Female hand writing signature on the paper document.

How to Construct Better Organ Donation Policy and Achieve Health Equity

By James R. Jolin

The United States is facing an organ donation crisis, with massive gaps between supply and demand.

Per estimates from the Department of Health and Human Services (HHS), over 106,000 Americans are currently awaiting this life-saving medical treatment. Further, the burden of this shortage falls unequally:  in 2020, while approximately 48% of white patients in need of transplants received an organ, only 27% of Black patients secured one.

The stakes are too high to allow the organ donation crisis to proceed in the U.S. without bold intervention. But with many policy options on the table, unresolved ethical concerns, and a patchwork of organ donation laws across the country, the proper path forward is not immediately clear.

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Melbourne, Australia - 1st November 2021: A person wearing full PPE holds a vial of sotrovimab medicine covid-19 virus treatment. It is under an emergency use authorization to treat covid in Australia.

Litigation Challenges Prioritization of Race or Ethnicity in Allocating COVID-19 Therapies

By James Lytle

Recent guidance from the U.S. Food & Drug Administration (FDA) encouraged several states to adopt policies that prioritized race or ethnicity in the allocation of monoclonal antibody treatments and oral antivirals for the treatment of SARS-CoV-2.

The guidance proved to be highly controversial, prompting two states, Utah and Minnesota, to withdraw their guidance, and leading a third state, New York, to become the subject of two federal lawsuits that challenge the guidance’s legality: one (Jacobson v. Bassett) brought by a white, non-Hispanic Cornell Law Professor, William Jacobson, in the Northern District of New York (“Jacobson”) and a second (Roberts v. Bassett) initiated by Jonathan Roberts and Charles Vavruska, two white, non-Hispanic residents of New York City in the Eastern District (“Roberts”).

Public health and policy experts have published commentaries on the challenging issues underlying New York’s COVID treatment guidelines and others have offered more detailed guidance, including on this blog, on what criteria should be used in allocating scarce COVID treatments. What follows is focused on the litigation pending in New York and its potential impact on the broader issues at the intersection of the pandemic response and racial equity.

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umbrella covering home under heavy rain.

Weathering the Climate Crisis: The Health Benefits and Policy Challenges of Home Weatherization

By James R. Jolin

Weatherization serves as an important yet strikingly neglected tool not only to meet vulnerable communities’ energy needs, but also to combat the negative health effects associated with the climate crisis.

In the United States, households with lower gross income experience higher “energy burdens” — that is, the proportion of a household’s income that is expended to meet energy costs. Indeed, households earning 200% of the federal poverty line spend an estimated 8% of their income on meeting energy costs, as compared to the national median of 3%. Weatherization, the catch-all term for home improvements intended to improve the efficiency of home energy use, is a way to decrease disparate energy costs across socioeconomic classes.

Standard weatherization measures, which include (but are not limited to) repairing and modernizing temperature control systems and installing insulation, reduce the amount of money households need to spend on heating and cooling. In all, weatherization measures save over $280 on average per year, according to the U.S. Department of Energy — a modest but nonetheless important savings.

Crucially, however, weatherization also confers significant health benefits, which are not only ideal in their own right, but also result in further significant financial savings.

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New York, USA, November 2021: Pfizer Covid-19 Paxlovid treatment box isolated on a white background.

How to Fairly Allocate Scarce COVID-19 Therapies

By Govind Persad, Monica Peek, and Seema Shah

Vaccines are no longer our only medical intervention for preventing severe COVID-19. Over the past few months, we have seen the arrival and wider availability of treatments such as monoclonal antibodies (mAbs), and more recently, of novel oral antiviral drugs like Paxlovid and molnupiravir.

The recent Delta and Omicron surges have made these therapies scarce. The Delta variant led the federal government to resume control over mAb supply and promulgate allocation guidelines. The Omicron variant exacerbated scarcity because only one of the currently available mAbs, sotrovimab, appears to be effective against it. While Paxlovid and molnupiravir are effective against Omicron, both will likely be in short supply for many months. Paxlovid is currently constrained by a lengthy manufacturing process. Molnupiravir — which is substantially less effective — is contraindicated for use in patients under 18 and not recommended for use during pregnancy.

To allocate COVID-19 vaccines, the CDC’s Advisory Committee on Immunization Practices, the National Academies of Sciences, Engineering and Medicine (NASEM), and the World Health Organization (WHO) identified ethical goals for prioritization, such as maximizing benefit and minimizing harm, mitigating health inequities, and reciprocity. These committees, particularly the NASEM and WHO committees, included ethics experts as well as experts in social science, biology, and medicine. Current federal guidelines for therapy allocation, in contrast, do not identify ethical objectives or involve ethics expertise.

In an open-access Viewpoint in Clinical Infectious Diseases, we identify ethical goals for the allocation of scarce therapies. We argue that the same ethical goals identified for vaccine allocation–in particular maximizing benefit, minimizing harm, and mitigating health inequities — are also relevant for therapy allocation. Because many people have now taken steps to mitigate pandemic scarcity, for instance by protecting themselves through vaccination, we argue that reciprocity is also relevant.

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Gavel and stethoscope.

Symposium Conclusion: Health Justice: Engaging Critical Perspectives in Health Law & Policy

By Lindsay F. Wiley and Ruqaiijah Yearby

As our digital symposium on health justice comes to a close, we have much to be thankful for and inspired by. We are honored to provide a platform for contributions from scholars spanning multiple disciplines, perspectives, and aspects of health law and policy. Collectively with these contributors, we aim to define the contours of the health justice movement and debates within it, and to explore how scholars, activists, communities, and public health officials can work together to engage critical perspectives in health law and policy.

As we described in our symposium introduction, the questions we posed to contributors focused their work on four main themes: (1) subordination (including discrimination and poverty) is the root cause of health injustice, (2) subordination shapes health through multiple pathways, (3) health justice engages multiple kinds of experiences and expertise, and (4) health justice requires empowering communities, redressing harm, and reconstructing systems. Most of the contributions to this symposium cut across more than one of these themes, but we present them here in four broad categories.

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Lady Justice blindfolded with scales.

Health Justice Can’t Be Blind

By Daniel E. Dawes

“Justice is blind.” We have all heard this phrase before, and seen the iconic representation: the blindfolded Lady Justice.

That blindfold is supposed to symbolize impartiality. It represents our strict subscription to the notion that impartiality and objectivity are the principles upon which our system is built and by which it is protected. This notion that justice is blind is one rooted in equality.

But justice should not always be blind. Rather than prioritizing equal treatment, sometimes justice demands that we treat individuals differently to ensure equal outcomes. This notion of justice is rooted in the principle of equity.

Put simply, equity takes fairness as its aim. Where equality entails the equal (i.e., impartial) treatment of individuals, equity demands a nuanced approach to ensure equal outcomes.

To achieve justice in the realm of health, our focus must be on equity, and not on blind equality.

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Patient receives Covid-19 vaccine.

The Target of Health Justice

By Sridhar Venkatapuram 

As we amplify, further develop, and advise in the realizing of health justice, there would be much benefit in clarifying the basic units of moral concern.

This call for more specificity relates to both who is the primary unit of moral concern (individuals, communities, nation-states, etc.) as well as what it is that we care about in relation to them (i.e., liberties, resources including health care, basic needs, respect, opportunities, capabilities, relationships, etc.).

In the current context of the COVID-19 pandemic, where vaccines have become the preeminent goods of value worldwide, I focus my discussion here on how distributing vaccines equitably at the level of geographical units such as districts or nation-states may obfuscate or tolerate injustices, as well as provide suboptimal control of the pandemic.

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SANTA PAULA, CALIFORNIA - CIRCA 1980's: A small-town barbershop, Santa Paula, CA.

The Road to Systemic Change: Health Justice, Equity, and Anti-Racism

By Keon L. Gilbert and Jerrell DeCaille

The health justice movement helps to marry social justice models with equity frameworks.

This critical partnership advances health equity through community-based approaches to health care and social services, collaborations that minimize duplicative services, and the creation of sustainable relationships to advocate for systemic change.

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BETHESDA, MD - JUNE 29, 2019: NIH NATIONAL INSTITUTES OF HEALTH sign emblem seal on gateway center entrance building at NIH campus. The NIH is the US's medical research agency.

The NIH Has the Opportunity to Address Research Funding Disparities

By Leah Pierson

The Biden administration plans to greatly increase funding for the National Institutes of Health (NIH) in 2022, presenting the agency with new opportunities to better align research funding with public health needs.

The NIH has long been criticized for disproportionately devoting its research dollars to the study of conditions that affect a small and advantaged portion of the global population.

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A volunteer loads food into the trunk of a vehicle during a drive thru food distribution by the Los Angeles Regional Food Bank at Exposition Park on Saturday, Jan. 23, 2021, in Los Angeles.

How Community Organizations and Health Departments Can Partner to Advance Health Justice

By Sarah de Guia, Rachel A. Davis, and Kiran Savage-Sangwan

Health justice is not just a cause or an idea, but the way forward for public health agencies and communities alike.

Beyond focusing attention on measurable disparities, the term health justice provides a vision for a fair future that minimizes inequities and sends a clear and urgent call to change discriminatory policies, practices, and systems. To achieve this vision, governments and other large institutions must share power with partners of all kinds to change the structural, systemic, and institutional causes of health and wealth disparities. Otherwise, these disparities will continue to keep our communities from achieving their greatest potential to live healthy, prosperous lives.

Our organizations — ChangeLab Solutions, Prevention Institute, and the California Pan-Ethnic Health Network, with support from The California Wellness Foundation and The Blue Shield of California Foundation — came together to help guide California policymakers in centering health justice in their approaches to COVID-19 response and recovery. Our work analyzing community health efforts in California during the COVID-19 pandemic underscores the necessity of collaborative partnerships in advancing health justice. Most importantly, our findings revealed the indispensable role that community-based organizations (CBOs) played in responding to community needs during this time of crisis.

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