People who are street involved such as those experiencing homelessness and drug use face multiple inequities in health and access to health care. Morbidity and mortality are significantly increased among those who are street involved. Incorporation of a harm reduction philosophy in health care has the potential to shift the moral context of health care delivery and enhance access to health care services. However, harm reduction with a primary focus on reducing the harms of drug use fails focus on the harms associated with the context of drug use such as homelessness, violence and poverty.
Ethical analysis of the underlying values of harm reduction and examination of different conceptions of justice are discussed as a basis for action that addresses a broad range of harms associated with drug use.
Theories of distributive justice that focus primarily on the distribution of material goods are limited as theoretical frameworks for addressing the root causes of harm associated with drug use. Social justice, reconceptualised and interpreted through a critical lens as described by Iris Marion Young, is presented as a promising alternative ethical framework.
A critical reinterpretation of social justice leads to insights that can illuminate structural inequities that contribute to the harms associated with the context of drug use. Such an approach provides promise as means of informing policy that aims to reduce a broad range of harms associated with drug use such as homelessness and poverty.
Our interest in a human rights and health discourse emerges from our efforts as social scientists to bring a meaningful social justice perspective to the realm of public health. In Canada, as in many countries, "health" is still firmly within the domain of the biomedical and the clinical. While considerable effort has been made to include more social, economic, and cultural perspectives, efforts to frame these issues as political phenomena have tended to be polarized into either a rich body of theoretical literature or case studies of interventions which have in varying degrees incorporated a social justice approach. What is still missing is a framework of discourse that allows various concepts of social justice to inform policy, intervention strategies, evaluation and evidence-based measures of effectiveness. This commentary examines the human rights discourse as conceptual space from which to build this framework.
The nursing profession has renewed its commitment to social and political mandates, resulting in increasing attention to issues pertaining to diversity, vulnerable populations, social determinants of health, advocacy and activism, and social justice in nursing curricula. Narratives from a qualitative study examining undergraduate nursing student learning in five innovative clinical settings (corrections, international, parish, rural, and aboriginal) resonate with these curricular emphases. Data were derived from focus groups and interviews with 65 undergraduate nursing students, clinical instructors, and RN mentors. Findings of this study reveal how students in innovative clinical placements bear witness to poverty, inequities, and marginalization (critical awareness), often resulting in dissonance and soul-searching (critical engagement), and a renewed commitment to social transformation (social change). These findings suggest the potential for transformative learning in these settings.
Social justice is a core value of public health. However, the public health core competencies for Canada document (release 1.0) does not contain any explicit reference to the essential attributes of social justice within the competencies themselves. We argue that social justice attributes should be integrated into the core competencies and propose examples for consideration.
Increase in the proportion of older persons in the population of most countries entails a change in the scale and structure of morbidity, which requires higher expenditures on health care and social service. Maintaining health and activity of older people is an important indicator of the effectiveness of public policies in the field of health and social welfare. Under these conditions the development of effective measures to promote prosperous aging is required, which includes primarily legislative, administrative and other measures, as well as development of a strategy and action plan of socio-economic nature, taking into account the needs of older people.
We sought to take a first step toward better integration of social concerns into empirical ecosystem service (ES) work. We did this by adapting cognitive anthropological techniques to study the Clayoquot Sound social-ecological system on the Pacific coast of Canada's Vancouver Island. We used freelisting and ranking exercises to elicit how locals perceive ESs and to determine locals' preferred food species. We analyzed these data with the freelist-analysis software package ANTHROPAC. We considered the results in light of an ongoing trophic cascade caused by the government reintroduction of sea otters (Enhydra lutris) and their spread along the island's Pacific coast. We interviewed 67 local residents (n = 29 females, n = 38 males; n = 26 self-identified First Nation individuals, and n = 41 non-First Nation individuals) and 4 government managers responsible for conservation policy in the region. We found that the mental categories participants-including trained ecologists-used to think about ESs, did not match the standard academic ES typology. With reference to the latest ecological model projections for the region, we found that First Nations individuals and women were most likely to perceive the most immediate ES losses from the trophic cascade, with the most certainty. The inverse was found for men and non-First Nations individuals, generally. This suggests that 2 historically disadvantaged groups (i.e., First Nations and women) are poised to experience the immediate impacts of the government-initiated trophic cascade as yet another social injustice in a long line of perceived inequities. Left unaddressed, this could complicate efforts at multistakeholder ecosystem management in the region.
The NASW Code of Ethics identifies social justice as one of six foundational values of the social work profession. Indigenous communities have long questioned the authenticity of this commitment and rightly so, given the historical activities of social work and social workers. Still, the commitment persists as an inspiration for an imperfect, yet determined, profession. This article presents a theoretical discussion of questions pertinent for social justice in social work practice in Native American communities: Whose definition of social justice should prevail in work with and in Indigenous communities? What can a revisioning of social justice mean to the development of Native communities and for Native youths in particular? What methods or processes of social work are most appropriate for this social justice work? This article presents a case for the practice of youth participatory action research as one method to work for social justice in Native communities.
While nurses address lesbian, gay, bisexual, transgendered, intersexed, and queer (henceforth LGBTIQ) patients' health needs, the professional nursing practice value of social justice provides a larger role for nurses in identifying and minimizing social barriers faced by LGBTIQ patients.
This paper examines the social and health-related experiences of LGBTIQ youth in Canada, a country which has removed many of the social and legal barriers faced by LGBTIQ in countries such as the United States. An awareness of the Canadian LGBTIQ experience is instructive for nurses in different countries, as it reveals both the possibilities and limitations of social legislation that is more inclusive of LGBTIQ youth.
Review of literature in PubMed, Academic Search Premier, government documents.
The literature reveals that exclusion, isolation, and fear remain realities for Canadian LGBTIQ adolescents. The Canadian experience suggests that negative social attitudes toward LGBTIQ persist despite progressive legislation. The value of social justice positions nurses to constructively intervene in promoting the health and well-being of LGBTIQ youth in the face of social homophobia.
In Australia, Japan, Sweden, and Switzerland, the average life expectancy is now greater than 80 years. But in Angola, Malawi, Sierra Leone, and Zimbabwe, the average life expectancy is less than 40 years. The situation is even worse than these statistics suggest because average figures tend to mask inequalities within countries. What are we to make of a world with such inequal health prospects? What does justice demand in terms of global health? To address these problems, I characterize justice at the local level, at the domestic or social level, and at the international or global level. Because social conditions, structures, and institutions have such a profound influence on the health of populations, I begin by focusing attention on the relationship between social justice and health prospects. Then I go on to discuss health prospects and the problem of global justice. Here I distinguish two views: a cosmopolitan view and a political view of global justice. In my account of global justice, I modify and use the political view that John Rawls developed in The Law of Peoples. I try to show why an adequate political account must include three duties: a duty not to harm, a duty to reconstruct international arrangements, and a duty to assist.
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.
Notes
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Community health clinical education in Canada: part 2--developing competencies to address social justice, equity, and the social determinants of health.
Recently, several Canadian professional nursing associations have highlighted the expectations that community health nurses (CHNs) should address the social determinants of health and promote social justice and equity. These developments have important implications for (pre-licensure) CHN clinical education. This article reports the findings of a qualitative descriptive study that explored how baccalaureate nursing programs in Canada address the development of competencies related to social justice, equity, and the social determinants of health in their community health clinical courses. Focus group interviews were held with community health clinical course leaders in selected Canadian baccalaureate nursing programs. The findings foster understanding of key enablers and challenges when providing students with clinical opportunities to develop the CHN role related to social injustice, inequity, and the social determinants of health. The findings may also have implications for nursing programs internationally that are addressing these concepts in their community health clinical courses.
Department of Community Medicine and Rehabilitation, Occupational Therapy, and Center for Population studies/Ageing and Living Condition Programme, Umeå University, Sweden. ingeborg.nilsson@umu.se
The evolving theory of occupational justice links the concept to social justice and to concerns for a justice of difference: a justice that recognizes occupational rights to inclusive participation in everyday occupations for all persons in society, regardless of age, ability, gender, social class, or other differences. The purpose of this descriptive paper is to inspire and empower health professionals to build a theoretical bridge to practice with an occupational justice lens. Using illustrations from a study of leisure and the use of everyday technology in the lives of very old people in Northern Sweden, the authors argue that an occupational justice lens may inspire and empower health professionals to engage in critical dialogue on occupational justice; use global thinking about occupation, health, justice, and the environment; and combine population and individualized approaches. The authors propose that taking these initiatives to bridge theory and practice will energize health professionals to enable inclusive participation in everyday occupations in diverse contexts.
The social determinants of health (SDH) are recognized as important indicators of health and well-being. Health-care services (primary, secondary, tertiary care) have not until recently been considered an SDH. Inequities in access to health care are changing this view. These inequities include barriers faced by certain population groups at point of care, such as the lack of cultural competence of health-care providers. The authors show how a social justice perspective can help nurses understand how to link inequities in access to poorer health outcomes, and they call on nurses to break the cycle of oppression that contributes to these inequities.
We consider the case of intensive resource extractive projects in the Blueberry River First Nations in Northern British Columbia, Canada, as a case study. Drawing on the parallels between concepts of cumulative environmental and cumulative health impacts, we highlight three axes along which to gauge the effects of intensive extraction projects. These are environmental, health, and social justice axes. Using an intersectional analysis highlights the way in which using individual indicators to measure impact, rather than considering cumulative effects, hides the full extent by which the affected First Nations communities are impacted by intensive extraction projects. We use the case study to contemplate several mechanisms at the intersection of these axes whereby the negative effects of each not only add but also amplify through their interactions. For example, direct impact along the environmental axis indirectly amplifies other health and social justice impacts separately from the direct impacts on those axes. We conclude there is significant work still to be done to use cumulative indicators to study the impacts of extractive industry projects-like liquefied natural gas-on peoples, environments, and health.
This paper asks the question of how much should society spend on diagnosis as opposed to medical treatments and compensation when implementing its goals of distributive justice in health policy through publicly-funded medical entitlement programs in a world of limited information? A model is presented in which social planners seek to maximize expected social welfare by allocating medical goods, including diagnostic tests among medically dissimilar individuals when there is imperfect information about the medical condition of an individual, subject to the resource constraints of a medical entitlement fund. The goals of distributive justice underlying the social welfare function is governed by a parameter representing society's aversion to inequality. It is argued that society, given its aversion to inequality, need not always entitle the medically more fortunate individual to less treatment and compensation. Moreover, in most cases, it is socially desirable to spend a finite and equal amount on diagnostic tests for each individual, even though there is some probability of misdiagnosis. In some unusual cases, zero expenditures on diagnostic tests will be socially optimal.
