An absolute decline in US life expectancy in low education whites has alarmed policy makers and attracted media attention. Depending on which studies are correct, low education white women have lost between 3 and 5 years of lifespan; men, between 6 months and 3 years. Although absolute declines in life expectancy are relatively rare, some commentators see the public alarm as reflecting a racist concern for white lives over black ones. How ought we ethically to evaluate this lifespan contraction in (...) low education whites? Should we care, or is it racist to care? Does it constitute an injustice or reflect justice being done? I argue that the lifespan contraction in low education whites violates key normative criteria used to make determinations of health justice, and that these judgments do not vitiate concerns about racism. I conclude with reflections on US population health policy and building an inclusive health equity movement. (shrink)

Background This paper describes the design, implementation, and process outcomes from three public deliberations held in three tribal communities. Although increasingly used around the globe to address collective challenges, our study is among the first to adapt public deliberation for use with exclusively Indigenous populations. In question was how to design deliberations for tribal communities and whether this adapted model would achieve key deliberative goals and be well received.Methods We adapted democratic deliberation, an approach to stakeholder engagement, for use with (...) three tribal communities to respect tribal values and customs. Public deliberation convenes people from diverse backgrounds in reasoned reflection and dialogue in search of collective solutions. The deliberation planning process and design were informed by frameworks of enclave deliberation and community-based participatory research, which share key egalitarian values. The deliberations were collaboratively designed with tribal leadership and extensive partner input and involvement in the deliberations. Each deliberation posed different, locally relevant questions about genomic research, but used the same deliberation structure and measures to gauge the quality and experience of deliberation.Results A total of 52 individuals participated in the deliberations across all three sites. Deliberants were balanced in gender, spanned decades in age, and were diverse in educational attainment and exposure to health research. Overall, the deliberations were positively evaluated. Participant perceptions and external observer datasets depict three deliberations that offered intensive conversation experiences in which participants learned from one another, reported feeling respected and connected to one another, and endorsed this intensive form of engagement.Conclusion The adapted deliberations achieved key deliberative goals and were generally well received. Limitations of the study are described. (shrink)

Book reviewed in this article: Reshaping the Female Body: The Dilemma of Cosmetic Surgery. By Kathy Davis.

Persons of low socioeconomic status generallyexperience worse health and shorter lives thantheir better off counterparts. They alsosuffer a greater incidence of adversepsychosocial characteristics, such as lowself-esteem, self-efficacy, and self-masteryand increased cynicism and hostility. Thesepopulation data suggest another category ofharm to persons: diminished moral agency. Chronic socioeconomic deprivation can createenvironments that undermine the development ofself and capacities constitutive to moralagency – i.e., the capacity forself-determination and crafting a life of one''sown. The harm affects not only the choicesa person makes, but the (...) chooser herself. Thismoral harm is particularly salient in modernWestern societies, especially in the UnitedStates, where success and failure is attributedto the individual, with little notice of thelarger social and political realities thatinform an individual''s circumstances and choices. (shrink)

Childhood obesity may have severe long‐term consequences for health—indeed, for the overall course of a person's life. Do these harms amount to a problem of social justice? And if so, what should be done about it? Parents are usually granted considerable leeway to make decisions that affect their children's health. Social and moral theory has often overlooked the family, however, leaving us with an inadequateunderstanding of parental autonomy and of how social policy may influence it.

Childhood obesity may have severe long-term consequences for health—indeed, for the overall course of a person's life. Do these harms amount to a problem of social justice? And if so, what should be done about it? Parents are usually granted considerable leeway to make decisions that affect their children's health. Social and moral theory has often overlooked the family, however, leaving us with an inadequate understanding of parental autonomy and of how social policy may influence it.

Critics from a variety of camps have argued that bioethics has suffered an indifference to Cases have been described as thin and the selves inhabiting them hollow. This criticism has been driven at least in part by a reworked conception of the self. The rational and autonomous self that once dominated bioethics discourse has been replaced with a more self, a self embedded in stories, relationships, families, communities, cultures, and other particularitythese differences—matter. They matter because they figure importantly into our (...) ethical analyses of cases, affecting, for example, how we interact with and treat patients. And with this shift has come increasing attention to the processes of moral inquiry that enable inquirers to gather all of this moral information and find their way from complex cases to context-sensitive responses. (shrink)

Among the greatest challenges to improving health is determining how cultural diversity should influence healthcare practices and organizations, public health measures, biomedical research, and community partnering. Important but seldom addressed are challenges for bioethicists.

Shift work is a fixture of our 24-hour economy, with approximately 18 per cent of workers in the USA engaging in shift work, many overnight. Since shift work has been linked to an increased risk for an array of serious maladies, including cardiometabolic disorders and cancer, and is done disproportionately by the poor and by minorities, shift work is a highly prevalent economic and occupational health disparity. Here we draw primarily on the state of science around shift work and breast (...) cancer to argue that shift work represents a public health threat serious enough to warrant a precautionary stance. We use the precautionary principle to advance our case and view it as a moral compass for shift work research, empowering public health to cast shift work within the domain of health disparities deserving action despite scientific uncertainty. With the precautionary principle, we call for a deliberative decision-making process and formation of a broad shift work research collaboration to protect the health of many millions who work at night. (shrink)

This essay argues that a failure to think and talk critically and candidly about White privilege and White poverty is a key threat to the United States of America's precarious democracy. Whiteness frames one of America's most pressing collective challenges—the poor state of the nation's health, which lags behind other wealthy nations and is marred by deep and entrenched class‐ and race‐based inequities. The broadscale remedies experts recommend demand what is in short supply: trust in evidence, experts, government, and one (...) another. The authors’ prescription is threefold, beginning with a call for intersectional health studies and reports that avoid one‐dimensional misrepresentations of widespread health problems as simply Black or White problems. Second, there is the need for a “critical consciousness” about race and class. Lastly, the essay calls for widescale opportunities for Americans to engage in cross‐racial and cross‐class democratic conversations about their struggles and aspirations in search of common ground. (shrink)

Social work and bioethics are fields deeply committed to cross-disciplinary collaboration to do their respective work. While scholars and practitioners from both fields share a commitment to social justice and to respecting the dignity, integrity and the worth of all persons, the overlap between the fields, including shared values, has received little attention. The purpose of this article is to describe the ways in which greater collaboration between the two fields can broaden their scope, enrich their scholarship, and better ground (...) their practice. We describe the potential for realizing such benefits in two areas – health care ethics consultation and social inequalities in health – arguing that the fields both complement and challenge one another, making them ideal partners for the interdisciplinary inquiry and problem-solving so often called for today in health and health care. (shrink)

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.

Among the greatest challenges to improving health is determining how cultural diversity should influence healthcare practices and organizations, public health measures, biomedical research, and community partnering. Important but seldom addressed are challenges for bioethicists.

Book reviewed in this article: Reshaping the Female Body: The Dilemma of Cosmetic Surgery. By Kathy Davis.