Unmet legal needs contribute to housing, income, and food insecurity, along with other conditions that harm health and drive health inequity. Addressing health injustice requires new tools for the next generations of lawyers, doctors, and other healthcare professionals. An interprofessional group of co-authors argue that law and medical schools and other university partners should develop and cultivate Academic Medical-Legal Partnerships (A-MLPs), which are uniquely positioned to leverage service, education, and research resources, to advance health justice.

Prenatal alcohol exposure interferes with neurodevelopment. The brain is particularly susceptible to the adverse consequences of prenatal alcohol exposure, and numerous studies have documented changes to brain anatomy and function, as well as consequences for cognition, behavior, and mental health. Studies in typically developing individuals have shown that the brain undergoes dynamic developmental processes over an individual’s lifespan. Furthermore, magnetic resonance imaging studies in other neurodevelopmental and psychiatric disorders have shown that their developmental trajectories differ from the typical pattern. Therefore, (...) to understand long-term clinical outcomes of fetal alcohol spectrum disorders, it is necessary to investigate changes in neurodevelopmental trajectories in this population. Here we review studies that have used MRI to evaluate changes in brain structure and function over time via cross-sectional or longitudinal methods in individuals with PAE. Research demonstrates that individuals with PAE have atypical cortical and white matter microstructural developmental trajectories through childhood and adolescence. More research is needed to understand how factors such as sex and postnatal experiences may further mediate these trajectories. Furthermore, nothing is known about the trajectories beyond young adulthood. (shrink)

Mary Wollstonecraft’s visionary treatise, originally published in 1792, was the first book to present women’s rights as an issue of universal human rights. Ideal for coursework and classroom study, this comprehensive edition of Wollstonecraft’s groundbreaking feminist argument includes illuminating essays by leading scholars that highlight the author’s significant contributions to modern political philosophy, making a powerful case for her as one of the most substantive political thinkers of the Enlightenment era. No other scholarly work to date has examined as closely (...) both the ideological moorings and the enduring legacy of Wollstonecraft’s courageous discourse. (shrink)

In “Mathematical Truth,” Paul Benacerraf raises an epistemic challenge for mathematical platonists. In this paper, I examine the assumptions that motivate Benacerraf’s original challenge, and use them to construct a new causal challenge for the epistemology of mathematics. This new challenge, which I call ‘Gödel’s Gap’, appeals to intuitive insights into mathematical knowledge. Though it is a causal challenge, it does not rely on any obviously objectionable constraints on knowledge. As a result, it is more compelling than the original challenge. (...) It is also more general; the challenge applies equally to platonistic and non-platonistic accounts of mathematical truth. And it can be generalized beyond the case of mathematical knowledge to pose a challenge for, e.g., moral knowledge. (shrink)

Kit Fine and Gideon Rosen propose to define constitutive essence in terms of ground-theoretic notions and some form of consequential essence. But we think that the Fine–Rosen proposal is a mistake. On the Fine–Rosen proposal, constitutive essence ends up including properties that, on the central notion of essence, are necessary but not essential. This is because consequential essence is closed under logical consequence, and the ability of logical consequence to add properties to an object’s consequential essence outstrips the ability of (...) ground-theoretic notions, as used in the Fine–Rosen proposal, to take those properties out. The necessary-but-not-essential properties that, on the Fine–Rosen proposal, end up in constitutive essence include the sorts of necessary-but-not-essential properties that, others have noted, end up in consequential essence. (shrink)

Hartry Field’s epistemological challenge to the mathematical platonist is often cast as an improvement on Paul Benacerraf’s original epistemological challenge. I disagree. While Field’s challenge is more difficult for the platonist to address than Benacerraf’s, I argue that this is because Field’s version is a special case of what I call the ‘sociological challenge’. The sociological challenge applies equally to platonists and fictionalists, and addressing it requires a serious examination of mathematical practice. I argue that the non-sociological part of Field’s (...) challenge amounts to a minor reformulation of Benacerraf’s original challenge. So, I contend, Field’s challenge is not an improvement on Benacerraf’s. What is new to Field’s challenge is as much a problem for the fictionalist as it is for the platonist. (shrink)

This is a collection of essays written by Moore which form a thorough examination of the theory of criminal responsibility. The author covers a wide range of topics, giving the book a coherence and unity which is rare in assembled essays. Perhaps the most significant feature of this book is Moore's espousal of a retributivist theory of punishment. This anti-utilitarian standpoint is a common thread throughout the book. It is also a trend which is currently manifesting itself in (...) all areas of moral, political and legal philosophy, but Moore is one of the first to apply such attitudes so systematically to criminal law theory. As such, this innovative, new book will be of great interest to all scholars in this field. (shrink)

In print for the first time in over ten years, Act and Crime provides a unified account of the theory of action presupposed by both Anglo-American criminal law and the morality that underlies it. The book defends the view that human actions are always volitionally caused bodily movements and nothing else. The theory is used to illuminate three major problems in the drafting and the interpretation of criminal codes: 1) what the voluntary act requirement both does and should require; 2) (...) what complex descriptions of actions prohibited by criminal codes both do and should require ; and 3) when two actions are 'the same' for purposes of assessing whether multiple prosecutions and multiple punishments are warranted. The book both contributes to the development of a coherent theory of action in philosophy, and it provides both legislators and judges a grounding in three of the most basic elements of criminal liability. (shrink)

The standard argument for the existence of distinctively mathematical objects like numbers has two main premises: some mathematical claims are true, and the truth of those claims requires the existence of distinctively mathematical objects. Most nominalists deny. Those who deny typically reject Quine’s criterion of ontological commitment. I target a different assumption in a standard type of semantic argument for. Benacerraf’s semantic argument, for example, relies on the claim that two sentences, one about numbers and the other about cities, have (...) the same grammatical form. He makes this claim on the grounds that the two sentences are superficially similar. I argue that these grounds are not sufficient. Other sentences with the same superficial form appear to have different grammatical forms. I offer two plausible interpretations of Benacerraf’s number sentence that make use of plural quantification. These interpretations appear not to incur ontological commitments to distinctively mathematical objects, even assuming Quine’s criterion. Such interpretations open a new, plural strategy for the mathematical nominalist. (shrink)

The Benacerraf Problem of Mathematical Truth and Knowledge Before philosophical theorizing, people tend to believe that most of the claims generally accepted in mathematics—claims like “2+3=5” and “there are infinitely many prime numbers”—are true, and that people know many of them. Even after philosophical theorizing, most people remain committed to mathematical truth and mathematical knowledge. … Continue reading The Benacerraf Problem of Mathematical Truth and Knowledge →.

Wright claims that his and Hale’s abstractionist neologicist project is primarily epistemological in aim. Its epistemological aims include establishing the possibility of a priori mathematical knowledge, and establishing the possibility of reference to abstract mathematical objects. But, as Wright acknowledges, there is a question of how neologicist epistemology applies to actual, ordinary mathematical beliefs. I take up this question, focusing on arithmetic. Following a suggestion of Hale and Wright, I consider the possibility that the neologicist account provides an idealised reconstruction (...) of how people acquire cognition of numbers or arithmetical knowledge. I conclude that it is unlikely that this account can be used to reconstruct even idealised answers to pressing questions about our actual epistemology. (shrink)

Supersaturated hcp f -Zr alloys containing 22-28 at.% N were prepared by nitriding sheets of Zr in an atmosphere of high-purity N 2 , followed by homogenization under high-purity Ar gas. Quenching and isothermal ageing of the alloys for various times between 500 and 650°C resulted in precipitation of a metastable phase, rather than the equilibrium phase ZrN. This investigation focused on determining the structure, orientation relationship, habit plane, morphology, growth kinetics and atomic growth mechanism of this non-equilibrium precipitate using (...) transmission electron microscopy imaging and diffraction techniques, high-resolution transmission electron microscopy, electron-energy-loss spectroscopy and various simulation programs. The precipitate, which was arbitrarily designated the  phase, has a monoclinic Bravais lattice. Its lattice parameters are a = 0.32 nm, b = 0.60 nm, c = 0.56 nm, f = g = 90° and n = 121.5°. Its orientation relationship with the f matrix is $$ _alpha /mskip-2/ _xiquad adquad [01bar 10] _alpha /mskip-2/ [001]_xi, $$ and the average habit plane of lenticularly shaped precipitates is $_alpha$ . Determination of the structure and other aspects of the phase transformation are discussed. (shrink)

Organizational virtue orientation (OVO), an organizational-level construct, refers to the integrated set of beliefs and values that support ethical character traits and virtuous behaviors. To advance the study of organizational virtue, we examine OVO in firms making their initial public offerings (IPOs), with respect to key external stakeholders that serve as financial intermediaries (i.e., venture capital firms and underwriting banks). Drawing on stakeholder and resource dependence theories, we argue that mutual interdependencies occur between financial intermediaries and IPO firms such that (...) venture capital firms’ ownership levels and underwriter reputation are positively associated with the selection of more virtuous IPO firms. We also argue for the moderating relationship of IPO firm age on these main relationships; since IPO firms have more history and information availability, less importance will be placed on OVO in the selection process. In support of our hypotheses, the results of this study suggest the organizational virtue of IPO firms influences the selection decisions of financial intermediaries by reflecting positively on these key stakeholders to improve legitimacy and reputation. (shrink)

Neural reuse theories should interest developmental psychologists because these theories can potentially illuminate the developmental relations among psychological characteristics observed across the lifespan. Characteristics that develop by exploiting pre-existing neural circuits can be thought of as developmental homologues. And, understood in this way, the homology concept that has proven valuable for evolutionary biologists can be used productively to study psychological/behavioral development.

How are the properties of computer programs proved? We discuss three approaches in this article: inductive invariants, functional semantics, and explicit semantics. Because the first approach has received by far the most attention, it has produced the most impressive results to date. However, the field is now moving away from the inductive invariant approach.

Rationale: Deep brain stimulation (DBS) of the hippocampus is proposed for enhancement of memory impaired by injury or disease. Many pre-clinical DBS paradigms can be addressed in epilepsy patients undergoing intracranial monitoring for seizure localization, since they already have electrodes implanted in brain areas of interest. Even though epilepsy is usually not a memory disorder targeted by DBS, the studies can nevertheless model other memory-impacting disorders, such as Traumatic Brain Injury (TBI). Methods: Human patients undergoing Phase II invasive monitoring for (...) intractable epilepsy were implanted with depth electrodes capable of recording neurophysiological signals. Subjects performed a delayed-match-to-sample (DMS) memory task while hippocampal ensembles from CA1 and CA3 cell layers were recorded to estimate a multi-input, multi-output (MIMO) model of CA3-to-CA1 neural encoding and a memory decoding model (MDM) to decode memory information from CA3 and CA1 neuronal signals. After model estimation, subjects again performed the DMS task while either MIMO-based or MDM-based patterned stimulation was delivered to CA1 electrode sites during the encoding phase of the DMS trials. Each subject was sorted (post hoc) by prior experience of repeated and/or mild-to-moderate brain injury (RMBI), TBI, or no history (control) and scored for percentage successful delayed recognition (DR) recall on stimulated vs. non-stimulated DMS trials. The subject’s medical history was unknown to the experimenters until after individual subject memory retention results were scored. Results: When examined compared to control subjects, both TBI and RMBI subjects showed increased memory retention in response to both MIMO and MDM-based hippocampal stimulation. Furthermore, effects of stimulation were also greater in subjects who were evaluated as having pre-existing mild-to-moderate memory impairment. Conclusion: These results show that hippocampal stimulation for memory facilitation was more beneficial for subjects who had previously suffered a brain injury (other than epilepsy), compared to control (epilepsy) subjects who had not suffered a brain injury. This study demonstrates that the epilepsy/intracranial recording model can be extended to test the ability of DBS to restore memory function in subjects who previously suffered a brain injury other than epilepsy, and support further investigation into the beneficial effect of DBS in TBI patients. (shrink)

Chefs have been recognized as potentially important partners in efforts to promote local food systems. Drawing on the diffusion of innovation framework we (a) examine the characteristics of chefs and restaurants that have adopted local foods; (b) identified local food attributes valued by restaurants; (c) examine how restaurants function as opinion leaders promoting local foods; (d) explored network linkages between culinary and production organizations; and (e) finally, we consider some of the barriers to more widespread adoption of local foods in (...) the culinary community. Analyzing quantitative and qualitative data collected from interviews with individuals from 71 restaurants, we compare and contrast restaurants that utilize relatively large amounts of locally-produced ingredients with restaurants using few, if any, local products. Results reveal that chefs are most interested in intrinsic food qualities, such as taste and freshness, and less interested in production standards. As opinion leaders, chefs utilize signage, wait staff, and cooking classes to promote local foods; however, the diffusion process across restaurants, and between restaurants and producers, is limited by network associations. Structural barriers such as distribution problems and lack of convenience were identified as limiting more widespread use of locally-grown foods. We offer several implications of this research for further work that seeks to engage chefs as opinion leaders who are important to building greater support for local food systems. (shrink)

In this paper the problematic nature of the morality of management, in particular related to business organisations operating under Anglo-American capitalism, is explored. MacIntyre’s critique of managers in After Virtue serves as the starting point but this critique is itself subjected to analysis leading to a more balanced and contemporary view of the morality of management than MacIntyre provides. Paradoxically perhaps, MacIntyre’s own virtues-goods-practice-institution schema is shown to provide a way of re-imagining business organisations and management and thereby holds out (...) the possibility of resolving the issue of the morality of management within such organisations. Implications for management practice are drawn out. (shrink)

In this response to the review of Moore, Causation and Responsibility, by Larry Alexander and Kimberly Ferzan, previously published in this journal, two issues are discussed. The first is whether causation, counterfactual dependence, moral blame, and culpability, are all scalar properties or relations, that is, matters of more-or-less rather than either-or. The second issue discussed is whether deontological moral obligation is best described as a prohibition against using another as a means, or rather, as a prohibition on an agent (...) strongly causing a prohibited result that was not about to happen anyway while intending to do so. (shrink)

The paper builds on the postulate of “myths we live by,” which shape our imaginative life (and hence our social expectations), but which are also open to reflective study and reinvention. It applies this principle, in particular, to the concepts of love and vulnerability. We are accustomed to think of the condition of vulnerability in an objectifying and distancing way, as something that affects the bearers of specific (disadvantaged) social identities. Against this picture, which can serve as a pretext for (...) paternalist and controlling attitudes to the groups in question – notably to women – Anderson urges us to reimagine our vulnerability as a condition not merely of exposure to violence but of openness to mutual affection, love, and friendship. Hegel’s celebrated image of the owl of Minerva, which takes wing only with the coming of dusk, suggests an association of (philosophical) wisdom with negativity – with the experience of death or loss. Anderson, by contrast, proposes an alternative and more hopeful image of the dawn of enlightenment, in the guise of new ethical dispositions shaped by an emancipatory (and so, no longer an oppressive or sexist) conception of our capacity for love. Her main interlocutors or influences in this piece are Judith Butler (who contributes the idea of a “relational ontology”), Michèle Le Doeuff, and Mary Midgley. (shrink)

The concept of causation is fundamental to ascribing moral and legal responsibility for events. Yet the precise relationship between causation and responsibility remains unclear. This book clarifies that relationship through an analysis of the best accounts of causation in metaphysics, and a critique of the confusion in legal doctrine.

Sensory and tracking technologies are being introduced into workplaces in ways Taylor and the Gilbreths could only have imagined. New work design experiments merge wellness with productivity to measure and modulate the affective and emotional labour of resilience that is necessary to survive the turbulence of the widespread incorporation of agile management systems, in which workers are expected to take symbolic direction from machines. The Quantified Workplace project was carried out by one company that fitted sensory algorithmic devices to workers’ (...) computers and bodies, which, this article argues, identify workers’ so-called agility and reveal management practices that track affective and emotional labour, categorized in the project as stress, subjective productivity and wellbeing. Capital’s accelerated attempts to capture more areas of work and workers’ capacities facilitate the conversion of labour power into a source of value but also results in alienation and abstraction. Participants’ resistance to participation in the Quantified Workplace reveals tensions in the labour process when affect is measured in processes of corporate change. (shrink)

Infants can see someone pointing to one of two buckets and infer that the toy they are seeking is hidden inside. Great apes do not succeed in this task, but, surprisingly, domestic dogs do. However, whether children and dogs understand these communicative acts in the same way is not yet known. To test this possibility, an experimenter did not point, look, or extend any part of her body towards either bucket, but instead lifted and shook one via a centrally pulled (...) rope. She did this either intentionally or accidentally, and did or did not address her act to the subject using ostensive cues. Young 2-year-old children but not dogs understood the experimenter’s act in intentional conditions. While ostensive pulling of the rope made no difference to children’s success, it actually hindered dogs’ performance. We conclude that while human children may be capable of inferring communicative intent from a wide variety actions, so long as these actions are performed intentionally, dogs are likely to be less flexible in this respect. Their understanding of communicative intention may be more dependent upon bodily markers of communicative intent, including gaze, orientation, extended limbs, and vocalisations. This may be because humans have come under selective pressure to develop skills for communicating with absent interlocutors – where bodily co-presence is not possible. (shrink)

Yaffe's handling of two general questions is assessed in this review. The first question is why mere attempts (as opposed to successful wrongdoing) should be made punishable in a well-conceived criminal code. The second question is how attempt liability should be conceived in such a code. As to the first question, Yaffe's nonsubstantive mode of answering it (in terms of his ) is contrasted to answers based on some more substantive desert-bases; Yaffe's own more substantive kind of answer (in terms (...) of a desert-base of ) is examined in light of the implication that the traditional requirements of trying and intending are mere proxies for faulty reason recognition and response as the basis for blaming and punishing attempts. As to the second question, Yaffe's analysis of trying in terms of a is examined in some detail. Canvassed here are the subquestions of: (1) whether appropriate assessibility by certain norms of rationality can give the nature of intending and thus of trying; (2) whether the externally de dicto intent requirements of criminal law statutes can easily be interpreted and applied by standard, extensional methods; (3) whether the distinctions between various kinds of elements within the content of intentions, can be justified ontologically or only practically; (4) whether actors necessarily intend results of their actions that are to other results that clearly are intended, and if not, whether such actors are nonetheless just as blameworthy for those results as if they did intend them; and (5) whether intention with respect to circumstance-elements differ (in either their psychology or in their moral effect) from beliefs with respect to such circumstance-elements. (shrink)

It is nearly 10 years since Patrick Haggard and colleagues first reported the ‘intentional binding’ effect . The intentional binding effect refers to the subjective compression of the temporal interval between a voluntary action and its external sensory consequence. Since the first report, considerable interest has been generated and a fascinating array of studies has accumulated. Much of the interest in intentional binding comes from the promise to shed light on human agency. In this review we survey studies on intentional (...) binding, focusing, in particular, on the link between intentional binding and the sense of agency . We suggest that, whilst it is yet to be fully explicated, the link between intentional binding and the sense of agency is compelling. We conclude by considering outstanding questions and future directions for research on intentional binding. (shrink)

Photo ID 72893750 © Rawpixelimages|Dreamstime.com ABSTRACT Solidarity is a concept increasingly employed in bioethics whose application merits further clarity and explanation. Given how vital cooperation and community-level care are to mitigating communicable disease transmission, we use lessons from the COVID-19 pandemic to reveal how solidarity is a useful descriptive and analytical tool for public health scholars, practitioners, and policymakers. Drawing upon an influential framework of solidarity that highlights how solidarity arises from the ground up, we reveal how structural forces can (...) impact the cultivation of solidarity from the top down, particularly through ensuring robust access to important social determinants of health. Public health institutions can support solidarity movements among individuals and communities by adopting a lens of social justice when considering public health priorities and, in turn, promote health equity. INTRODUCTION Over the past two decades, scholars have invoked the concept of solidarity when assessing a wide range of topics in bioethics, from CRISPR-Cas9 technology to organ donation to structural racism.[1] However, the growing literature on solidarity has not fully examined the roles and responsibilities of institutions and governments in fostering solidarity, especially regarding public health measures that implicate entire populations. We argue that it remains unclear how public health institutions should engage with solidarity and how their engagement will affect public health and its ethics. We first take Prainsack and Buyx’ three-tiered framework as an analytical starting point.[2] We then explore how public health institutions can foster solidarity by carefully considering factors that may bolster it on an interpersonal, community, and national scale. We conclude that public health institutions should adopt a lens of social justice to promote solidarity at the interpersonal and community levels, thereby promoting equity in future public health efforts. BACKGROUND Calls for solidarity in bioethics raise longstanding normative questions about the nature and limits of our duties to one another and how to weigh autonomy over considerations of justice.[3] Though the term is diversely applied, Prainsack and Buyx propose a potentially unifying definition in the 2011 Nuffield Council report, “Solidarity: Reflections On An Emerging Concept in Bioethics.” The report defines solidarity as an activity involving “shared practices reflecting a collective commitment to carry financial, social, emotional, and or other ‘costs’ to assist others.” Their conceptualization also includes important features that distinguish solidarity from other values like empathy or altruism: solidarity emphasizes action rather than mere internal feeling and recognition of connection as motivation.[4] Bioethicists have since applied this conceptualization when analyzing issues in public and global health, given that population-level efforts need cooperation from individuals and communities. Prainsack and Buyx further note that solidarity is relevant in bioethics discourses about justice and equity, in support of providing aid to low- and middle-income countries, and as a value exemplified by European welfare states.[5] Other bioethicists have argued that promoting solidarity can contribute to community engagement, partnership with Tribal communities, and global health equity.[6] Most recently, scholars have applied solidarity as a lens to assess the COVID-19 pandemic, highlighting the pitfalls of national mitigation efforts and global disparities in disease outcomes.[7] I. Solidarity at Three Levels It seems impossible to foster solidarity in public health if we cannot identify it in general contexts. Prainsack and Buyx articulate three levels of solidarity: interpersonal solidarity, group solidarity, and legal or contractual codifications of solidarity.[8] They argue that each level inherently informs the one ‘above’ it in a unilateral direction. In other words, solidarity is fundamentally a bottom-up phenomenon. Solidarity among individuals influences group norms, which then have the potential to shape policy and institutional practice.[9] Within the Prainsack and Buyx framework, it would seem nonsensical to posit how solidarity might be expressed vertically or from the “top down.” It appears intuitively odd to imagine how a government entity might ‘be’ in solidarity with a person or group if solidarity requires some cognition about their condition per Prainsack and Buyx’ definition. Some have argued that solidarity does not seem like something that one can impose, as instances of it arise from agents recognizing and acting upon some bond rather than in response to a command. Indeed, people may be rightfully hesitant to engage in solidarity if the official messaging is overly paternalistic or coercive.[10] However, some authors have countered that governments can express solidarity through enacting structural and policy changes, though it is ambiguous how these actions are distinct from a justice-driven approach.[11] If a bottom-up approach is thus the most practical means of achieving policy that reflects solidarity, then it does not add much to public health. Institutions would be ineffective without the population’s initiation of the corresponding social norms. However, we find this conclusion overly pessimistic. Fostering a culture of solidarity to improve public health has potential merit. Prainsack and Buyx’ framework overlooks how public health actors can influence solidarity between individuals and across communities. To clarify, we agree with the view that solidarity is a bottom-up phenomenon. Solidarity may not be able to originate in a top-down fashion, but we suggest that public health institutions can take a more active role in providing the public with accurate information, promoting social justice, and intervening in the social determinants of health. II. The COVID-19 Pandemic as a Case Study Lessons learned from the ongoing COVID-19 pandemic support our argument. The pandemic deepened socioeconomic disparities in the US and hindered access to vital resources such as food, housing, and healthcare.[12] Prainsack recently noted: “[n]ext to the immediate health effects of the virus, poverty and grave inequalities have been the root causes of human suffering during the pandemic.”[13] Prior to the pandemic, many rural and low-income populations lacked reliable access to the internet and devices like laptops or smartphones. This continued lack of access restricts the flow of information and prevents people from accessing telemedicine services.[14] Preexisting social, political, and health inequities worsened health outcomes among many marginalized racial and ethnic groups. It is well-documented that communities of color, including Black, American Indian or Alaska Native, and Latinx populations, had greater COVID-related mortality and morbidity due to the effects of structural racism.[15] Although federal US agencies such as the Centers for Disease Control and Prevention enacted laws that provided safety nets (e.g., the Federal Eviction Moratorium), the majority of such programs have ended, leaving many with little assistance and the threat of further hardship.[16] These disparities are relevant because Prainsack, Buyx, and others note that solidarity arises from agents recognizing and acting on some perceived attainable collective goal(s). Income inequality and disparate access to food, education, and health care may lead people to consider public health goals unattainable. This could limit the desire to work toward those goals collectively.[17] The existing literature on collective action theory supports this intuition. It emphasizes that structural conditions, such as an absence of perceived hope for social change among a group, can lead to low ‘group efficacy’ and little willingness to cooperate, both within and across socioeconomic strata.[18] The pandemic spurred countless messages from public health agencies. The messaging did not recognize or attend to the different material realities and circumstances of the US population. How can people feel comfortable getting vaccinated if they deeply distrust the government, including public health institutions? How can people remain motivated to wear masks and distance themselves if they cannot afford basic necessities and work jobs without adequate pay and leave policies? We ask these questions to illustrate how socioeconomic disparities can marginalize people if they feel ignored, apathetic, or resentful of those better off or those in power whom they perceive to “not be doing enough.” This marginalization precludes the formation of solidarity. There are instances when a population has disparate access to resources and social capital, but solidarity may still emerge from a shared goal or vision for the future. For example, a heterogeneous population living in the same town may come together to protest an environmental injustice that impacts their water supply with the common goal of securing access to safe drinking water. However, many populations in the US failed to recognize shared goals of this kind during the COVID-19 pandemic. A significant minority of the US population was reluctant to acknowledge the severity of COVID-19 infection and thus refused to participate in efforts to mitigate its spread. Even between groups who shared the goal of slowing COVID-19 transmission, the methods were widely debated. Approximately 20 percent of the adult population eligible for vaccination remains unvaccinated.[19] Governmental bodies responsible for disseminating information, coordinating the allocation of resources, and establishing guidelines have a large role in mediating these disagreements and intervening in socioeconomic conditions that impact people's ability and willingness to engage in solidarity. III. Solidarity, Social Justice, and the Role of Public Health Institutions Adopting a lens of social justice provides further insights into how public health actors impact solidarity. Powers and Faden argue that the “foundational moral justification for the social institution of public health is social justice.”[20] Their theory of social justice has two aims. First, it ensures that everyone has a sufficient amount of the six core elements of well-being and that public health institutions are responsible for “adopting policies and creating environments” where all can flourish.[21] Second, public health institutions should distribute resources meant to promote well-being and focus on the “needs of those who are the most disadvantaged.”[22] Public health institutions should enact policies that address injustice. In doing so, public health institutions can seed the opportunity to build solidarity from the bottom up. Equipping individuals and communities with resources will foster cooperation and adherence to policies that require solidarity, such as masking and vaccination. This is consistent with arguments illustrating how institutions such as Tribal governments promote the conditions needed for their group, and especially its most vulnerable members, to flourish.[23] Addressing social determinants of health with a social justice lens will create the circumstances under which more individuals and groups can find common causes and foster solidarity. In the long run, such efforts may result in the establishment of values and practices from the bottom up. There are societal and public health preconditions required before institutions can expect their audience to act in solidarity with one another. Through their great influence over information and resources, public institutions do have the power to impact what values are most widespread. Furthermore, public health may foster trust and hope, which are important psychosocial factors that influence collective action,[24] if policies increase access to resources that promote well-being. Messaging efficacy also depends on the context of public trust, education, and whether the institutions meet one’s basic needs. Disparate messaging across different public institutions may confuse or disillusion individuals. To apply our theory of solidarity to the decision to vaccinate, a policy would be to foster conditions that facilitate access to vaccines and information about vaccine efficacy instead of imposing a top-down mandate without first eliciting public trust. IV. Counterargument Some argue that discordant public health messaging, ineffective government, and inadequate social programs can also bring people together under pressure and foster solidarity. One may argue that the most powerful motivators towards solidarity are strife and disparity, as evidenced throughout history. During the pandemic alone, political struggle and personal hardship inspired solidarity in the US, from individual neighbors helping each other to mutual aid groups forming across communities. We thus do not claim that solidarity is possible only when our government programs and public health institutions are most effective. We instead point out that solidarity can be further hindered when people feel alienated, hopeless, and pitted against each other. CONCLUSION Many competing conceptualizations of solidarity persist in the bioethics literature, and Prainsack and Buyx offer one compelling framework that public health ethicists continue to draw upon.[25] However, their framework fails to acknowledge how public health institutions impact interpersonal and group solidarity. Public health institutions can foster solidarity through actions other than mere messaging, invoking catchphrases like “we are all in this together.” Efforts to address socioeconomic preconditions and alleviate health disparities can cultivate group solidarity. As we saw during the pandemic, cooperation and solidarity go hand-in-hand with disease mitigation efforts; solidarity has clear intrinsic value.[26] As this relationship becomes more apparent, we will continue to see attempts from public health institutions to foster or invoke solidarity. Therefore, public health institutions would be remiss to ignore their role in addressing the social determinants of health. Adopting a social justice lens when planning public health interventions will clarify and strengthen their role in facilitating solidarity. Ultimately, if health disparities continue to persist or widen, it is very hard to imagine how group solidarity can ever be achieved. The widescale adoption of many public health measures needed to promote health and well-being would be conducive to solidarity. - Disclaimer: The opinions expressed are the authors’ and do not represent the views of the NIH, DHHS, or the U.S. government. Funding Disclosure: This work was supported in part by the Intramural Program of the National Institutes of Health Clinical Center. - [1] John J Mulvihill et al., “Ethical Issues of CRISPR Technology and Gene Editing through the Lens of Solidarity,” British Medical Bulletin 122 (2017): 17–29, https://doi.org/10.1093/bmb/ldx002; Ben Saunders, “Altruism or Solidarity? The Motives for Organ Donation and Two Proposals,” Bioethics 26, no. 7 (September 2012): 376–81, https://doi.org/10.1111/j.1467-8519.2012.01989.x; -Vanessa Y Hiratsuka, “SPECIAL REPORT: A Critical Moment in Bioethics: Reckoning with Anti-Black Racism through Intergenerational Dialogue A Call for Solidarity in Bioethics: Confronting Anti-Black Racism Together,” 2022, https://doi.org/10.1002/hast.1380. [2] Prainsack and Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics London: Nuffield Council on Bioethics, 2011; Prainsack and Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach.” Bioethics 26, no. 7 (September 2012): 343–50. https://doi.org/10.1111/J.1467-8519.2012.01987.X. [3] Bob Simpson, “A ‘We’ Problem for Bioethics and the Social Sciences: A Response to Barbara Prainsack,” Science, Technology, & Human Values 43, no. 1 (January 12, 2018): 45–55, https://doi.org/10.1177/0162243917735899. [4] Barbara Prainsack and Alena Buyx, Solidarity: Reflections on an Emerging Concept in Bioethics (London: Nuffield Council on Bioethics, 2011). [5] Barbara Prainsack and Alena Buyx, “Solidarity in Contemporary Bioethics--towards a New Approach,” Bioethics 26, no. 7 (September 2012): 343–50, https://doi.org/10.1111/J.1467-8519.2012.01987.X. 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