It is well documented that the language skills of preschool children differ substantially and that these differences are highly predictive of their later academic success and achievements. Especially in the early phases of children’s lives, the importance of different structural and process characteristics of the home learning environment has been emphasized and research results have documented that process characteristics such as the quality of parental interaction behavior and the frequency of joint activities vary according to the socio-economic status of the (...) family. Further, both structural and process characteristics are associated with children’s language development. As most of the studies focus on single indicators or didn’t take the dynamics of parenting behavior across age into account, the present paper aims to investigate the associations of different characteristics of the home learning environment as well as their potentially changing impact on the language skills of 2-year-old children. Using data of 2.272 families of the infant cohort study of the German National Educational Panel Study, longitudinally assessed process characteristics and structural characteristics were considered. Language skills of the children at the age of two were measured by a standardized and validated parent report instrument. Results showed that all three process characteristics of the home learning environment are associated with the family’s SES; across three assessment waves nearly all process characteristics predicted children’s vocabulary and grammar skills with some process-specific changes across waves; despite separate direct effects of nearly all HLE-process characteristics in each wave, the amount of explained variance in a joint model including the HLE facets from each wave is hardly higher than in the separate models; and socioeconomic background predicted both language facets of the children in each model even when controlling for the assessed process characteristics of the home learning environment. (shrink)

New technologies create new complexities. Since non-invasive prenatal tests (NIPTs) were first introduced, keeping pace with complexity constitutes an ongoing task for medical societies, politics, and practice. NIPTs analyse the chromosomes of the fetus from a small blood sample. Initially, NIPTs were targeted at detecting trisomy 21 (Down syndrome): meanwhile there are sequencing techniques capable of analysing the entire genome of the unborn child. These yield findings of unclear relevance for the child’s future life, resulting in new responsibility structures and (...) dilemmas for the parents-to-be.The industry’s marketing strategies overemphasize the benefits of the tests while disregarding their consequences. This paper chooses the opposite path: starting with the underestimated consequences, it focuses on adverse developments and downsides. Disparities, paradoxes, and risks associated with NIPTs are illustrated, ethical conflicts described. Indications that new technologies developed to solve problems create new ones are examined. In the sense of critical thinking, seemingly robust knowledge is scrutinized for uncertainties and ambiguities. It analyses how the interplay between genetic knowledge and social discourse results in new dimensions of responsibility not only for parents-to-be, but also for decision-makers, authorities, and professional societies, illustrated by a review of different national policies and implementation programmes. As shown by the new NIPT policy in Norway, the consequences can be startling. Finally, a lawsuit in the United States illustrates how an agency can risk forfeiting its legitimation in connection with the inaccuracy of NIPTs. (shrink)

Drawing on interdisciplinary, feminist insights, we encourage social psychologists to embrace the active participation of marginalized groups in social disparities research. We explain how the absence of marginalized groups' perspectives in research presents a serious challenge to understanding intergroup dynamics and concomitant disparities, and how their inclusion could assuage some of social psychology's “fatal flaws.”.

There are two problems with the logic of Cesario's argument for abandoning existing research on social bias. First, laboratory findings of decisional bias have social significance even if Cesario is right that the research strips away real-world context. Second, the argument makes overly skeptical demands of a research program seeking complex causal linkages between micro- and macro-scale phenomena.

The COVID-19 pandemic has posed many challenges, especially for families. Both the public and the scientific community are currently discussing the extent to which school closings have worsened existing social differences, especially with regard to children’s academic and socio-emotional development. At the same time, parents have had to manage childcare and home schooling alongside their jobs and personal burdens posed by the pandemic. Parents’ possibilities for meeting these cognitive and emotional challenges might also depend on the different conditions in (...) families. For this reason, the present paper investigates the structural and process characteristics of the family as well as children’s and parents’ psychological characteristics that predict how parents assess their ability to support their child’s learning during homeschooling as well as parents’ perceived emotional stress caused by school closure. The study analyses data of the Newborn Cohort Study of the German National Educational Panel Study. The two dependent variables were measured during the COVID-19 pandemic after the first school closure in Germany, at a time when the children of this cohort were attending second grade. Besides a number of control variables, families’ structural characteristics [socioeconomic status, education], process characteristics, parents’ psychological characteristics, and the child’s psychological characteristics from earlier waves were included as predictors. The results of structural equation models show that perceived stress was associated with structural factors and the preceding psychological stress of parents. Parents with higher preceding stress reported higher perceived stress. Interestingly, higher-educated parents also reported more stress than lower educated parents during the pandemic. The effect was the other way around for SES – parents with lower SES reported more stress than parents with higher SES. The self-reported abilities to support the learning of the child seemed to be mainly predicted by the parent’s education as well as preceding psychological stress. To sum up, the results identify important aspects that determine how parents handle the challenges of the school closures. Especially, socially disadvantaged families carry their burden into the pandemic. (shrink)

Social health disparities are increasing in most countries around the world. During the past two decades, a large amount of evidence has emerged about the health consequences of social inequalities. Despite such evidence, the concept of medical fairness, as traditionally defined by the World Medical Association, has remained unchallenged and even reinforced by some scholars who emphasize that doctors should remain neutral to the socioeconomic status of their patients when providing clinical care. The inconsistency between public health (...) and clinical care perspectives raises tension between a narrow interpretation of the ethics of justice, which stresses the importance of equality and impartiality, and the ethics of care, which highlights the importance of particularity and individuality in clinical practice. This article analyzes the concept of medical fairness using the emerging evidence that demonstrates the impact of social health disparities on clinical care. It proposes a new approach of medical fairness based on equity rather than on equality and provides a consistent ethical framework based on Paul Ricoeur’s three levels of medical judgments. This integrative framework provides a better balance between public health and clinical care in medical practice. (shrink)

Older minority Americans experience worse health outcomes than their white counterparts, exhibiting the need for social justice in all areas of their health care. Justice, fairness, and equity are crucial to minimizing conditions that adversely affect the health of individuals and communities. In this paper, Alzheimer's disease (AD) is used as an example of a health care disparity among elderly Americans that requires social justice interventions. Cultural factors play a crucial role in AD screening, diagnosis, and access to (...) care, and are often a barrier to support and equality for minority communities. The “conundrum of health disparities” refers to the interplay between disparity, social justice, and cultural interpretation, and encourages researchers to understand both (1) disparity caused by economic and structural barriers to access, treatment, and diagnosis, and (2) disparity due to cultural interpretation of disease, in order to effectively address health care issues and concerns among elderly Americans. (shrink)

Although the federal government and several state governments have recognized that structural discrimination limits less privileged groups’ ability to be healthy, the measures adopted to eliminate health disparities do not address structural discrimination. Historical and modern-day structural discrimination in employment has limited racial and ethnic minority individuals’ economic conditions by segregating them to low wage jobs that lack benefits, which has been associated with health disparities. Health justice provides a community-driven approach to transform the government’s efforts to eliminate (...) health disparities, by acknowledging the problem of structural discrimination; empowering less privileged groups to create and implement structural change; and providing support to redress harm. (shrink)

Rawls' Difference Principle asserts that a basic economic structure is just if it makes the worst off people as well off as is feasible. How well off someone is is to be measured by an ‘index’ of ‘primary social goods’. It is this index that gives content to the principle, and Rawls gives no adequate directions for constructing it. In this essay a version of the difference principle is proposed that fits much of what Rawls says, but that makes (...) use of no index. Instead of invoking an index of primary social goods, the principle formulated here invokes a partial ordering of prospects for opportunities. (shrink)

The government recognizes that social factors cause racial inequalities in access to resources and opportunities that result in racial health disparities. However, this recognition fails to acknowledge the root cause of these racial inequalities: structural racism. As a result, racial health disparities persist.

Empirical evidence demonstrates that minority and marginalized populations receive less and lower quality healthcare than more advantaged groups. Ethical analyses of these disparities explain their injustice. That disparities exist and constitute a moral wrong are uncontroversial views. Less clear are the exact causes of healthcare disparities.

Philosophy of epidemiology has recently emerged as a distinct branch of philosophy. The field will surely benefit from pluralism, reflected in the broad range of topics and perspectives in this special issue. Here, I argue that a healthy pluralistic field of philosophy of epidemiology has social responsibilities that require the field as a whole to engage actively with research on social determinants of health and health disparities. Practicing epidemiologists and the broader community of public health scientists have (...) gradually acknowledged that much of their attention ought to be paid to these, i.e. inequitable between-population health variations that largely reflect the world’s inequitable distribution of resources and social conditions. The paper illustrates how and why health disparities and social determinants of health, through no ill will, become de facto secondary concerns in Alex Broadbent’s field-defining Philosophy of Epidemiology, showing the ease with which these topics can be incidentally sidelined. As means for philosophy of epidemiology to meet its social responsibility obligations, I suggest philosophy of epidemiology expand its attention to two particular lines research. First, the paper discusses Geoffrey Rose’s concept of “causes of incidence”—causes of disparities between populations—and argues for the importance of engaging with these causes. Second, the paper argues for the value of engaging with Bruce Link and Jo Phelan’s “fundamental causes” model of how flexible social resources serve as buffers from harms, generating a plethora of shifting and locally-contingent health effects. (shrink)

The principles of autonomy, beneficence, non-maleficence, and justice are well established ethical principles in health research. Of these principles, justice has received less attention by health researchers. The purpose of this article is to broaden the discussion of health research ethics, particularly the ethical principle of justice, to include societal considerations — who and what are studied and why? — and to critique current applications of ethical principles within this broader view. We will use a feminist intersectional approach in the (...) context of health disparities research to firmly establish inseparable links between health research ethics, social action, and social justice. The aim is to provide an ethical approach to health disparities research that simultaneously describes and seeks to eliminate health disparities. (shrink)

The commentary brings up two topics. The first concerns whether and how a patient’s socioeconomic status should count in clinical care. We provide a brief summary of Puschel and colleagues’ view and discuss it in relation to other accounts. We share their conclusion; considering SES in clinical care can be justified from a fairness perspective. Yet, we question the claim that this is a new perspective, and argue that the reason for the claim of novelty is an insufficient use of (...) references. This leads to the second topic, which is a discussion of citation practices in philosophical/ethics papers. We describe common deviations from academic standards, and suggest how unfortunate practices can be reduced. (shrink)

It is usually accepted that whether or not indirect discrimination is a form of immoral discrimination, it appears to be structurally different from direct discrimination. First, it seems that either one involves the agent focusing on different things while making a decision. Second, it seems that the victim’s group membership is relevant to the outcomes of either sort of action in different ways. In virtue of these two facts, it is usually concluded that indirect discrimination is structurally different from direct (...) discrimination. I argue against the notion that indirect discrimination and direct discrimination have significantly different structures. I first argue that both kinds of discrimination involve similar decision-making processes. Second, I analyze how being in a social group affects personal identity, and from there argue that indirect discrimination and direct discrimination are about group membership similarly. In virtue of these two arguments, I conclude that direct and indirect discrimination are structurally similar. (shrink)

Disparities in socioeconomic status correlate closely with health, so that the lower a person's social position, the worse his health, an effect that the epidemiologist Michael Marmot has labeled the status syndrome. Marmot has argued that differences in autonomy, understood in terms of control, underlie the status syndrome. He has, therefore, recommended that the American medical profession champion policies that improve patient autonomy. In this paper, I clarify the kind of control Marmot sees as connecting differences in socioeconomic (...) status to health disparities. I then discuss his use of Amartya Sen's capabilities approach to justice, arguing that he is unsuccessful in relating autonomy as a descriptive property with a normative framework that can adequately explain why and to what extent we should reduce health disparities. (shrink)

While the domestic effect of structural racism and other social vulnerabilities on Covid‐19 mortality in the United States has received some attention, there has been much less discussion (with some notable exceptions) of how structural global inequalities will further exacerbate Covid‐related health disparity across the world. This may be partially due to the delayed availability of accurate and comparable data from overwhelmed systems, particularly in low‐ and middle‐income countries. However, early methods to procure and develop treatments and vaccines by (...) some high‐income countries reflect ongoing protectionist and nationalistic attitudes that can systemically exclude access for people in regions with weaker health systems. What's needed is a global coordinated effort, based on the principle of solidarity, to foster equitable health care access. (shrink)

Public health emergencies expose social injustice and health disparities, resulting in calls to address their structural causes once the acute crisis has passed. The COVID-19 pandemic is highlighting and exacerbating global, national, and regional disparities in relation to the benefits and burdens of undertaking critical basic public health mitigation measures such as physical distancing. In the United States, attempts to address the COVID-19 pandemic are complicated by striking racial, economic, and geographic inequities. These synergistic inequities exist in (...) both urban and rural areas but take on a particular character and impact in areas of rural poverty. Rural areas face a diverse set of structural challenges, including inadequate public health, clinical, and other infrastructure and economic precarity, hampering the ability of communities and individuals to implement mitigation measures. Public health ethics demands that personnel address both the tactical, real-time adjustment of typical mitigation tools to improve their effectiveness among the rural poor as well as the strategic, longer-term structural causes of health and social injustice that continue to disadvantage this population. (shrink)

In “Should We Impose Quotas? Evaluating the ‘Disparate Impact’ Argument Against Legalization of Assisted Suicide,” Ronald Lindsay argues that it should make no difference to the debate over legalizing assisted suicide whether the risks associated with legalization would fall disproportionately on the poor, people with disabilities, racial minorities, or any other especially vulnerable social group. Even assuming such an inequitable distribution of risks would occur, he maintains, attempting to avoid such an outcome is not a good reason to deny (...) assisted suicide to “competent persons who truly voluntarily choose it.”Those of us who worry that legalization will differentially burden already disadvantaged segments of society have generally taken it for granted that the possibility of such disparities raises significant public policy concerns. By insisting on an explanation of this assumption — and, in so doing, making explicit the tension between autonomy and equality that underlies the assisted suicide debate — Lindsay has significantly advanced the ongoing conversation. While I disagree with his analysis, I commend him for a thoughtful, provocative, and important contribution to the literature. (shrink)

Corresponding Author, Health Policy & Ethics Fellow, Chronic Disease Prevention & Control Research Center, Department of Medicine, Baylor College of Medicine, 1709 Dryden, Suite 1025, Houston, TX 77030, USA. Tel.: 713.798.5482; Fax: 713 798 3990; Email: danielg{at}bcm.edu ' + u + '@' + d + ' '//--> . Abstract This article defends a broad model of public health, one that specifically addresses the social epidemiologic research suggesting that social conditions are primary determinants of health. The article proceeds by (...) critiquing one of the strongest arguments in favor of a narrow model, advanced by Mark Rothstein. The critique sets up the argument that a model of public health that does not address what actually causes health and disease is unlikely to improve public health. Assessing the substantial evidence regarding the social determinants of health, the article engages the policy paradox that precludes utopian prescriptions but demands more than mere expedience. CiteULike Connotea Del.icio.us What's this? (shrink)

In “Should We Impose Quotas? Evaluating the ‘Disparate Impact’ Argument Against Legalization of Assisted Suicide,” Ronald Lindsay argues that it should make no difference to the debate over legalizing assisted suicide whether the risks associated with legalization would fall disproportionately on the poor, people with disabilities, racial minorities, or any other especially vulnerable social group. Even assuming such an inequitable distribution of risks would occur, he maintains, attempting to avoid such an outcome is not a good reason to deny (...) assisted suicide to “competent persons who truly voluntarily choose it.”Those of us who worry that legalization will differentially burden already disadvantaged segments of society have generally taken it for granted that the possibility of such disparities raises significant public policy concerns. By insisting on an explanation of this assumption — and, in so doing, making explicit the tension between autonomy and equality that underlies the assisted suicide debate — Lindsay has significantly advanced the ongoing conversation. While I disagree with his analysis, I commend him for a thoughtful, provocative, and important contribution to the literature. (shrink)

Multidimensional concepts are everywhere, and they are important. Examples include moral value, welfare, scientific confirmation, democracy, and biodiversity. How, if at all, can we aggregate the underlying dimensions of a multidimensional concept F to yield verdicts about which things are Fer than which overall? Social choice theory can be used to model and investigate this aggregation problem. Here, we focus on a particularly thorny problem made salient by this social choice-theoretic framework: the underlying dimensions of a given concept (...) might be measurable on different types of scales—e.g., some ordinal and some cardinal. An underappreciated impossibility theorem due to Anna Khmelnitskaya shows that seemingly plausible constraints on aggregation across scale types are inconsistent. This impossibility threatens to render the notion of overall Fness incoherent. We attempt to defuse this threat, arguing that the impossibility depends on an overly restrictive conception of measurement and of how measurement constrains aggregation. Adopting a more flexible—and, we think, more perspicuous—conception of measurement opens an array of possibilities for aggregation across disparate scale types. (shrink)

Existing social disparities in the United States are inconsistent with Lincoln’s promise of democracy; therefore, there is a need for a critical conceptualization of the first principles that undergird American democracy and the genesis of democratic social change in America. This study aimed to construct a grounded theory that provides an understanding of the process of American democratic social change. The result was the construction of two frameworks: the demoralization process that triggers social change, and (...) a formal grounded theory that could explain democratic social change endeavors across different domains and levels of analysis. This democratic social change grounded theory answers the research question: How do the principles of the American founding documents provide an understanding of the process of American democratic social change? (shrink)

This article examines how people of color can biologically inherit the deleterious effects of white racism. Drawing primarily on the field of epigenetics, I demonstrate how transgenerational racial disparities are in fact racist disparities that can be manifest physiologically, helping constitute the chemicals, hormones, cells, and fibers of the human body. Epigenetics can be used to demonstrate how white racism can have durable effects on the biological constitution of human beings that are not limited to the specific person (...) who is the target of white racism, but instead extend to that person's offspring. In this way, the field of epigenetics can help philosophers and others understand the transgenerational biological impact of social forces such as white racism. It reveals that the damage done by white racism is more extensive than critical philosophers of race might have realized, and also that interventions against white racism must address not just the economic, geographical, social, and psychological, but also the biological aspects of human existence. In particular, the article examines racist disparities in preterm birth rates and argues that the scope and significance of prenatal care for African American women must be expanded intergenerationally and include wide-scale forms of racial justice. (shrink)

The paper summarizes recently published data and recommendations about healthcare disparities experienced by African Americans who have Medicare or other healthcare coverage. Against this background the paper addresses the ethics of such disparities and how disadvantages of vulnerable populations like African Americans are typically maintained indecision making about how to respond to such disparities. Considering how to respond to disparities reveals much that vulnerable populations would bring to the policy-making table, if they can also be heard (...) when they get there. The paper argues that vulnerable populations like African Americans need fair representation in bodies deciding what to do about such disparities and that fairness requires proportional representation at all levels of decisions that affect healthcare – a radical change. In this decision setting, howto provide adequate protection of minorities needs much further attention. The most attractive decision-making model is deliberative democracy. The paper shows that in deliberation, fair representation requires not only having a voice in decisions, but a fair hearing of those voices. Achieving a fair hearing requires changes in norms of communication and training of all to give importance to greetings and other measures of civility and trust building, and to be open to diverse forms of expression. Decisions about how to respond to healthcare disparities would include what programs to initiate for whom, howto evaluate the programs, and what to do in response to such evaluations. Conclusions are that achieving such goals will take a sea change in how healthcare institutions and providers do their business, and that social activism at every level will be needed to effect these changes. The discussion highlights many ethical issues that need much greater attention. (shrink)

Although there is clearly a need for evidenced‐based behavioral or biomedical prevention or treatment programs for suicide, substance abuse, and sexual health targeted to members of the LGBT population under the age of eighteen, few such programs exist, due in substantial part to limited research knowledge. Ambiguities in regulations that govern human subjects protections and the related inconsistencies in institutional review board (IRB) interpretations of regulatory language are the key reason for the lack of rigorous clinical trial evidence to support (...) treatment choices and prevention approaches to reducing health disparities for this population. Given the socially sensitive nature of suicide, substance abuse, and HIV and STI research in general and LGBT research specifically, in the absence of empirical data to guide their decisions, IRBs must often rely on subjective judgments of minimal risk, which can lead to overestimation of the magnitude and probability of psychological, social, and informational harms that might arise from LGBT youth participation in clinical trials. In addition, more than other youth, LGBT adolescents whose families are unaware of their sexual orientation or gender identity or whose families have victimized them on account of it may be reluctant to participate in studies that require guardian permission. This, in turn, intensifies problems of recruitment and unbiased sampling. However, many IRBs are reluctant to apply federal regulations permitting waiver of guardian permission under conditions in which such permission is clearly not “feasible” or “reasonable” to require. Consequently, many investigators have excluded LGBT individuals under eighteen years of age in health intervention research proposals because of anticipated or actual difficulties obtaining IRB approval. This situation is in conflict with current ethical discourse focusing on the right of youths to participate in trials that will protect them from receiving developmentally untested, inappropriate, and unsafe treatments. In this article, we describe these barriers and recommendations for providing LGBT youth safe and fair access to health research. (shrink)

Some psychologists aim to secure a role for psychological explanations in understanding contemporary social disparities, a concern that plays out in debates over the relevance of the Implicit Association Test. Meta-analysts disagree about the predictive validity of the IAT and about the importance of implicit attitudes in explaining racial disparities. Here, I use the IAT to articulate and explore one route to establishing the relevance of psychological attitudes with small effects: an appeal to a process of “accumulation” (...) that aggregates small effects into large harms. After characterizing mechanisms of accumulation and considering some candidate examples, I argue that such mechanisms suggest how a contemporary attitude with small effects could figure in the explanation of large disparities, but they do not vindicate the importance of such an attitude since such mechanisms are typically also determined by competing causes. I close by sketching several strategies for advancing a defense of the relevance of attitudes with small effects. (shrink)

Digital health includes applications for smartphones and smart speakers as well as more traditional ways to access health information electronically, such as through your health care provider's online web‐based patient portal. As the number of digital health offerings—such as smartphone health trackers and web‐based patient portals—grows, what benefit do ethics, or bioethics, perspectives bring to digital health product development? For starters, the field of bioethics is concerned about issues of social justice, including equitable benefit and minimization and fair distribution (...) of the burden of harms. Researchers who employ user‐centered design methods should consider what digital health applications and products would look like if issues like equity and accessibility were foregrounded throughout design and development. One group whose needs are often neglected in the design of digital health products is older adults. Many people anticipate that the digital divide among older adults will close as the current generation of tech‐savvy consumers ages up. But since technology is constantly evolving, this divide may be constantly recreated. As bioethics moves ever further into the technology era, I want it to be mindful of the creation of digital health care disparities. (shrink)

Although similar environmental issues are present across the globe, residents of different countries vary in the extent to which they are concerned about and act upon these issues. Drawing on data from the 2010 Environment module of the International Social Survey Programme, this study tests the structural comparability of environmental attitudes across 32 countries and examines how pro-environmental behaviours are linked to relevant attitudes. A confirmatory factor analysis from structural equation modelling helps identify three latent constructs of environmental attitudes: (...) willingness to sacrifice, biospheric orientation and environmental scepticism. Further regression analyses reveal that the linkages between pro-environmental behaviours and the constructs of environmental attitudes converge in some countries but are less consistent in others. The findings help pinpoint signs of global convergence and national disparities, which merit more extensive analyses amid the recent surge in the availability of diverse empirical data from around the world. (shrink)

While the effects of COVID-19 are being felt globally, the pandemic disproportionately affects lower- and middle-income countries (LMICs) by exacerbating existing global health disparities. In this article, we illustrate how intersecting upstream social determinants of global health form a disparity pathway that compromises LMICs’ ability to respond to the pandemic. We consider pre-existing disease burden and baseline susceptibility, limited disease prevention resources, and unequal access to basic and specialized health care, essential drugs, and clinical trials. Recognizing that ongoing (...) and underlying disparity issues will require long-term correction efforts, this pathway approach is nonetheless helpful to inform ethical responses to this global pandemic. It can facilitate international cooperation during the pandemic to reduce the disparate burdens among different regions without imposing significant burden on any particular contributor. The pathway approach allows international stakeholders in various social positions to respond to different components of the pathway based on their respective strengths and resources to help break the cycle of global health inequity. Guided by the ethical principles of relational and pragmatic solidarity, we argue for a coordinated global division of labor such that different stakeholders can collaborate to foster equitable healthcare access during this pandemic. (shrink)

Over the past two decades, we have seen an increase in the use of medical-legal partnerships in health-care and/or legal settings to address health disparities affecting vulnerable populations. MLPs increase medical teams' capacity to address social and environmental threats to patients' health, such as unsafe housing conditions, through partnership with legal professionals. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines, we systematically reviewed observational studies published from January 1993-January 2016 to investigate the capacity of MLPs (...) to address legal and health disparities. We identified 13 articles for qualitative analysis from an initial pool of 355 records. The resulting pool of 13 articles revealed more information regarding the capacity of MLPs to address legal outcomes than their capacity to address health outcomes; only 4 studies directly addressed the impact of MLP intervention on patient wellbeing and/or patient utilization of healthcare services. We call for further evaluation/longitudinal studies that specifically address MLPs' short and long term effects upon patient health disparities. Finally, given the demonstrated capacity of MLPs to address unmet legal needs, and their evident potential in regards to improving health outcomes, we present the MLP model as a framework to address HIV-related legal and health disparities. (shrink)

This paper provides a conceptual framework to explain why disparities may exist in food safety code compliance by food stores in different neighborhoods. Explanations include market dynamics, community characteristics, retailer attributes, inspector characteristics, and enforcement approaches, and interactions among the factors. A preliminary and limited empirical test of some of these relationships in Detroit, Michigan shows a higher rate of food safety violations by stores in poorer neighborhoods and in neighborhoods with higher concentrations of African-American residents. Stores inspected by (...) female inspectors also scored higher numbers of critical violations, suggesting a need for greater examination of the social relations associated with enforcement interactions in food safety studies. (shrink)

This article examines the responsibilities of researchers who conduct exploratory research to provide a service to vulnerable respondents. The term “service” is used to denote the provision of a tangible benefit in relation to the research question that is apart from the altruistic research benefits. This article explores what this “service” could look like, who might be responsible for providing it, and the challenges associated with such a service. The article argues that not providing a tangible benefit to vulnerable research (...) participants is inconsistent with the principle of social justice that undergirds much of the rationale for conducting health disparities research. (shrink)

Social work is a contested tradition, torn between the demands of social governance and autonomy. Today, this struggle is reflected in the division between the dominant, neoliberal agenda of service provision and the resistance offered by various critical perspectives employed by disparate groups of practitioners serving diverse communities. Critical social work challenges oppressive conditions and discourses, in addition to addressing their consequences in individuals’ lives. However, very few recent critical theorists informing critical social work have advocated (...) revolution. A challenging exception can be found in the work of Cornelius Castoriadis (1922–97), whose explication of ontological underdetermination and creation evades the pitfalls of both structural determinism and post-structural relativism, enabling an understanding of society as the contested creation of collective imaginaries in action and a politics of radical transformation. On this basis, we argue that Castoriadis’s radical-democratic revisioning of revolutionary praxis can help in reimagining critical social work’s emancipatory potential. (shrink)

Positing implicit social cognitive processes is common in the social cognition literature. We see it in discussions of theories of mentalizing, empathy, and infants' social-cognitive capacities. However, there is little effort to articulate what counts as implicit social cognition in general, so theorizing about implicit social cognition is extremely disparate across each of these sub-domains. In this paper, I argue that Michael Brownstein’s account of implicit cognition promises to be a fruitful, unifying account of implicit (...) cognition in general, and it is well suited to explain implicit cognition in various sub-domains of social cognition. (shrink)

This article questions the widespread use of experimental social psychology to understand real-world group disparities. Standard experimental practice is to design studies in which participants make judgments of targets who vary only on the social categories to which they belong. This is typically done under simplified decision landscapes and with untrained decision-makers. For example, to understand racial disparities in police shootings, researchers show pictures of armed and unarmed Black and White men to undergraduates and have them (...) press “shoot” and “don't shoot” buttons. Having demonstrated categorical bias under these conditions, researchers then use such findings to claim that real-world disparities are also due to decision-maker bias. I describe three flaws inherent in this approach, flaws which undermine any direct contribution of experimental studies to explaining group disparities. First, the decision landscapes used in experimental studies lack crucial components present in actual decisions. Second, categorical effects in experimental studies are not interpreted in light of other effects on outcomes, including behavioral differences across groups. Third, there is no systematic testing of whether the contingencies required to produce experimental effects are present in real-world decisions. I apply this analysis to three research topics to illustrate the scope of the problem. I discuss how this research tradition has skewed our understanding of the human mind within and beyond the discipline and how results from experimental studies of bias are generally misunderstood. I conclude by arguing that the current research tradition should be abandoned. (shrink)

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)

Welfare economics, social choice theory, distributional analysis, and pverty assessments are all important ingredients of problems in concepts and measurement. This book is a collection of papers, written over the last twenty years or so, which deal with issues of social choice, rights, poverty, and inequality. These are issues which form part of most people's everyday concerns. The book will appeal to an audience which goes well beyond the constituency of academic specialists.

In this research, we shed new light on the empirical link between corporate social performance (CSP) and corporate financial performance (CFP) via the application of empirical models and methods new to the CSP–CFP literature. Applying advanced financial models to a uniquely constructed panel dataset, we demonstrate that a significant overall CSP–CFP relationship exists and that this relationship is, in part, conditioned on firms’ industry-specific context. To accommodate the estimation of time-invariant industry and industry-interaction effects, we estimate linear mixed models (...) in our test of the CSP–CFP relationship. Our results show both a significant overall CSP effect as well as significant industry effects between CSP and CFP. In conflict with expectations, the unweighted average effect of CSP on CFP is negative. Our industry analysis, however, shows that in over 17% of the industries in our sample, the effect of CSP on CFP for socially responsible firms is positive. We also examine the multidimensional nature of the CSP construct in an industry context by exploring the CSP dimension–industry nexus and identify dimensions of social performance that are associated with either better or worse financial performance. Our results confirm the existence of disparate CSP dimension–industry effects on CFP, thus our results provide important and actionable information to decision makers considering whether and how to commit corporate resources to social performance. (shrink)

Using Michel Foucault’s framework of technologies can be a guide to understand how teachers become technological components that receive governance. Through this governance, pedagogical practices are perceived as similar yet may be vastly different. I utilize three of Foucault’s technologies to understand the differences in teacher practices. The first being governmental technologies, which are the rules and regulations that confine pedagogical practices. Second, the consumer technologies or the goods and services needed to sustain the rules that regulate pedagogy. Third is (...) organizational technology, or ways in which one might police and govern the use of the pedagogical practices. (shrink)

I have never doubted that the problem of inequalities in health status and access to needed care is a difficult ethical and political challenge. After reading the essays in Understanding Health Inequalities and Justice: New Conversations across the Disciplines, edited by Mara Buchbinder, Michele Rivkin-Fish, and Rebecca Walker, I concluded that despair was the only suitable response in the face of daunting ethical and political complexity. The editors of this volume have three questions in mind that they asked contributors to (...) address. How do scholars from various disciplines approach relations between health inequalities and ideals of justice? Social scientists want to offer empirical descriptions of inequalities in health status across a range of social groups, but there are numerous ways of offering such descriptions. Are they all “correct”? Philosophers and medical ethicists want to make normative judgments regarding which inequalities matter, ethically speaking. So do we need to know when considerations of justice are relevant to assessing health inequalities and which considerations of justice are most relevant in specific contexts? Ultimately, the question is which of these scholarly approaches is most useful for improving health policy. (shrink)