Health disparities are primarily driven by structural inequality including systemic racism. Medical educators, led by the AAMC, have tended to minimize these core drivers of health disparities. Ins...

A bold new approach to combatting the inherent corruption of representative democracy This provocative book reveals how the majority of modern liberal democracies have become increasingly oligarchic, suffering from a form of structural political decay first conceptualized by ancient philosophers. Systemic Corruption argues that the problem cannot be blamed on the actions of corrupt politicians but is built into the very fabric of our representative systems. Camila Vergara provides a compelling and original genealogy of political corruption from ancient to (...) modern thought, and shows how representative democracy was designed to protect the interests of the already rich and powerful to the detriment of the majority. Unable to contain the unrelenting force of oligarchy, especially after experimenting with neoliberal policies, most democracies have been corrupted into oligarchic democracies. Vergara explains how to reverse this corrupting trajectory by establishing a new counterpower strong enough to control the ruling elites. Building on the anti-oligarchic institutional innovations proposed by plebeian philosophers, she rethinks the republic as a mixed order in which popular power is institutionalized to check the power of oligarchy. Vergara demonstrates how a plebeian republic would establish a network of local assemblies with the power to push for reform from the grassroots, independent of political parties and representative government. Drawing on neglected insights from Niccolò Machiavelli, Nicolas de Condorcet, Rosa Luxemburg, and Hannah Arendt, Systemic Corruption proposes to reverse the decay of democracy with the establishment of anti-oligarchic institutions through which common people can collectively resist the domination of the few. (shrink)

The literature on cross-sector partnerships has increasingly focused attention on broader systemic or system-level change. However, research to date has been partial and fragmented, and the very idea of systemic change remains conceptually underdeveloped. In this article, we seek to better understand what is meant by systemic change in the context of cross-sector partnerships and use this as a basis to discuss the contributions to the Thematic Symposium. We present evidence from a broad, multidisciplinary systematized review of (...) the extant literature, develop an original definition of systemic change, and offer a framework for understanding the interactions between actors, partnerships, systemic change, and issues. We conclude with some suggestions for future research that we believe will enhance the literature in its next phase of development. (shrink)

This month the American Journal of Bioethics examines the intersectionality of medicine, ethics, and race. In “Race, Power, and COVID-19: A Call for Advocacy Within Bioethics,” Mithani and colleagu...

Systemic financial risk is one of the most significant collective action problems facing societies. The Great Recession brought attention to a tragedy of the commons in capital markets, in which market participants, from the first-time homebuyer to Wall Street financiers, acted in ways beneficial to themselves individually, but which together caused substantial collective harm. Two kinds of risk are at play in complex chains of transactions in financial markets: ordinary market risk and systemic risk. Two moral questions are (...) relevant in such cases. First, from the standpoint of interactional morality, does a person have a moral duty to avoid risk of harm to others if their financial transactions contribute in some way, however small, to the loss or harm? This article identifies the conditions in which persons are morally responsible in such cases. Second, from the standpoint of institutional morality, how should society distribute the risk of harm associated with massively complex financial markets? This question is considered in the context of the home mortgage credit market. Luck egalitarianism, in particular a Dworkinian insurance scheme to allocate risks and resources relating to mortgage credit and private home ownership, offers substantial promise. (shrink)

Open peer commentary on the article “The Circular Conditions of Second-order Science Sporadically Illustrated with Agent-based Experiments at the Roots of Observation” by Manfred Füllsack. Upshot: I address Füllsack’s main conclusions in his article regarding the meaning of second-order observations. Especially envisaged are the epistemological and ontological difficulties raised by his scrutiny of the merging between systemic-internal conditions of second-order reflexivity and the thematic-theoretical accounts of selection, intentionality and purposiveness in evolutionary systems.

The intensification of cross-sector collaboration phenomena has occurred in multiple fields of action. Organizations in the private, public, and social sectors are working together to tackle society’s most wicked problems. Some success has resulted in a generalized belief that cross-sector collaborations represent the new paradigm to manage complex problems. Yet, important knowledge gaps remain about how cross-sector alliances generate value for society, particularly to its beneficiaries. This paper answers the question: How cross-sector collaborations lead to systemic change? It uses (...) a qualitative embedded case study design. I use two general cases of alliance-based interventions in the developing country Colombia. Embedded cases within each general case identify evidence of collective action capacity of the beneficiaries. Findings identify and explain alliances’ contributions to beneficiaries’ capacity building: brokering trust and creating spaces where beneficiaries develop an emergent collective action capacity. Alliances also enable beneficiaries to enact that capacity by building bridges, circulating capitals, and buffering relationships to protect people’s initiatives. Alliances and empowered collectives of beneficiaries produce systemic change using five mechanisms: brokering trust, creating spaces, building bridges, circulating capitals, and buffering relationships. Beneficiaries increased capacity for collective action is an outcome that becomes an alliance input, leading overtime to further benefits involving systemic change. (shrink)

Conferralism about race is a version of social constructivism about race, where the agents of construction seem to be individual agents. However, an important aspect of racism is systemic or structural, and seemingly not about the behavior of individual agents. Can conferralism account for that? In this paper, I begin to address that question by focusing on recent criticism of conferralism by Linda Martín Alcoff and Aaron Griffith.

The purpose of cultural competence education for medical professionals is to ensure respectful care and reduce health disparities. Yet as Berger and Miller (2021) show, the cultural competence framework is dated, confused, and self-defeating. They argue that the framework ignores the primary driver of health disparities—systemic racism—and is apt to exacerbate rather than mitigate bias and ethnocentrism. They propose replacing cultural competence with a framework that attends to two social aspects of structural inequality: health and social policy, and institutional-system (...) activity; and two psychological aspects of structural inequality: the clinical encounter, and the epistemic. -/- We agree with the structural approach. To that end, we think it would be fruitful to include attention to physical contributors to structural inequality, namely the material artifacts used in medicine. Devices, tools, and technologies can materialize biases, perpetuate oppression, and contribute to health disparities. Granted, not everything that interests philosophers can be squeezed into medical education. Nevertheless, there are compelling reasons for including the study of material artifacts in education designed to reduce health disparities. First, devices and tools often carry forward biases from the past, and keep biases hidden from plain sight. Second, by studying these artifacts, future clinicians can begin to see themselves as part of a larger sociotechnical system. Finally, as medicine becomes increasingly tech-laden, it’s important for clinicians to see how material artifacts (including algorithms) connect individuals to structures. This will help to undermine oversimplified narratives according to which objective tools and technologies can correct for the bias and subjectivity of flawed human beings. (shrink)

Should officeholders be held individually responsible for submitting to systemically corrupt institutional practices? We draw a structural analogy between individual action under coercive threat and individual participation in systemic corruption, and we argue that officeholders who submit to corrupt institutional practices are not excused by the existence of a systemic coercive threat. Even when they have good personal reasons to accept the threat, they remain individually morally assessable and, in the circumstances, they are also individually blameworthy for actions (...) performed in their institutional capacity. (shrink)

World Futures, Volume 67, Issue 4-5, Page 217-218, May 2011.

This paper argues that some of the major theories in current business ethics fail to provide an adequate account of moral responsibility for the creation of systemic financial risk. Using the trading of credit default swaps (CDS) during the 2008 financial crisis as a case study, I will formulate three challenges that these theories must address: the problem of risk imposition, the problem of unstructured collective harm and the problem of limited knowledge. These challenges will be used to work (...) out key shortcomings of stakeholder approaches and Integrative Social Contracts Theory. I will argue that pluralist connection models used in political theory can help to overcome these shortcomings. Adopting an approach based on these models shows that financial institutions incur obligations in five main areas: managing their own risk profile; remedying some of the harms caused by financial crises; supporting the development of better epistemic methods; curbing the transmission and amplification of initial losses; and instigating structural reforms. (shrink)

ABSTRACTThe aim of this paper is twofold. Firstly, to examine questions about the role and responsibilities of transaction lawyers working in the financial sector that, it is argued here, deserve closer scrutiny than they have hitherto received since the banking and economic crisis of 2008. It considers the manner in which the conduct of such lawyers in the pre-crisis financial markets may have played a particular role in contributing to the sources of latent risk that bore systemic fruit in (...) 2008. It poses the question, ‘Could they have acted differently?’. The first section concludes that there are strong and persuasive arguments both for and against reorienting the responsibilities of the transaction lawyer to include some obligation to take account of the risk to the financial system which the transactions they are conducting for their clients may pose. Secondly, this paper explores ways in which, nonetheless, financial sector lawyers could – and indeed should – be expected to play a part... (shrink)

This paper argues that some of the major theories in current business ethics fail to provide an adequate account of moral responsibility for the creation of systemic financial risk. Using the trading of credit default swaps during the 2008 financial crisis as a case study, I will formulate three challenges that these theories must address: the problem of risk imposition, the problem of unstructured collective harm and the problem of limited knowledge. These challenges will be used to work out (...) key shortcomings of stakeholder approaches and Integrative Social Contracts Theory. I will argue that pluralist connection models used in political theory can help to overcome these shortcomings. Adopting an approach based on these models shows that financial institutions incur obligations in five main areas: managing their own risk profile; remedying some of the harms caused by financial crises; supporting the development of better epistemic methods; curbing the transmission and amplification of initial losses; and instigating structural reforms. (shrink)

Resilient socioeconomic unsustainability poses a threat to democracy whose importance has yet to be fully acknowledged. As the prospect of sustainability transition wanes, so does perceived legitimacy of institutions. This further limits representative institutions' ability to take action, making democratic deepening all the more urgent. I investigate this argument through an illustrative case study, the 2017 People's Climate March. In a context of resilient unsustainability, protesters have little expectation that institutions might address the ecological crisis and this view is likely (...) to spread. New ways of thinking about this problem and a new research agenda are needed. (shrink)

This paper follows on from a brief debate about the role of conscientious objection in healthcare, where the issue arose as to whether conscientious objection is (or can) be a tool of resistance against systemic injustice. The paper contributes to this debate by highlighting that some authors generally opposed to conscientious objection in healthcare have shown some support to this idea. Perhaps if there is one area in which all can agree, it is that in healthcare conscientious objection should (...) be allowed so as to prevent cases of systemic injustice. (shrink)

This paper suggests that “systemic risk” has a distinctive kind of moral significance. Two intuitive data points need to be explained. The first is that the systematic imposition of risk can be wrongful or unjust in and of itself, even if harm never ensues. The second is that, even so, there may be no one in particular to blame. We can explain both ideas in terms of what I call responsibilities of “Collective Due Care.” Collective Due Care arguably precludes (...) purely aggregative cost-benefit decision-making and requires one kind of “precautionary” attitude in public choice. (shrink)

Critical realism, especially as developed by Roy Bhaskar, embodies at its heart systemic and holistic concepts such as totality, emergence, open systems, stratification, autopoiesis and holistic causality. These concepts have their own long history of development in disciplines such as systems thinking and cybernetics, but there is an absence in Bhaskar’s writings, and that absence is a lack of any reference to the corresponding systems literature. The purpose of this paper is threefold: (i) to demonstrate the extent of this (...) correspondence; (ii) to show that critical realism can benefit from an exposure to these other discourses; and (iii) to show that systems thinking too can gain philosophically from critical realism. (shrink)

This volume explores contemporary social conflict, focusing on a sort of violence that rarely receives coverage in the evening news. This violence occurs when powerful institutions seek to manipulate the thoughts of marginalized people-manufacturing their feelings and fostering a sense of inferiority-for the purpose of disciplinary control. Many American institutions strategically orchestrate this psychic violence through tactics of systemic humiliation. This book reveals how certain counter-measures, based in a commitment to human dignity and respect for every person's inherent moral (...) worth, can combat this violence. Rothbart and other contributors showcase various examples of this tug-of-war in the US, including the politics of race and class in the 2016 presidential campaign, the dehumanizing treatment of people with mental disabilities, and destructive parenting styles that foster cycles of humiliation and emotional pain. (shrink)

This paper questions the extension of the common notion of violence, i.e., “subjective violence,” involving the intentional use of force to inflict injury or damage, towards social injustice as “systemic violence.” Systemic violence is altogether unlike subjective violence and the work of Slavoj Žižek illustrates that conceptual obfuscation in this regard may lead to an overly broad and facile justification of revolutionary violence as counter-violence to systemic violence, appealing to the ethics of self-defense. I argue that revolutionary (...) violence is only justified to counter subjective violence inflicted or organized by the state. Thus I reject in conclusion Žižek’s further defense of revolutionary violence as retributive and as “shock therapy” necessary to disrupt the old society. (shrink)

A shift in popular discourse over the last few years makes it makes it tempting to think that the answer to the question whether racism is essentially systemic is yes. My argument, however, is that there are forms of racism—things that are properly counted as instances of racism—that are distinct from and independent of systemic racism. These include ideational racism, ideological racism, racism as antipathy, and racism as prejudice and bigotry. Systemic racism does exist and is not (...) reducible to these other forms of racism. It is arguably the form of racism that should be of most concern to us, but it is not the only form that racism takes. (shrink)

Based on the daily data from January 2, 2019, to September 30, 2020, this paper uses the extended CoVaR model to measure the spillover effect of systemic risk among top 10 securities companies by market value in China, All Share Brokerage Index, All Share Financials Index, All Share Insurance Index, and CSI Banks Index. The conclusions are as follows: there are risk spillover effects among 10 securities companies, which are asymmetric and bidirectional and highly volatile in a short period (...) of time; the spillover effect of systematic risk of securities companies is not necessarily related to the market value of securities companies but has a strong relationship with the stock market; there are risk spillover effects between the sample securities companies and the four major indexes, but there are significant differences in the size of the spillover effects; the securities industry has a great risk spillover effect on the financial industry, but the risk spillover effect of other financial sectors on the securities industry is very small. Finally, we put forward countermeasures and suggestions. (shrink)

Identity and democracy and, more particularly, national identity and deliberative democracy account for a controversial relationship. However, from a classical deliberative democratic point of view, the controversy over who is the ‘we’ that needs to stand together in contemporary complex societies settled with the constitution of modern states. In this sense, the main contribution of this paper is twofold. On the one hand, I rebut the analytical appropriateness and conceptual coherence of Habermas’ discursive approach to democracy for the case of (...) plurinational societies in contemporary constitutional democracies. A discussion of a test case – Catalonia – demonstrates that this inadequacy renders incoherent the deliberative model regarding one of its most fundamental premises: the equal weight of the principles of law and the principle of democracy. On the other hand, I sustain that the challenge is not about identity but democracy, and more particularly, about the role deliberative democracy is called to play when controversy challenges whether the people of a state do conform to a single people or not. More concretely, I explore the opportunities offered by the systemic turn to sustain a more realistic approach to deliberative democracy regarding its capacity to steer society towards integration in the context of the system of public deliberation. (shrink)

The concentration of socio-economic power and social inequality are characteristic features of contemporary society. Not the least, they tend to undermine democratic legislation: Democratic constit...

Given their heterogeneity and lack of defining markers, it is surprising that multipotent mesenchymal stem/stromal cells (MSCs) have attracted so much translational attention, especially as increasing evidence points to their predominant effect being not by donor differentiation but via paracrine mediators and exosomes. Achieving long-term MSC donor chimerism for treatment of chronic disease remains a challenge, requiring enhanced MSC homing/engraftment properties and manipulation of niches to direct MSC behaviour. Meanwhile advances in nanoparticle technology are furthering the development of MSCs as (...) vehicles for targeted drug delivery. For treatment of acute injuries, systemic cell-free exosome delivery may ultimately displace current emphasis on empiric donor-cell transplantation for anti-inflammatory, immunomodulatory and repair-promoting effects. Exploration of potential clinical sources of MSCs has led to increased utilisation of perinatal MSCs in allogeneic clinical trials, reflecting their ease of collection and developmentally advantageous properties. (shrink)