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Environmental health remains a niche topic in bioethics, despite being a prominent social determinant of health. In this paper we argue that if bioethicists are to take the project of health justice as a serious one, then we have to address environmental injustices and the threats they pose to our bioethics principles, health equity, and clinical care. To do this, we lay out three arguments supporting prioritizing environmental health in bioethics based on bioethics principles including a commitment to vulnerable populations and justice. We also highlight and advocate for environmental law efforts that align with these priorities, focusing specifically on the need for a right to a healthy environment. Our intention is to draw attention to the legal and ethical concepts that underlie the importance of a healthy environment, and urge bioethicists to prioritize both legal and ethical advocacy against environmental injustices in their practice. [ABSTRACT FROM AUTHOR]

In this paper, we present the results of a scoping review in which we examined the scientific literature (2010–2021) on faith-based organizations (FBOs) working within the field of poverty alleviation, focusing on the way studies define and use the term FBO. Fifty-two relevant studies were identified and included. Our research shows that the term FBOs is primarily used in American studies. Moreover, there is no broad consensus on the exact definition or meaning of the term nor on its scope. Because of this lack of consensus and the inherent shortcomings of the term, we suggest to replace the term FBO by the term "religion-based solidarity initiatives" (RSIs), We define RSIs as: "Initiatives that, from a religious inspiration, aim at organizing collective action for and/or providing support or services to people in vulnerable positions." These initiatives can range from small scale ad hoc initiatives till large scale formal organizations. [ABSTRACT FROM AUTHOR]

Public health officials promoted COVID-19 vaccines to limit burdens placed on the U.S. healthcare system and end the pandemic. People in some closed religious communities refused to vaccinate and likely acquired temporary immunity through infection. This paper compares the death rates in Amish, Old Order Mennonites, and conservative Mennonite groups to a rate estimated for the U.S. population. Approximately two-thirds of the U.S. population was immunized against COVID-19, while few in the Amish/Mennonite community were. We find divergent patterns. Once vaccines became available, excess deaths declined in the general population and remained elevated among Amish and Mennonites. Vaccination campaigns must consider and value the cultural beliefs of closed religious communities to be effective. [ABSTRACT FROM AUTHOR]

Our society gives certain rights and protections to those who are punished and incarcerated, deeming them a vulnerable group in need of additional protections because they are under state control. Despite these protections, prisoners are still susceptible to mistreatment and abuse. This paper delves into one area in which prisoners are particularly vulnerable—the use of prison labor to fight wildfires in the western United States. In this paper, I first broadly discuss prison labor, before going into the current ethical principles and guidelines in the field of corrections that address the treatment of prisoners and prison labor. I argue that these principles and guidelines should be augmented to help those in corrections to make decisions about what is ethical; suggesting that how researchers evaluate proposed research projects could serve as a model for decision-making. I then introduce prison fire camps, considering whether they are ethical by research ethics principles, and suggesting how they can be changed to better reflect the values professed by our society. [ABSTRACT FROM AUTHOR]

The impacts of this pandemic have not been felt equally. The current pandemic has aggravated preexisting prejudices and shed light on long-standing social, economic, and health inequities that have been and continue to be perpetuated by systems of oppression. Psychologists are in a unique position to collaboratively work with marginalized individuals navigating pandemic threat, discrimination, and oppressive systems. This paper presents best practice recommendations for U.S.-based psychologists working with marginalized populations impacted by COVID-19. Psychologists are encouraged to synchronously develop the following three areas of evidence-based practice, as they relate to the impacts of COVID-19: (a) self-reflection and self-awareness in a COVID-19 context (i.e., reflecting on one's identities and one's knowledge and attitudes toward sociohistorical inequities), (b) knowledge acquisition (i.e., adopting an attitude of cultural humility, identifying "emotional contagion," identifying impacts of systemic injustice that may be compounded by COVID-19, and recognizing racial trauma in clients of color), and (c) collaboration with clients (i.e., identify the mental health toll of oppressive systems, explore COVID-19 relevant and culturally responsive methods of healing, encourage virtual community engagement, and incorporate ethnic and racial identity development in personal and professional work). Engaging with these best practice recommendations should result in the psychologist's improved ability to identify and address the consequences of systemic oppression that have been highlighted and exacerbated by COVID-19 on their own behavior and their clients' mental health. Furthermore, psychologists engaged with these best practice recommendations should find themselves better prepared to utilize culturally responsive interventions despite barriers created by COVID-19. [ABSTRACT FROM AUTHOR]

Objectives This paper examines health profiles and work environments of hired U.S. farmworkers to understand the risk to essential workers and their employers, to the food supply, and to rural health systems such as what is possible with the COVID-19 pandemic. Methods Large-sample statistical methods and proprietary data from the National Agricultural Workers Survey from 2000 to 2018 were used to assess factors associated with exposure to COVID-19 and vulnerabilities associated with medical complications. Results An aging workforce and increased access to health care within the crop worker population has been associated with a higher reported incidence of diabetes, asthma, and heart disease among workers over time. These trends confirm a vulnerable, but essential, workforce with higher risks for COVID-19 complications than would have been true of U.S. farmworkers as a group in earlier years. Conclusions Increasing age and disease burden in the U.S. agricultural labor force puts workers at increased risk for developing COVID-19 complications. Limits to field sanitation and housing quality inflate the probability of the development of COVID-19 hotbeds in rural communities that could further compromise the physical health of workers, the economic health of farm establishments, the agricultural supply-chain, and rural health capacities. Additional and more targeted worker protections may minimize public health and economic costs in the long run. [ABSTRACT FROM AUTHOR]

Despite significant progress in research on the treatment and prevention of psychological, behavioral, and health problems, the translation of this knowledge into population-wide benefit remains limited. This paper reviews the state of America's children and families, highlighting the influence of stressful contextual and social conditions on child and family well-being and the concentration of disadvantage in numerous neighborhoods and communities throughout the nation. It then briefly reviews the progress that has been made in pinpointing policies that can reduce stressful contextual conditions such as poverty, discrimination, and the marketing of unhealthful foods and substances. It also describes numerous family and school interventions that have proven benefit in preventing psychological and behavioral problems as diverse as tobacco, alcohol, and other drug use; depression; antisocial behavior; academic failure; obesity prevention; and early childbearing. We argue that progress in translating existing knowledge into widespread benefit will require a nationwide effort to intervene comprehensively in neighborhoods and communities of concentrated disadvantage. We present a strategic plan for how such an effort could be organized. The first step in this organizing would be the creation of a broad and diverse coalition of organizations concerned with advancing public health and well-being. Such a coalition could increase public support both for the policies needed to focus on these disadvantaged areas and the research needed to incrementally improve our ability to help these areas. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence (IPV) against women in the United States (US) remains a complex public health crisis. Women who experience IPV are among the most vulnerable patients seen in primary care. Screening increases the detection of IPV and, when paired with appropriate response interventions, can mitigate the health effects of IPV. The Department of Veterans Affairs (VA) has encouraged evidence-based IPV screening programs since 2014, yet adoption is modest and questions remain regarding the optimal ways to implement these practices, which are not yet available within the majority of VA primary care clinics.Methods/design: This paper describes the planned evaluation of VA's nationwide implementation of IPV screening programs in primary care clinics through a randomized implementation-effectiveness hybrid type 2 trial. With the support of our VA operational partners, we propose a stepped wedge design to compare the impact of two implementation strategies of differing intensities (toolkit + implementation as usual vs. toolkit + implementation facilitation) and investigate the clinical effectiveness of IPV screening programs. Using balanced randomization, 16-20 VA Medical Centers will be assigned to receive implementation facilitation in one of three waves, with implementation support lasting 6 months. Implementation facilitation in this effort consists of the coordinated efforts of the two types of facilitators, external and internal. Implementation facilitation is compared to dissemination of a toolkit plus implementation as usual. We propose a mixed methods approach to collect quantitative (clinical records data) and qualitative (key informant interviews) implementation outcomes, as well as quantitative (clinical records data) clinical effectiveness outcomes. We will supplement these data collection methods with provider surveys to assess discrete implementation strategies used before, during, and following implementation facilitation. The integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework will guide the qualitative data collection and analysis. Summative data will be analyzed using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework.Discussion: This research will advance national VHA efforts by identifying the practices and strategies useful for enhancing the implementation of IPV screening programs, thereby ultimately improving services for and health of women seen in primary care.Trial Registration: NCT04106193. Registered on 23 September 2019. [ABSTRACT FROM AUTHOR]

This paper examines the implications of recent developments in U.S. intercountry adoption (ICA) policy for vulnerable children. We review policy and practices from 2004-2018, including (1) the 2008 implementation of the Hague Convention and (2) the 2017 changes in Hague accrediting entities for adoption agencies. By analyzing the ICA contexts of the top five States of origin, we argue the decline in ICA is from factors within States of origin rather than U.S. policy. Though ICA benefits individual children's development, it can cause harm at a systems level, so the decline in ICA has mixed implications for vulnerable children. [ABSTRACT FROM AUTHOR]

While the overall impact of the COVID-19 pandemic on U.S. population health has been devastating, it has not affected everyone equally. The risks of hospitalization and death from the disease are relatively low for the population as a whole, but much higher for specific subpopulations defined by age, health status, and race or ethnicity. The extent to which Americans perceive these disparities is an open question, with potentially important political implications. Recognition of unequal impacts may prime concerns about justice and fairness, making Americans more concerned and willing to support government intervention. On the other hand, belief that the pandemic primarily threatens "other people" or out-groups may reduce, rather than increase, a person's concern. Partisanship and media consumption habits are also likely to play a role in these perceptions, as they do in most issues related to COVID-19. In this paper, we use original survey data from the Cooperative Election Study (N = 1000) to explore Americans' perceptions of which groups are most harmed by the pandemic, the demographic and political determinants of these perceptions, and the relationship of these perceptions with their opinions about COVID-related mitigation policy. We find that, on average, people perceived accurately that certain groups (e.g., Black Americans, older people) were more affected, but these group perceptions varied by demographic and political characteristics of respondents. We find, in contrast with recent experimental evidence, that the perception that populations of color were harmed was associated with more support for pandemic mitigation strategies. More research should investigate the relationships among pandemic politics and the racial dynamics of the target populations most affected. • In fall 2020, survey participants recognized groups harmed by COVID based on age. • They had lower recognition of racial groups harmed, lowest for Native Americans. • Perceptions of groups harmed varies by information exposure and politics. • Perceiving group disparities was associated with more support for pandemic policy. • The racial dynamics surrounding the politics of COVID-19 requires more attention. [ABSTRACT FROM AUTHOR]

The vulnerability of deafblind people is considered axiomatic; they are seen not only as a vulnerable group but also as one of the most vulnerable. This paper aims to synthesise existing knowledge to determine what is known about such vulnerability. A comprehensive literature search was undertaken between April 2013 and May 2014. The review method was informed by systematic review principles. An approach based on a 'hierarchy of evidence' would have reduced the amount of literature reviewed significantly, to the point where synthesis would not be possible. Included material was appraised and an interpretative rather than aggregative approach to synthesis adopted. Drawing on principles of critical interpretive synthesis, rather than being a determiner of whether material should be included or excluded, a critique of the literature is offered within the synthesis. Twenty-eight references were identified for inclusion, originating from the UK, USA, Australia, Continental Europe and the Nordic Countries. No empirical studies specifically examining the experience of vulnerability of deafblind people were found. However, deafblind people describe feelings of vulnerability in studies exploring their experiences more generally, and in personal accounts of living with the impairment. Literature produced by practitioners and specialist organisations also explores the topic. Deafblind people are identified as a population 'at risk' of various adverse outcomes, particularly when compared to the non-deafblind majority, and deafblind people describe being and feeling vulnerable in various situations. The literature largely relates to negative outcomes and includes significantly less exploration of positive risk taking, coping capacity and resilience. Deafblind people do not appear to describe themselves as being vulnerable as a permanent state, suggesting a need for greater exploration of the experience among all sections of this heterogeneous population, with consideration of the concepts of resilience and coping capacity. [ABSTRACT FROM AUTHOR]

This paper evaluates the content of the syllabi of postgraduate courses on public health ethics (PHE) within accredited schools and programs of public health (PH) in the United States in order to gain an awareness of the topics addressed within these courses. Methods: Data was gathered via the analysis of syllabi of courses on PHE. In 2012, information was requested by e-mail from the 48 schools and 86 PH programs accredited by the U.S. Council on Education for Public Health for 2012. The 'Epidemiology and PHE Syllabi' project of the University of Miami also was consulted. A table of topics was drawn up in order to carry out content analysis of the documents. Results: Data was obtained from 25 schools (52%) and 36 accredited programs (42%); 36 syllabi were gathered and 75 different topics were found. Of these, 38 topics were addressed in six or more syllabi and can be grouped as follows: foundations of PHE; autonomy and its limits; infectious disease control; justice; research ethics; health education and promotion; environmental and occupational health; screening; genetics; privacy and confidentiality; and community-based practice and vulnerable populations. Conclusions: The analyzed syllabi show high variability in curricular content. The debate with regard to whether a core curriculum on PHE should be established is ongoing. The results of this work might be of interest for schools and programs of PH in other countries or regions of the world in order to develop or ameliorate their own PHE syllabi. [ABSTRACT FROM AUTHOR]

'Evidence-based' is the key criterion for decision making not only in medicine and other health professions, where it originated and revolutionized what was previously subjective, opinion-based practice, but also across policy and service development. The 'evidence-based' epistemology uses the hierarchy of evidence - a qualitative ranking of information for consideration, as to its cogency - based on a biomedical view of human health. Evidence-based medicine originally proposed that it would contribute to justice by providing the means to make objective, and therefore, fair and equitable decisions, as well as helping to stop the use of ineffective treatments, thus minimizing costs. In this paper, we argue, however, that due to the epistemological ranking of evidence and its implications, only one type of question can ever be answered using this framework and that some groups are unjustly disregarded or excluded because of the limitations inherent in its epistemology; therefore, evidence-based decision making, whether in medicine, other health professions, or policy settings, using the hierarchy of evidence, in fact, can contribute to injustice. This injustice occurs through preferenced evidence generation set against a highly pressurized and competitive research environment, where funding is restricted and the mantra 'publish or perish' creates separate drivers and considerations for research design other than the research problem. We provide evidence of the lack of evidence generation for three specific minority groups and suggest that the epistemological foundations of an evidence-based strategy be revised to include measures of quality that reflect a connectedness not only between the researchers and the affected stakeholders (patient population, service providers, etc.) but also between the methodology/analysis and the problem trying to be solved. [ABSTRACT FROM AUTHOR]