Social Justice In Health Care Research Articles

The concept of intersectionality in bioethics: a systematic review

BackgroundIntersectionality is a concept that originated in Black feminist movements in the US-American context of the 1970s and 1980s, particularly in the work of feminist scholar and lawyer Kimberlé W. Crenshaw. Intersectional approaches aim to highlight the interconnectedness of gender and sexuality with other social categories, such as race, class, age, and ability to look at how individuals are discriminated against and privileged in institutions and societal power structures. Intersectionality is a “traveling concept”, which also made its way into bioethical research.MethodsWe conducted a systematic review to answer the question of where and how the concept of intersectionality is applied in bioethical research. The PubMed and Web of Science databases were systematically searched and 192 articles addressing bioethical topics and intersectionality were finally included.ResultsThe qualitative analysis resulted in a category system with five main categories: (1) application purpose and function, (2) social dimensions, (3) levels, (4) health-care disciplines and academic fields, and (5) challenges, limitations, and critique. The variety of academic fields and health-care disciplines working with the concept ranges from psychology, through gynaecology to palliative care and deaf studies. Important functions that the concept of intersectionality fulfils in bioethical research are making inequities visible, creating better health data collections and embracing self-reflection. Intersectionality is also a critical praxis and fits neatly into the overarching goal of bioethics to work toward social justice in health care. Intersectionality aims at making research results relevant for respective communities and patients, and informs the development of policies.ConclusionsThis systematic review is, to the best of our knowledge, the first one to provide a full overview of the reference to intersectionality in bioethical scholarship. It creates a basis for future research that applies intersectionality as a theoretical and methodical tool for analysing bioethical questions.

Advancing anti-oppression and social justice in healthcare through competency-based medical education (CBME)

Competency-based medical education (CBME) focuses on preparing physicians to improve the health of patients and populations. In the context of ongoing health disparities worldwide, medical educators must implement CBME in ways that advance social justice and anti-oppression. In this article, authors describe how CBME can be implemented to promote equity pedagogy, an approach to education in which curricular design, teaching, assessment strategies, and learning environments support learners from diverse groups to be successful. The five core components of CBME programs – outcomes competency framework, progressive sequencing of competencies, learning experiences tailored to learners’ needs, teaching focused on competencies, and programmatic assessment – enable individualization of learning experiences and teaching and encourage learners to partner with their teachers in driving their learning. These educational approaches appreciate each learner’s background, experiences, and strengths. Using an exemplar case study, the authors illustrate how CBME can afford opportunities to enhance anti-oppression and social justice in medical education and promote each learner’s success in meeting the expected outcomes of training. The authors provide recommendations for individuals and institutions implementing CBME to enact equity pedagogy.

EXAMINING JUSTICE AND INEQUALITIES IN THE HEALTH SECTOR WITHIN THE CONTEXT OF PUBLIC HEALTH NURSING

Aim: The social determinants of health are crucial for understanding the factors that influence social justice in healthcare. Besides medical care, factors such as housing, education, employment, and income disparities need to be considered for a healthy life. The aim of this review is to examine justice and inequalities in the healthcare sector within the context of public health nursing. Method: Literature search was conducted between December 01, 2023, and January 31, 2024, using the English translations of key terms such as "health sector," "justice," "inequalities," "public health nursing," or "health" and "social justice" and "inequities" in Google Scholar, Medline, Pubmed, and Sciencedirect search engines. Results: Justice in the healthcare sector is defined as the absence of systematic differences in health or its fundamental indicators among social groups with different levels of social advantage or disadvantage within a society. This implies equal access to healthcare services for every individual and the absence of unjust distribution of health opportunities, ensuring no barriers to health access. The focus should be on preserving the health of everyone in society, not just individuals. The goal of justice in the healthcare sector is to eliminate barriers preventing access to health resources and services for everyone as a whole. Data indicate numerous attitudes and reasons contributing to social justice inequalities in the healthcare sector. Conclusion: Public health nurses focus on addressing the social determinants of health and aim to eliminate health inequalities through leadership, interdisciplinary collaboration, advocacy, education, and care roles. By actively contributing at these levels, public health nurses can strengthen the healthcare system and work towards a better future.

An Online Photovoice Study Designed by Researchers from Art and Social Work to Better Understand the Experience of Chronic Pain by Women of Color

In 1980s British feminist artist-photographer Jo Spence used phototherapy to challenge normative and medicalized constructions of the female cancer patient by documenting her illness and was then employed as a consultant by hospitals who, through her work, recognized the need to change physicians’ practices and attitudes, which objectified patients. Photovoice, a Community Based Participatory Design method where participants take photographs and combine them with short text narratives, is similar to Spence’s artistic method. It has been used widely in health and social work settings. Healthcare professionals are aware of the power of images as catalysts for meaning making in medical encounters with people in pain; as part of multidisciplinary analysis, because images can enhance a person’s sense of agency in relation to their pain, especially in clinical contexts. Photographs can also establish a common ground for discussing meaning, therefore Photovoice can make the hidden experience of pain visible through collaborative photo-texts. These are subsequently shared with other patients and healthcare workers to aid them in specialist consultations. However, few studies have addressed gender and race-related health disparities in treating chronic pain. This paper draws on the authors’ study with twenty women of color who created photo-text works about their experiences living with and being treated for chronic pain. In this novel online Photovoice study, participants engaged with asynchronous videos created by an artist-professor about the meanings viewers make of a photograph, including how perspective, angle, and lighting can affect the viewer’s emotional response to photographs. Participants then deployed Photovoice through six synchronous sessions led by a social work professor with extensive experience designing and facilitating Photovoice studies. The resulting image-text works by study participants address health inequity and argue for health equity as a hallmark of social justice in healthcare by focusing on exposing and reducing healthcare disparities.

A Continuous Quality Improvement Framework for Sustainable Action and Advancement of Diversity, Equity, Inclusion, and Belonging in Physical Therapy.

To address racial and ethnic disparities, physical therapy organizations, educational institutions, and clinical practices seek to advance diversity, equity, inclusion (DEI), and social justice in health care. Although our professional organizations have crafted proclamations, resource lists, developed new accreditation standards, and strategic plans, we lack a unifying framework and action tools for substantial and sustained progress. In addition, the DEI acronym is missing the essential element of belonging (B), that is, sharing a sense of purpose and feeling safe to contribute opinions as a valued member of an organization. Therefore, the purpose of this position paper is to propose the utilization of a continuous quality-improvement (CQI) framework using Plan-Do-Study-Act (PDSA) cycles to advance DEI-B in physical therapy education and practice. The CQI framework and PDSA cycles are data-driven, iterative approaches for identifying areas for improvement, implementing interventions, collecting data, analyzing outcomes, and taking evidence-based next action steps. Application of this framework can enhance sustainability of DEI-B goals and foster progress toward the proposed accreditation criteria of the Commission on Accreditation in Physical Therapy Education in this critical area. Tenants for PDSA team success are presented, and PDSA cycles are described. Addressing racism and advancing DEI-B efforts in the physical therapy profession requires bold, sustained, and intentional action that incorporates standards, strategies, and methods for measuring change. Examples of PDSA DEI-B initiatives, interventions, and outcomes are provided to illustrate how this approach can be implemented within a physical therapy education program. Using this CQI framework provides our profession with a DEI-B roadmap for advancing incremental and sustained progress.

Barriers and Challenges in Caring for Transgender People: Implications for Clinical Practice and the Experience From a Specialized Center

Background: Transgender people often experience social exclusion and transphobic attitudes, which have an adverse impact on their socioeconomic life and health status. Within health services, -discriminatory practices and mistreatment derive from the lack of cultural competence by -healthcare providers. Objective: This article features existing barriers in the provision of healthcare to transgender populations and suggests approaches to manage the relevant challenges. Methods: A thorough review of the literature was performed, and the operation of a specialized unit wass presented. Results: Health professionals are often unskilled or unwilling to offer transgender care, while most healthcare service institutions do not offer specialized treatments. Incomplete health insurance coverage and shortages of personal income impede trans individuals' access to healthcare. Certain practices and policies are needed for scientifically and culturally competent services. Conclusions: The social vulnerability and the unique health needs of transgender persons urgently call for accessible and effective care for gender minority individuals. The integration of gender identity issues into continuous medical and nursing education is a key component of transgender-friendly care. Implications for Nursing: The integration of diversity as a core value in health services, the ability of health personnel to deliver transgender care, and the provision of insurance coverage solely based on medical needs are necessary steps to achieve social justice in healthcare.

A Framework for Anti-Racist Publication in Palliative Care: Structures, Processes, and Outcomes

Systemic or structural racism describes an embedded pattern of explicit and implicit racial biases that, through policy and action, systematically confer advantage to white people and disadvantage Black, indigenous, and other people of color. Hospice and palliative care journals participate in this broader system of racial discrimination. Building on palliative care's explicit focus on patients’ goals and values, which may in and of itself comprise a form of social justice in healthcare, palliative care journals and their publishers have an opportunity to lead others in cultivating anti-racist practices and explicitly promoting equity. The publication life cycle of submission and solicitation, manuscript peer-review, and publication provide a framework for examining the structures, processes, and outcomes by which palliative care and other journals might address systemic racism. We describe the current academic publishing landscape, which diminishes the voices and experiences of racial and ethnic minority patients and undermines the careers of under-represented scholars. We then propose reforms that we believe will improve publication equity and quality as well as healthcare outcomes. These include an Equity in Publication checklist, solicitation of manuscripts on equity-relevant topics, promotion of scholars through editorial structures and peer review processes, and a standard Equity Rating for publications. Greater efforts to include non-dominant voices in every aspect of publication, through appropriate recognition of their scholarship and remuneration for their efforts, will drive equity in health outcomes. By pursuing an anti-racist and equity-focused publishing agenda, hospice and palliative medicine journals and their publishers have an opportunity to transform healthcare.

Cross-cultural communication in medical settings

Today there is a strong tendency to incorporate the bioethical principle of social justice in healthcare in cross-cultural communication. Considering cultural differences makes it possible to ensure that the human right to medical care and wellbeing is fully respected. Several types of most vulnerable populations were identified - immigrants and social minorities. When seeking medical care they face a number of problems such as culture and language barriers, lower socio-economic status, lack of literacy, which impede effective communication and care provision. The most promising ways of coping with the problem are developing cultural competence and practicing a patient-centered approach. New curricula aiming at raising cultural awareness have been elaborated for practical use in medical schools.

Dr Hope Landrine, 1954–2019: In memoriam

A note of commemoration of the life and work and Dr Hope Landrine, 1954-2019. Dr Landrine was Associate Editor of the Journal of Health Psychology for two decades and a frequent contributor to the journal. Hope Landrine's research in the health psychology and public health fields was pioneering and pathfinding. Dr Landrine's focus on ethnic minorities, specifically those living in segregated and poor neighbourhoods, is a significant corpus of work that provides a challenging perspective on social justice in health care.

The Life of a Black Medical Trainee in the United States: Past, Present, Future

An Introduction to the History of Black Medical TraineesIn these unprecedented times, Black medical professionals must deliver excellent medical care and uphold the highest standards of their profession while living through a devastating pandemic. They must do so in a time when the country tries to reconcile with generations of racism and injustice. The current social environment in America is particularly challenging for medical trainees such as medical students and resident physicians who must focus on their educational requirements and careers in settings that are often averse to addressing topics such as racism. This plight is not new for Black medical trainees, as they have been fighting for centuries to obtain an equitable seat at the table of medical education. Throughout the 19th century and early 20th century, Black physicians were repeatedly disenfranchised from the predominantly white medical societies, most notably the American Medical Association (AMA), which was established in 1847. Racially integrated medical organizations such as the National Medical Society of Washington D.C. (NMS), which was founded in 1870, were developed to challenge discriminatory practices of the American Medical Association against Black practitioners. The inception of the National Medical Association (NMA) in 1895 allowed Black doctors to advocate for disadvantaged patient populations and focus efforts on health issues pertinent to the underserved. The Struggles of the Black TraineeHowever, Black and underrepresented minorities continue to face challenges with medical school matriculation and retention. A 2015 AAMC report showed that Black male medical school matriculants failed to increase significantly between 1978 and 2014. From 2006 to 2018, the number of Black medical school matriculants increased from 6.7% to 7.1%. Solutions for Improving Medical Education for the Black TraineeTo improve these matriculation statistics, it is critical that institutions integrate innovative measures such as robust recruitment pipelines to expose underrepresented high school and college students to the medical field, as well as seek diversity actively in administration to dismantle the ingrained ideologies of systemic racism rooted in healthcare and medical education. To combat the institutionalized racism that has plagued medical education throughout its existence, collaboration as a unified front is essential to achieving the equity and social justice in healthcare that patients deserve.

The promotion of social justice in healthcare

As nurses, we can advocate for health equity and equality for our vulnerable patient populations.

Социальная справедливость в здравоохранении: опыт и оценки россиян

Жанна Владимировна Савельева – доктор социологических наук, доцент, кафедра истории, философии и социологии, Казанский государственный медицинский университет. Адрес: 420012, Казань, ул. Бутлерова, д. 49. E-mail: gedier@mail.ru
 Лайсан Музиповна Мухарямова – доктор политических наук, профессор, заведующая кафедрой истории, философии и социологии, Казанский государственный медицинский университет. Адрес: 420012, Казань, ул. Бутлерова, д. 49. E-mail: l.mukharyamova@yandex.ru
 Ирина Борисовна Кузнецова – кандидат социологических наук, доцент, старший научный сотрудник, Школа географии, Земли и наук об окружающей среде, Университет Бирмингема; доцент кафедры истории, философии и социологии, Казанский государственный медицинский университет. E-mail: i.kuznetsova@bham.ac.uk
 Цитирование: Савельева Ж.В., Мухарямова Л.М., Кузнецова И.Б. (2018) Социальная справедливость в здравоохранении: опыт и оценки россиян // Мир России. Т. 27. № 3. С. 154–179. DOI: 10.17323/1811-038X-2018-27-3-154-179
 
 В статье проанализированы оценки экспертов и мнение населения о справедливости российского здравоохранения. Проблема актуализируется в свете постсоциалистических трансформаций, снижения расходов на здравоохранение, неблагоприятных показателей здоровья россиян и обращает к научным дискуссиям в отношении трактовки равенства в сфере здоровья, соотношения прав, возможностей и равенства результатов, ответственности субъекта за здоровье, принципов распределения благ здравоохранения. Эмпирической базой работы являются результаты интервью с экспертами в области организации здравоохранения, пациентами и массового опроса населения двух республик: Татарстан и Марий Эл (2016–2017 гг.).
 Результаты исследования выявили следующие проблемы: территориальные программы госгарантий и объемов медицинской помощи приводят к неравенству в доступе к здоровью как на межрегиональном уровне, так и между жителями городских и сельских территорий; своевременная диагностика и лечение малодоступны, прежде всего для пожилых и малообеспеченных граждан. Вопрос о справедливости здравоохранения в России вызвал затруднения у трети респондентов, мнения остальных разделились примерно поровну; вместе с тем значительная доля населения в последние годы видит улучшение качества здравоохранения своего региона либо оценивает ситуацию как сбалансированную; большинство опрошенных жителей разделяют идеи дистрибутивного понимания справедливости в здоровье, отвергая рыночные принципы платежей и идеи сопряжения меры ответственности за здоровье и инициативы оплаты медуслуг неработающим населением; лучшими средствами борьбы с несправедливостью в здравоохранении население считает увеличение расходов на здравоохранение, борьбу с коррупцией в высших эшелонах власти и повышение доступности бесплатных медицинских услуг. Исследование показало, что положение дел в российском здравоохранении имеет институционально закрепленные механизмы, препятствующие осуществлению справедливых принципов равных возможностей в отношении здоровья.

Равенство и справедливость в отношении здоровья: к поиску аналитических инструментов оценки

Лайсан Музиповна Мухарямова – д.полит.н, профессор, заведующая кафедрой истории, философии и социологии, Казанский государственный медицинский университет. Казань, Россия. Электронная почта: l.mukharyamova@yandex.ru
 Ирина Борисовна Кузнецова– к. с.н., доцент, cтарший научный сотрудник, Школа географии, Земли и наук об окружающей среде, Университет Бирмингема, Бирмингем, Соединенное королевство, доцент кафедры истории, философии и социологии, Казанский государственный медицинский университет. Электронная почта: i.kuznetsova@bham.ac.uk
 DOI: 10.17323/727-0634-2017-15-4-651-659
 Статья представляет собой обзор современных западных подходов к пониманию справедливости в отношении здоровья, обозначая основные дискуссионные моменты. Вслед за Уиллом Кимликой в академических дискуссиях о справедливости выделяются проблемы ответственности и равенства. Вопросы о соотношении между индивидуальной ответственностью и социальными факторами являются фундаментальными для всех современных теорий справедливости в отношении здоровья. Равенство может пониматься как экономическое равенство, как равенство возможностей или как равенство в свободе. Согласно ученым, объясняющим состояние здоровья через призму индивидуальной ответственности, получение неравных медицинских услуг справедливо, если это неравенство является результатом личного выбора и собственных действий. Вместе с тем зависимость количества и качества медицинских услуг от ответственности людей за свое здоровье увеличивает риски для тех, кто уже находится в наихудшем положении. Другая группа ученых анализирует социальные детерминанты здоровья, включающие в себя обстоятельства повседневной жизни, доступность удовлетворения материальных потребностей, окружающую среду, а также социальные, экономические и политические условия, социальные и культурные нормы. Детерминанты формируются вследствие политики и под воздействием распределения финансов, власти и других ресурсов на глобальном, национальном и местном уровне, выступают главными причинами несправедливости. При этом если социальная справедливость понимается как наличие возможностей (в случае с здравоохранением – равный доступ к здоровью), то здоровье тождественно справедливости. Обеспечение справедливости в отношении здоровья является социально-экономической, политической и этической проблемой, решение которой возможно только в таком междисциплинарном поле. Признание на международном уровне социальных факторов здоровья и необходимости преодоления неравенства в отношении доступа к здравоохранению, актуализируют исследование влияния социально-экономических детерминант на индивидуальное поведение людей.

Values in medicine

Medical doctors should be studying in the future not only about the “alleviation of physical and mental pain and suffering” but also about the “restoration of social functioning of their patients. Medical professionals are urged to carry their culture of helping and caring as contributions to society. They also assume responsibility for the careful use of available resources and their equitable distribution. Central values of medicine are respect for human dignity, respect for self-determination and autonomy, the primacy of patient welfare, the principle of noninjury, and solidarity. Questions of values deal with particularly complex areas of personal identity, because values are causes and reasons for decisions and actions. The potential damage of medical interventions is not automatically justified by the desire to help. The ratio between benefit and risks of medical measures must always be critically appreciated. The professional medical ethic is the basis for the contract between medicine and society with three basic principles: primacy of patient welfare, respect for the rights of self-determination (autonomy) of patients (informed consent), and promoting social justice in health care (solidarity). From these principles, normative values are derived, indispensably connected with medical responsibilities and obligations. Development of these values is discussed in the light of the philosophical background of the dignity of the individual person and the process of decision-making.

How Can We Measure Progress on Social Justice in Health Care? The Case of Egypt

—Social justice, broadly defined as providing equal access to liberties, rights, and opportunities especially for the least advantaged members of society, is a priority of several governments in the Middle East and North Africa (MENA) post−Arab Spring as well as globally. Achieving social justice in the field of health care is consistent with the principles of universal health coverage and is an important means to achieve this aim. To translate this abstract concept into concrete action, we propose a novel diagnostic method and then apply it to the case of Egypt, a country with a stated goal of achieving social justice in health care. This allows us to assess progress and then suggest targeted recommendations through which to improve social justice in health care. Through a comprehensive analysis of primary and secondary qualitative and quantitative data sources, we first identify six disadvantaged groups in Egypt and then analyze the status of these groups with respect to the three objectives of a health system—improving health outcomes, financial protection, and public satisfaction. Our results suggest that Egypt faces 11 challenges to achieving social justice in health care that can be addressed through 14 short- and medium-term recommendations drawn from global evidence of what works. Implementing these health system changes can help advance social justice in health care in Egypt.

ENHANCING COMMUNITY HEALTH BY IMPROVING PHYSICIAN PARTICIPATION.

Leading medical associations have called for renewed standards of medical professionalism, including stronger public advocacy, a commitment to social justice in health care, and greater community engagement. New strategies are needed to enhance community participation among physicians, which can improve public trust in the medical profession and contribute needed expertise and teamwork to matters of community health. One strategy is to incorporate community participation and leadership in medical training through community-based organization (CBO) placement of residents. We describe a model CBO placement program within a family medicine residency in Harlem, New York City. This program enables residents to partner with organizations that address social, political, economic, and environmental determinants of health in underserved populations, and to assume leadership roles in community health activities. Broader implementation of this model in other settings, both urban and rural, can enhance community participation by physicians within a sustainable framework, and promote medical professionalism and community health.

The Space That Difference Makes: On Marginality, Social Justice and the Future of the Health Humanities.

Feminist theorist and educator, bell hooks, asserts that to seek true liberation one must choose marginality. One must choose to occupy the space outside the binary between colonizer-colonized, hegemonic center-periphery, and us-them in order to create a location of possibility. This essay will reveal the practice of social justice as the navigation of the space that difference makes and argue that choosing marginality provides a framework for health humanities work towards social justice in health care. The space of the launderette that is depicted in Hanif Kureishi's 1986 film, My Beautiful Laundrette, provides an example of choosing marginality and illustrates how difference structures both real and imagined spaces, which influences how individuals ultimately perceive one another. We will draw from the work of bell hooks; political geographer, Edward Soja; and Marxist philosopher, Henri Lefebvre, to demonstrate the importance of the health humanities' position at the margin to traditional health care education.

Anti-Oppressive Practice and Reflexive Lifeworld-Led Approaches to Care: A Framework for Teaching Nurses about Social Justice.

This paper was initially written for a European Academy of Caring Science workshop and aimed to provide clarity and direction about Caring Science by offering some ideas emerging from the philosophy, themes, and projects of EACS. An underpinning concept for the work of the Academy is the lifeworld. The focus of the workshop was to explore the lifeworld of the patient, student, and carer. The intention was to promote discussion around the need to provide alternative ways to conceptualise caring relevant knowledge, naming phenomena and practices central to caring sciences, and the educational curriculum and its adequacy for caring science. This paper seeks to identify concepts and approaches to understanding oppression, power, and justice which enable nurses to challenge the structures in health care environments which discriminate or disempower clients. Anti-oppressive practice theory and reflexive lifeworld-led approaches to care enable nurses to be critical of their practice. A framework for teaching social justice in health care is offered to augment teaching students to challenge oppressive practice and to assist nurses to reflect and develop conceptual models to guide practices which are central to promoting caring interactions.

Accounting for social accountability: developing critiques of social accountability within medical education.

The concept of the social accountability of medical schools has garnered many followers, in response to a broad desire for greater social justice in health care. As its use has spread, the term 'social accountability' has become a meta-narrative for social justice and an inevitable and unquestionable good, while at the same time becoming increasingly ambiguous in its meaning and intent. In this article, we use the lenses of postmodernism and critical reflexivity to unpack the multiple meanings of social accountability. In our view, subjecting the concept of 'social accountability' to critique will enhance the ability to appraise the ways in which it is understood and enacted. We contend that critical reflexivity is necessary for social accountability to achieve its aspirations, and hence we must be prepared to become accountable not only for our actions, but also for the ideologies and discourses underlying them.

Achieving waiting list reform: a pilot program integrating waiting time, category and patient factors

Equity in resource allocation is central to the tenet of social justice in health care. The management of surgical waiting lists is of critical importance to clinicians, patients and regulators. In most hospital environments, the basic process has remained unchanged for decades. Patients are assigned to one of three urgency-related categories. Clinicians consequently administer three competing patient pools. The basis by which patients are selected for treatment may be difficult to define. The specific clinical circumstances of each patient are often unreported and may be unknown to those administering the list. Waiting list bias is also recognised. This may reflect clinician advocacy, pressure to meet category timeframe restrictions or perceived training requirements. In this environment, it is difficult to demonstrate propriety in care. We report the implementation of a pilot program to redesign waiting list management within a South Australian public hospital unit. This allows assemblage of patients into a single list. Overall priority is determined by balancing clinical acuity and waiting time. The determination of acuity takes into account both the primary category and the specific characteristics of each patient that are relevant to their intended procedure. Uniquely, the process is applicable to lists containing patients with dissimilar conditions. This paper reviews the limitations of current approaches in meeting reasonable community expectations. The principles and social justification underpinning this reform are introduced. Finally, the benefits offered by the program are discussed and interim results are reported.