engagement, policy, advocacy, and systems change. Lived Experience and the Long Game of Health Equity Dr. Lisa Cooper's personal and professional trajectory underscores the necessity of integrating lived experiences into health equity work. Drawing parallels between systemic health challenges in Liberia and Baltimore, Dr. Cooper highlights that health equity is both deeply personal and inherently political. She advocates using one's power, whether from positions of privilege or marginalization, to bridge divides and catalyze change. Her research emphasizes that patients from marginalized backgrounds often face reduced rapport with physicians, decreased decision-making involvement, and lower-quality communication, particularly when implicit racial bias is present.

This chapter underscores the critical need to integrate social determinants of health (SDOH) into medical education, with a particular focus on food insecurity, poverty, and housing insecurity. These determinants profoundly impact health outcomes, perpetuate disparities, and place a significant burden on healthcare systems. By addressing these factors through targeted educational strategies, medical schools can prepare future physicians to identify, understand, and mitigate the systemic barriers to health equity. The chapter explores the multifaceted implications of these SDOH on physical and mental health, offering innovative educational strategies such as case-based learning, community partnerships, and interprofessional training to equip students with practical skills and empathy. It addresses the barriers to implementing SDOH-focused curricula, including time constraints and resistance from stakeholders, while highlighting opportunities such as advancements in virtual simulation technology and alignment with accreditation standards emphasizing health equity. Advocacy and institutional reforms are emphasized as pivotal components of equipping future physicians to champion systemic change and address health disparities. Ultimately, the chapter advocates for the integration of SDOH into medical education as a moral and practical imperative, fostering a healthcare workforce committed to advancing equitable health outcomes for all communities.

Justice-involved individuals convicted of crimes involving violence are often depicted as chaotic, whereas the chaos they encounter in criminal justice institutions is not commonly reported. Nonetheless, we found that chaos can be co-constituted at points where justiceinvolved individuals and justice institutions intersect. Our findings are drawn from qualitative research on a pharmacotherapy trial designed to reduce violence: Reducing impulsivity in

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Resumen. La idea de que la enfermedad y la muerte son hechos naturales a los que no podemos escapar, es una creencia muy extendida tanto entre la gente del común como entre académicos y políticos. Llama la atención, sin embargo, que solo unos pocos hayan entendido que estos procesos no se dan de la misma forma entre ricos y pobres, y que la mayoría de las enfermedades y las defunciones no solo son más frecuentes, sino también más tempranas entre estos últimos. La preocupación por los efectos nocivos de la pobreza y la precariedad socioeconómica sobre la salud se observa ya en las denuncias de los socialistas y de la medicina social europea desde el siglo xix; sin embargo, los gobiernos europeos solo incorporan formalmente este tema a partir de 1980, cuando el médico escocés sir Douglas Black (1913-2002), presidente de la Asociación Médica Británica, publicó un informe sobre desigualdades en el sistema inglés de salud que le había sido solicitado por el gobierno laborista. Dicho estudio, conocido en la literatura como el Informe Black reveló marcadas diferencias en salud en la población de Inglaterra, que los autores atribuían a la prevalencia de comportamientos de riesgo en estos grupos y a ciertas condiciones estructurales como ingreso, riqueza, poder, ambiente y acceso a servicios. En los años siguientes, el Informe Black generó un amplio debate en el mundo anglosajón sobre el problema de las diferencias en salud que se observan entre los grupos humanos. Sin embargo, la mayoría de los estudios sobre el tema se han centrado hasta hoy en la medición de las desigualdades como variables fácticas, sin profundizar en su origen estructural y, sobre todo, sin discutir ni cuestionar este origen.

Background: Medical Legal Partnerships (MLPs) are collaborations between healthcare and legal services that aim to address the health-harming impacts of unmet legal needs. Better characterization of existing MLP models would be a resource for new and expanding MLPs to glean insight into challenges and opportunities to consider. This scoping review aimed to examine and map outcomes reported by MLPs. Methods: MEDLINE, EMBASE, CINAHL, and the Index to Legal Periodicals databases were searched, and studies reporting qualitative or quantitative outcomes of a MLP were eligible for inclusion. Independent dual review of titles, abstracts, and full-texts was conducted and the reported outcomes were analyzed. Results: Thirty studies met inclusion criteria. Children and families were the most commonly served populations. The most frequently addressed legal needs pertained to housing, income, and personal/family stability. MLPs were associated with improved health, health services use, and legal outcomes. Education of healthcare professionals was associated with increased knowledge and confidence in addressing social needs. Conclusion: Overall, MLPs effectively partner healthcare and legal services to mitigate the health-harming consequences of unmet legal needs. MLPs facilitate access to care in legal circumstances that would otherwise exacerbate health conditions, and largely benefit communities that have been historically underserved by medical and legal systems.

Purpose: Social Determinants of Health is a conceptual framework typically used to understand patterns of health and ill-health at the population level. Its applicability to children and youth who already have a health condition, in this case, a neurodisability, is not well understood, particularly when the "health" component of that framework is extended to include more pluralistic notions of well-being. The purpose of this study was to address this challenge and to develop an ecosocial framework that is conceptually integrative and meaningful to children and youth with neurodisabilities and their families. Methods: Drawing on a critical literature review, a conceptual analysis approach, and a secondary analysis of a compendium of 36 social determinants of health models, we critically analysed how these models map onto the context of childhood neurodisability and identified key conceptual and empirical challenges. The emerging framework was further validated through iterative stakeholder consultation with parents, self-advocates, researchers, practitioners, community leaders, and decision-makers. Results: The review and consultation process generated The Canadian Framework for Social Determinants of Health and Well-being among Children with Neurodisabilities and their Families. This new framework consists of two hemispheres encompassing explanatory (or observational) and action-oriented (or transformational) components relating to social determinants of health and well-being and living a daily life of quality in childhood neurodisability. Conclusion: The proposed framework provides a roadmap for practitioners, policy-makers, and researchers as well as activists, families, and communities, to reflect on both social determinants and social change processes that shape the health, well-being, and everyday lives of children and youth with neurodisabilities and their families. ä IMPLICATIONS FOR REHABILITATION Social Determinants of Health provides a conceptual framework for understanding the social causes and consequences of health and ill-health at the population level. In childhood neurodisability, however, it is important to consider pluralistic notions of "well-being" and living a daily "life of quality" that may relate, but are not limited, to health. The Canadian Framework for Social Determinants of Health and Well-being among Children with Neurodisabilities and their Families comprises an explanatory hemisphere of social determinants, factors, and contingencies, and an action-oriented hemisphere that identifies different forms and levels of mobilization that can guide rehabilitation practice to achieve social change in the lives of children, youth, and their families. Using an ecosocial perspective, this framework provides a roadmap for future research and policy development that is relevant to children and families as well as to current perspectives in rehabilitation, social and health justice, and childhood, disability, and neurodiversity rights.

In this paper, we present an argument strengthening the view of Norman Daniels, Bruce Kennedy and Ichiro Kawachi that justice is good for one's health. We argue that the pathways through which social factors produce inequalities in sleep more strongly imply a unidirectional and non-voluntary causality than with most other public health issues. Specifically, we argue against the 'voluntarism objection'-an objection that suggests that adverse public health outcomes can be traced back to the free and voluntary choices of individual actors. Our argument proceeds along two lines: an empirical line and a conceptual line. We first show that much of the empirical research on sleep supports the view that those with fewer opportunities are those who have poorer sleep habits. We then argue that sleep-related decisions are not of the same nature as most other lifestyle choices, and therefore are not as easily susceptible to the voluntarism objection.

Background: Medical Legal Partnerships (MLPs) are collaborations between healthcare and legal services that aim to address the health-harming impacts of unmet legal needs. Better characterization of existing MLP models would be a resource for new and expanding MLPs to glean insight into challenges and opportunities to consider. This scoping review aimed to examine and map outcomes reported by MLPs. Methods: MEDLINE, EMBASE, CINAHL, and the Index to Legal Periodicals databases were searched, and studies reporting qualitative or quantitative outcomes of a MLP were eligible for inclusion. Independent dual review of titles, abstracts, and full-texts was conducted and the reported outcomes were analyzed. Results: Thirty studies met inclusion criteria. Children and families were the most commonly served populations. The most frequently addressed legal needs pertained to housing, income, and personal/family stability. MLPs were associated with improved health, health services use, and legal outcomes. Education of healthcare professionals was associated with increased knowledge and confidence in addressing social needs. Conclusion: Overall, MLPs effectively partner healthcare and legal services to mitigate the health-harming consequences of unmet legal needs. MLPs facilitate access to care in legal circumstances that would otherwise exacerbate health conditions, and largely benefit communities that have been historically underserved by medical and legal systems.

With attention to the field of public health ethics growing, significant time has been devoted to identifying a sound ethical justification for paternalistic interventions that override individual autonomy to prevent people from adopting unhealthy behaviors. Efforts focused on specifying the conditions that warrant paternalism, however, are largely misplaced. On empirical and ethical grounds, public health should seek instead to expand individual autonomy to improve population health. To promote autonomy, the field should redirect current efforts toward clarifying principles of justice. Although public health’s most highly visible stance is associated with an egalitarian conception of “social justice,” it is imperative that public health professionals address gaping divisions in public understandings of justice. I present recommendations for initiating this process.

Background: Medical Legal Partnerships (MLPs) are collaborations between healthcare and legal services that aim to address the health-harming impacts of unmet legal needs. Better characterization of existing MLP models would be a resource for new and expanding MLPs to glean insight into challenges and opportunities to consider. This scoping review aimed to examine and map outcomes reported by MLPs. Methods: MEDLINE, EMBASE, CINAHL, and the Index to Legal Periodicals databases were searched, and studies reporting qualitative or quantitative outcomes of a MLP were eligible for inclusion. Independent dual review of titles, abstracts, and full-texts was conducted and the reported outcomes were analyzed. Results: Thirty studies met inclusion criteria. Children and families were the most commonly served populations. The most frequently addressed legal needs pertained to housing, income, and personal/family stability. MLPs were associated with improved health, health services use, and legal outcomes. Education of healthcare professionals was associated with increased knowledge and confidence in addressing social needs. Conclusion: Overall, MLPs effectively partner healthcare and legal services to mitigate the health-harming consequences of unmet legal needs. MLPs facilitate access to care in legal circumstances that would otherwise exacerbate health conditions, and largely benefit communities that have been historically underserved by medical and legal systems.

Genome editing holds tremendous promise for preventing, ameliorating, or even curing disease, but a thorough discussion of its bioethical and social implications is necessary to protect humankind against harm, a central tenet of the original Hippocratic Oath. It is therefore essential that medical students, physicians, and all health care workers have a working understanding of what gene editing entails, the controversy surrounding its use, and its far-reaching clinical and ethical implications.

The social movement that has recently emerged in Chile has demanded the need to reform the current health system because it is considered unfair. This article aims to analyze the Chilean health system from the theories of social justice, identifying which would be at the base of this and of the health proposals made by the government after the social outbreak. Other theoretical approaches related to the concept of justice are proposed to achieve a change in the health system that is in tune with citizen demand.

This article is aimed at making a critical review on recommendations on the handling of the social, economic, community health and political impacts of coronavirus disease (COVID-19) in Indonesia and Rwanda. In regards to the concepts and issues contained in the aim of this article; certain findings were made. It is found that COVID-19 is like most global health crisis in the past, as it made its entrant unannounced and thus, the world was not prepared on how to contain it or eradicate its spread and transmission in good speed. In every legitimate government around the universe, one of the paramount concerns of such government is to ensure the health well-being of her citizens amidst her limited resources; thus, the governments of Indonesia and Rwanda have made similar efforts in that regard. Covid-19, since its discovery with myths and misconceptions, has had series of impacts in Indonesia and Rwanda, as well as other countries around the globe. Various techniques and approaches have been applied in tackling or managing the pandemic; however, this article is of the view that recommendations are to be in line with the peculiar nature and structure of the people, resources, facilities and government of a given country. Thus, an approach must be weighed to ascertain its feasibility in a given state; as what works in country A, may not work in country B. This article specifically makes recommendations based on ascertained SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis of the COVID-19 situations in the two countries.

The ethics of scarce life-sustaining and life-saving resource allocation is a complex topic with significant ethical ramifications that require comprehensive theoretical and practical analysis. The COVID-19 pandemic, especially for countries such as the United States who are less experienced with rationing healthcare resources, has forced healthcare systems to create and implement crisis standards of care guidelines to help clinicians make difficult ethical decisions in the face of limited time and scarce resources. This paper aims to deconstruct the philosophical concepts and moral theory behind several states’ crisis standards of care models in the U.S. to show how certain practices of resource rationing negatively impact and infringes upon the rights and wellbeing of individuals with underlying disabilities and/or comorbidities. An ethical evaluation and critique of Pennsylvania’s 2020 Interim Crisis Standards of Care (CSC) for Pandemic Guidelines’ as well as other states’ CSC frameworks will be made. To conclude, the foundations of an alternative equity-based approach to crisis standards of care that avoids adopting the dehumanizing ethic and discriminatory protocols present in states’ current crisis standards of care model will be proposed.

There is a social gradient in health that runs from the top to the bottom of society and affects all of us. A way to understand this link between status and health is to think of three fundamental human needs: health, autonomy and opportunity for full social participation. All the usual suspects affect healthmaterial conditions, smoking, diet, physical activity and the like-but autonomy and participation are two other crucial influences on health; and the lower the social status, the less autonomy and the less social participation.

When is it fair that some people are less healthy than others due to their own individual choices and preferences? In this paper, I explore two alternative answers. The first is a luck-egalitarian account that holds people responsible for choices that society could have reasonably expected them to avoid. I argue that this account is indeterminate and go on to sketch an alternative proposal based on Rawls’s idea of a “social division of responsibility.” This latter approach connects the notion of responsibility for health to the social conditions under which health-related behaviour is developed.

Gene-edited babies who might be born in the future should be monitored over the course of their life. These patients' physical, mental, and social health monitoring should be coordinated by clinicians in ways that anonymize patients' data for privacy protection but also allow for national and international aggregate evaluations. Transnational monitoring efforts should focus on safety and efficacy, social and disability justice, what constitutes the standard of care, and how best to promote both access to care and social and genomic research and innovation. In addition, effective and binding mechanisms for stopping or limiting uses of gene editing technology should be developed. Case Dr L and her team are germline editing researchers who are about to begin work with Dr M at her university hospital fertility clinic on a germline genome editing pilot protocol approved after extensive public comment and review by ethical, safety, disability and social justice, and regulatory bodies. Four couples in which both partners are carriers for well-studied severe monogenic conditions have given their consent to be involved in the clinical trial.

More than a few titles are not about addiction qua addiction, but deal with subject matter pertaining to the psychological, ethical and cultural questions that surround addiction as self-destructive behavior in the context of variables, causes, and consequences that are, we might say, at once individual or intrapersonal and interpersonal (in an intimate sense) and social. Yet the distinctions serve a purpose, as they are essential in addressing the specific dynamics and dialectics of interaction between these two dimensions or poles so as to better understand the nature of addiction in the contemporary world. The following bibliographies contain titles indirectly germane to our topic: (i) Beyond

This bibliography has two conspicuous constraints: books, in English. The emphasis is on recent works within the rubric of the title, and in particular on topics central (sometimes by implication, as some of the more empirically-oriented or anthropological titles attest) to social justice, thus books within both "law" and "ethics" are chosen insofar as they have some bearing (directly or indirectly) on social justice (hence, descriptively and normatively, questions of fairness and equality are paramount). And several of these foci are crystallized in the growing literature that extends beyond biomedical epidemiology under the heading of "social epidemiology." While the list aims to be fairly comprehensive, it is far from exhaustive and thus is best viewed as representative of the literature. I'm grateful to Professor Daniel Goldberg of East Carolina University (Bioethics and Interdisciplinary Studies) for the initial inspiration some years ago for this particular compilation. 2 We have known for over 150 years that an individual's chances of life and death are patterned according to social class: the more affluent and better educated people are, the longer and healthier their lives. These patterns persist even when there is universal access to health care-a finding quite surprising to those who think financial access to medical services is the primary determinant of health status. In fact, recent cross-national evidence suggests that the greater the degree of socio-economic inequality that exists within a society, the steeper the gradient of health inequality. As a result, middle-income groups in a more unequal society will have worse health than comparable or even poorer groups in a society with greater equality. Of course, we cannot infer causation from correlation, but there are plausible hypotheses about pathways which link social inequalities to health, and, even if more work remains to be done to clarify the exact mechanisms, it is not unreasonable to talk here [after Michael Marmot] about the social 'determinants' of health. -Norman Daniels, Bruce Kennedy, and Ichiro Kawachi Bibliographies with more or less family resemblance to this compilation (embedded links): (i) Transdisciplinary Perspectives on Addiction; (ii) Alternative and Complementary Medicine; (iii) Bioethics; (iv) Biological Psychiatry, Sullied Psychology and Pharmaceutical Reason; (v) Buddhism and Psychoanalysis; (vi) Death and Dying; (vii) Diseases, Epidemics, and Pandemics; (viii) Psychoanalytic Psychology and Therapy; and (ix) Sullied