Pulse oximeter used to measure pulse rate and oxygen levels in use on a person's finger.

‘I Can’t Breathe’: Racism in Medical Technology

By Aziza Ahmed

When Black Lives Matters (BLM) activists say “I can’t breathe,” they are acknowledging that breathing is not simply biological — it is enabled or disabled by law and politics. They are right.

In fact, the legal and political environment shapes and legitimates the very tools we use to monitor our capacity to breathe.

The racial justice uprisings and the COVID-19 pandemic have inspired advocates, scholars, and researchers to examine the assumptions about race that have embedded themselves into these tools — the medical technologies we use to measure if, and how, a person is breathing and absorbing oxygen.

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international connections concept art.

Moving Beyond a State-Centric Pandemic Preparedness Paradigm: A Call for Action

By Tsung-Ling Lee

Despite the World Health Organization’s (WHO) recent efforts to broaden participation, the international infectious disease control regime remains state-centric.

As such, the state-centric infectious disease regime violates the fundamental principle of how contagious diseases spread within and across countries — the virus recognizes no national borders, nor does the virus discriminate. The longstanding global health mantra — no country is safe until all countries are safe; no one is safe until everyone is safe — should guide global pandemic preparedness.

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FLINT, MICHIGAN January 23, 2016: City Of Flint Water Plant Sign In Flint, January 23, 2016, Flint, Michigan.

Digging Deep to Find Community-Based Health Justice

By Melissa S. Creary

Public health interventions aimed at Black and Brown communities frequently fail to recognize that these communities have, over and over, been made sick by the systems that shape their lives.

When we fail to recognize that these problems are happening repeatedly, we are likely to address the most recent and egregious error, ignoring the systemic patterns that preceded it. Public health and technological policy responses that do not address these underlying structural and historical conditions are a form of bounded justice, i.e., a limited response sufficient to quiet critics, but inadequate to reckon with historically entrenched realities.

By only responding to the acute crisis at hand, it is impossible to attend to fairness, entitlement, and equality — the basic social and physical infrastructures underlying them have been eroded by racism.

To achieve health justice, we must move beyond bounded justice. Rather than simply recognizing the existence of underlying social determinants of health, we must do the hard work to create and re-create systems, interventions, policies, and technologies that account for that erosion and offer high-grade reinforcements.

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U.S. Supreme Court

There’s No Justice Without Health Justice

By Yolonda Wilson

Last month the U.S. Supreme Court struck down the eviction moratorium issued by the Centers for Disease Control (CDC). The Court reasoned that, among other things, the eviction moratorium was an overreach by the CDC. That is, even in light of a global pandemic where being unhoused increases one’s risk of acute COVID-19 infection and subsequent serious illness, the Court rejected the CDC’s argument for the connection between housing justice and health justice. The Court raised several telling rhetorical questions in their decision that were intended to show the potentially troubling slippery slope that would commence if the moratorium were allowed to stand:

Could the CDC, for example, mandate free grocery delivery to the homes of the sick or vulnerable? Require manufacturers to provide free computers to enable people to work from home? Order telecommunications companies to provide free high-speed Internet service to facilitate remote work?

Whereas the Court viewed the eviction moratorium as an overreach that would lead to unthinkably absurd consequences for other sectors of social and economic life, a Black feminist conception of justice, as expressed, for example, in the historic statement of the Combahee River Collective, is necessarily grounded in a sense of the importance of community, rather than as a mere collection of individuals who may have little to no connection with or obligations to one another. Though the Court prioritized the interests of landlords and real estate agents, a Black feminist conception of justice foregrounds the needs of the overall community, such that if the well-being of the community depended on free grocery delivery to the sick and vulnerable, then so be it. The community rises and falls together, and so justice must account for the whole, not merely the well-heeled. Implicit in this conception of justice is an understanding that the community can only thrive, can only aspire to a Black feminist conception of justice, to the degree that the community is well or ill.

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globe.

Whose Global Health Security?

By Aeyal Gross

The current discussion within the World Health Organization (WHO) of a “pandemic treaty” aims at better solutions to “health emergencies.”

But, if this focus on “emergencies” comes at the expense of chronic and underlying issues, including the overall status of health systems, we risk replicating, with this legal instrument, the colonial legacy of international health supposedly left behind with the shift to “global health.” This points to the urgent need to rethink what is considered a “crisis” or an “emergency,” as part of the effort to “decolonize global health,” including global health law (GHL).

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Emergency room.

Truth and Reconciliation in Health Care: Addressing Medical Racism using a Health Justice Framework

By Amber Johnson

Healing processes, such as the truth and reconciliation process, can operationalize the three components of the health justice framework — community empowerment, structural remediation, and financial and structural supports — to address the trauma of medical racism. Structural remediation and institutional change is a long and slow process; however, changing the way we interact with each other — through healing processes — can lead to swift, radical changes. Consider, for example, interpersonal racism in patient/provider health care interactions.

Interpersonal racism in patient/provider interaction can determine whether a patient’s needs are met, and can be the deciding factor between survival or death. From communication between a provider and a patient, to diagnosis and treatment, to follow-up care and pain management, the patient/provider interaction is integral to obtaining access to quality health care. When interpersonal racism is at play, the quality of care is substandard and health outcomes are negatively impacted.

Interpersonal racism is one aspect of patient/provider interaction(s) that has massive implications for health outcomes, and it is also one that hospitals and medical staff have the direct agency, resources, and time to change. But this must be done at least partially on an individual level — neither patients nor providers can eradicate racism without acknowledging the truth of the harm caused and healing from the harm.

Acknowledging the truth may be achieved through a truth and reconciliation commission (TRC), a process whereby parties who have been harmed and parties who have caused harm are able to share their experiences and revise ahistorical narratives, so that they reflect the truth and seek justice in the form of reconciliation, reparations, or some form of resolution.

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Envelope from U.S. Citizenship and Immigration Services with the American flag on top/U.S. immigration concept.

Health Justice for Immigrants, Revisited

By Medha D. Makhlouf

A major contribution of health justice is that it provides a framework for understanding how universal access to health care protects collective, as well as individual, interests. The pandemic has underscored the collective nature of the health and wellbeing of every person living in the United States, regardless of immigration status.

In a 2019 article, Health Justice for Immigrants, I adopted and adapted the health justice framework to the problem of disparities in immigrant access to subsidized health coverage. I argued that, in future health care reforms, health justice requires that immigrants be included in the “universe” of universal access to health care. In this blog post, I revisit this argument in light of the COVID-19 pandemic.

This blog post applies the health justice lens to inequities in immigrant health and access to health care, drawing out lessons for the pandemic and post-pandemic eras. It describes three examples illustrating the utility of health justice for catalyzing cross-sector initiatives to improve health, reducing the role of bias in the design of interventions to address health disparities, and ensuring that such efforts are serving the needs of historically subordinated communities.

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Bracket fungi, or shelf fungi produce shelf- or bracket-shaped or occasionally circular fruiting bodies called conks. They are mainly found on trees.

Whack-a-Mole, Fungi, and Intersectionality, or What I’ve Learned from Health Justice

By Mary Crossley

Nearly three decades ago, I published my first law review article considering the law’s ability to address unequal treatment in a health care setting. The newly minted Americans with Disabilities Act was the law, and physicians’ reluctance to provide treatment to infants believed to be infected with HIV was the inequality. Eventually I expanded my horizon beyond disability law to consider potential legal remedies for physician bias across a range of patient traits. As I did so, I described the thread tying together my scholarly projects as “how the law responds (or fails to respond) to instances of health care inequality.”

The key word in that description was “instances.” It suggested that health inequality presents discrete problems for the law to address. Given those problems’ ubiquity, however, policy makers, regulators, and advocates deploying law against health inequities found themselves in a game of Whack-a-Mole. Whack one mole, and another one pops its head up. Address one instance of health injustice, and another pops up. The problem is that, no matter how quick our reaction times are, health inequality surrounds us, firmly embedded in American society. We need to look deeper to find its roots.

Over the last decade, the development of health justice frameworks, along with increasing public and legal attention to social determinants of health, have changed how I frame my scholarship, in several ways.

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Scales of justice and gavel on table.

Symposium Introduction: Health Justice: Engaging Critical Perspectives in Health Law and Policy

By Ruqaiijah Yearby and Lindsay F. Wiley

Public health scholars, advocates, and officials have long recognized that factors outside an individual’s control act as barriers to individual and community health.

To strive for health equity, in which everyone “has the opportunity to attain . . . full health potential and no one is disadvantaged from achieving this potential because of social position or any other socially defined circumstance,” many have adopted the social determinants of health (SDOH) model, which identifies social and economic factors that shape health. Yet, health equity has remained elusive in the United States, in part because the frameworks that most prominently guide health reform do not adequately address subordination as the root cause of health inequity, focus too much on individuals, and fail to center community voices and perspectives.

The health justice movement seeks to fill these gaps. Based in part on principles from the reproductive justice, environmental justice, food justice, and civil rights movements, the health justice movement rejects the notion that health inequity is an individual phenomenon best explained and addressed by focusing on health-related behaviors and access to health care. Instead it focuses on health inequity as a social phenomenon demanding wide-ranging structural interventions.

This digital symposium, part of the Health Justice: Engaging Critical Perspectives in Health Law & Policy Initiative launched in 2020, seeks to further define the contours of and debates within the health justice movement and explore how scholars, activists, communities, and public health officials can use health justice frameworks to achieve health equity.

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police cars lined up.

Policing Public Health: Carceral-Logic Lessons from a Mid-Size City

By Zain Lakhani, Alice Miller, Kayla Thomas, with Anna Wherry

When it comes to public health intervention in a contagion, policing remains a primary enforcement tool. And where a health state is intertwined with carceral logics, enforcement becomes coercive; emphasis is placed on the control of movement and behavior, rather than on support and care.

Our experience in New Haven during the first few months of the COVID-19 pandemic well illuminates this, while also revealing a logic of exceptional force lying dormant in municipal health practices.

Attending to the local is all the more important, albeit difficult, for fast moving and intensely quotidian practices, as COVID in the U.S. seems to be settling in as a pandemic of the local.

Our experience as activist-scholars working with a New Haven-based sex worker-led harm-reduction service and advocacy group, SWAN, suggests that by focusing on municipal practices, we can better understand what public health police power actually is. By orienting our scholarship toward the way social movements engage with local politics, we can then address how these police powers complicate the ability of those most at risk of both disease exposure and police abuse to engage with local authorities. Absent this engagement and critique, progressive policies for constructive state public health powers may be more vulnerable to attack from the right.

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