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Uzzi M, Whittaker S, Esposito MH, Dean LT, Buggs SA, Pollack Porter KM. Racial capitalism and firearm violence: Developing a theoretical framework for firearm violence research examining structural racism. Soc Sci Med 2024; 358:117255. [PMID: 39197276 DOI: 10.1016/j.socscimed.2024.117255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 08/05/2024] [Accepted: 08/14/2024] [Indexed: 09/01/2024]
Abstract
Despite the early promise of centering structural racism in explanatory models of firearm violence, there are noticeable gaps in what's been produced thus far; in particular, a deeper and more serious engagement with long-standing theories of racism is needed to further enrich our understanding of how structural inequalities produce unequal burdens of firearm-related harms. Thus, building on theories and concepts from a range of academic fields and Black philosophical perspectives, we developed a theoretical framework to help explain the role of place-based structural racism on firearm violence disparities. A central component of our framework is the concept racial capitalism, which contends that racial exploitation and the accumulation of assets depend on and reinforce one another. In this article, we present our framework and highlight how two processes related to racial capitalism-racialized dispossession and racialized spatial stigma-are connected with geographic disparities in firearm violence. We also present the results of an ecological cross-sectional study that reveals a potential key association between racial capitalism and firearm violence disparities on the neighborhood-level. We used a structural intersectionality approach and descriptive epidemiological methods to highlight and quantitatively describe spatial firearm violence disparities that could potentially be linked to the varying exposure of two dimensions of racial capitalism-historical redlining and contemporary racialized subprime mortgage lending. We found that sustained disadvantaged census tracts (tracts that were historically redlined and experienced higher contemporary subprime lending) experienced the highest burden of firearm violence in Baltimore City between 2015 and 2019. Our research suggests that racial capitalism could potentially be a root cause of firearm violence disparities. A theoretical framework based on racial capitalism can inform the development and usage of indicators and analytic methods for racism-related firearm violence research. Moreover, this framework can identify factors to prioritize in equity-based violence prevention policies and programs.
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Affiliation(s)
- Mudia Uzzi
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 750 East Pratt Street, 15th floor, Baltimore, MD, 21202, USA.
| | - Shannon Whittaker
- Department of Social and Behavioral Sciences, Yale School of Public Health, USA
| | | | - Lorraine T Dean
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
| | - Shani A Buggs
- Department of Emergency Medicine, University of California, Davis, USA
| | - Keshia M Pollack Porter
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 750 East Pratt Street, 15th floor, Baltimore, MD, 21202, USA
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Creary MS, Peoples W, Fleming PJ. Health Equity Requires Working Toward Antiracist Local Public Health Departments. Public Health Rep 2024; 139:527-531. [PMID: 38519864 PMCID: PMC11344980 DOI: 10.1177/00333549241237382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024] Open
Affiliation(s)
- Melissa S. Creary
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Whitney Peoples
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Paul J. Fleming
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Pecker LH, Cameron K. Sickle cell disease and infertility risks: implications for counseling and care of affected girls and women. Expert Rev Hematol 2024; 17:493-504. [PMID: 38913857 PMCID: PMC11293988 DOI: 10.1080/17474086.2024.2372320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 06/21/2024] [Indexed: 06/26/2024]
Abstract
INTRODUCTION Sickle cell disease (SCD), its treatments and cures present infertility risks. Fertility counseling is broadly indicated for affected girls and women and fertility preservation may appeal to some. Several streams of evidence suggest that the reproductive lifespan of women with SCD is reduced. Pregnancy is associated with high miscarriage rates. There are enduring questions about the effects of highly effective hydroxyurea treatment on female fertility. Current conditioning regimens for gene therapy or hematopoietic stem cell transplant are gonadotoxic. Fertility preservation methods exist as non-experimental standards of care for girls and women. Clinicians are challenged to overcome multifactorial barriers to incorporate fertility counseling and fertility preservation care into routine SCD care. AREAS COVERED Here we provide a narrative review of existing evidence regarding fertility and infertility risks in girls and women with SCD and consider counseling implications of existing evidence. EXPERT OPINION Addressing fertility for girls and women with SCD requires engaging concerns that emerge across the lifespan, acknowledging uncertainty and identifying barriers to care, some of which may be insurmountable without public policy changes. The contemporary SCD care paradigm can offer transformative SCD treatments alongside comprehensive counselling that addresses fertility risks and fertility preservation opportunities.
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Affiliation(s)
- Lydia H. Pecker
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Katie Cameron
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Reproductive Endocrinology and Infertility, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Ferryman K, Cesare N, Creary M, Nsoesie EO. Racism is an ethical issue for healthcare artificial intelligence. Cell Rep Med 2024; 5:101617. [PMID: 38897175 PMCID: PMC11228769 DOI: 10.1016/j.xcrm.2024.101617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 06/21/2023] [Accepted: 05/23/2024] [Indexed: 06/21/2024]
Abstract
There is growing attention and evidence that healthcare AI is vulnerable to racial bias. Despite the renewed attention to racism in the United States, racism is often disconnected from the literature on ethical AI. Addressing racism as an ethical issue will facilitate the development of trustworthy and responsible healthcare AI.
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Affiliation(s)
- Kadija Ferryman
- Johns Hopkins Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Nina Cesare
- Biostatistics and Epidemiology Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - Melissa Creary
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Elaine O Nsoesie
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Conn CAI, Creary MS, Desine S, Bonham VL. "Resilience?" perspectives from adults living with sickle cell disease. J Natl Med Assoc 2024; 116:219-227. [PMID: 38538428 DOI: 10.1016/j.jnma.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/21/2023] [Accepted: 01/02/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES This study examines and explores the definition of resilience in adults living with sickle cell disease (SCD) in the United States (U.S.). METHODS Participants were recruited between 2014 and 2018, from across the U.S. as part of Insights into Microbiome and Environmental Contributions to Sickle Cell Disease and Leg Ulcers Study (INSIGHTS). Inclusion criteria included age of 18+, a diagnosis of SCD, and completion of the Brief Resilience Scale (BRS). Thirty participants were randomly selected, 15 each from the lowest and highest BRS quartile. A semi-structured qualitative interview was administered. All participants identified as Black with an average age of 42.5 (13 F, 17 M). RESULTS Three main concepts emerged in response to the question "How do you define resilience?" (a) not giving up (b) how one deals with challenges and (c) moving forward. CONCLUSION This study suggests that current definitions of resilience used in validated survey measures do not match how adults living with SCD define resilience. Our results expand the understanding of resilience as a dynamic process, more about the process of "not giving up." These findings suggest that providers may find it productive to facilitate conversations with adults living with SCD around "how" they approach challenges. This study is also the first of its kind to examine resilience in a community living with SCD.
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Affiliation(s)
- Corinne April I Conn
- University of California Los Angeles Harbor, 100 W Carson St. Torrance CA 90502, USA.
| | - Melissa S Creary
- Department of Health Management and Policy, School of Public Health, University of Michigan, 500 S State St, Ann Arbor, MI 48109, USA
| | - Stacy Desine
- Department of Medicine, Division of Cardiovascular Medicine and Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University School of Medicine, 1161 21st Ave S # D3300, Nashville, TN 37232, USA
| | - Vence L Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, 10 Center Dr, Bethesda, MD 20814, USA
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Griffith DM. Antiracism and Health Equity Science: Overcoming Scientific Obstacles to Health Equity. Public Health Rep 2024; 139:288-293. [PMID: 38504480 PMCID: PMC11037222 DOI: 10.1177/00333549241236089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Affiliation(s)
- Derek M. Griffith
- Center for Men’s Health Equity, Georgetown University, Washington, DC, USA
- Racial Justice Institute, Georgetown University, Washington, DC, USA
- Department of Health Management and Policy, School of Health, Georgetown University, Washington, DC, USA
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Hogan T, Mancia A, Ndiaye K, Rodriguez B, Najand B, Zare H, Assari S. Highly Educated Black Americans Report Higher than Expected Perceived Job Demands. JOURNAL OF REHABILITATION THERAPY 2023; 5:11-17. [PMID: 38742232 PMCID: PMC11089532 DOI: 10.29245/2767-5122/2024/2.1138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Background Educational attainment has well established and widely recognized the effects on employment conditions and job demands. However, the way in which educational attainment correlates with perceived job demands may be inconsistent across racial groups as suggested by Minorities' Diminished Returns (MDRs). The aim was to test the moderating effect of race on the association between educational attainment and perceived job demands, particularly for Black and White individuals. Methods This study was a cross-sectional analysis of MIDUS Refresher 1, including 1,232 Black and White adults over the age of 25 in the United States. Education attainment was the independent variable and perceived job demands was the dependent variable covariates. Linear regression was used for multivariate models. Results- We observed positive association between education and perceived job demands, however, statistical interaction between race and education suggested stronger positive associations for Black than White individuals. Conclusion Being a highly educated Black professional in the United States equals high demand such increase stress is a risk factor of being a middle class black American. Innovated and bold market policies are required to solve this unfair dilemma.
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Affiliation(s)
- Tiffany Hogan
- Department of Urban Public Health, Charles R. Drew University of Medicine, Los Angeles, California, United States
| | - Amy Mancia
- Department of Urban Public Health, Charles R. Drew University of Medicine, Los Angeles, California, United States
| | - Kanah Ndiaye
- Department of Urban Public Health, Charles R. Drew University of Medicine, Los Angeles, California, United States
| | - Brenda Rodriguez
- Department of Urban Public Health, Charles R. Drew University of Medicine, Los Angeles, California, United States
| | - Babak Najand
- Marginalization-related Diminished Returns Center, Los Angeles, California, United States
| | - Hossein Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
- School of Business, University of Maryland Global Campus (UMGC), Adelphi, 20783, USA
| | - Shervin Assari
- Department of Urban Public Health, Charles R. Drew University of Medicine, Los Angeles, California, United States
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California, United States
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Pecker LH, Akinsete AM, Carroll CP, Lanzkron S, Kuo KHM, Hulbert M, Stenger E, Darbari DS. Life after sickle cell disease, is it really uhuru? Lancet Haematol 2023; 10:e946-e949. [PMID: 38030314 PMCID: PMC10957145 DOI: 10.1016/s2352-3026(23)00306-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Lydia H Pecker
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; Department of Gynecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Adeseye M Akinsete
- Department of Pediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | - C Patrick Carroll
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sophie Lanzkron
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Kevin H M Kuo
- Division of Hematology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Monica Hulbert
- Division of Pediatric Hematology, Department of Pediatrics, Washington University, St Louis, MO, USA
| | - Elizabeth Stenger
- Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Deepika S Darbari
- Division of Hematology, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Spector-Bagdady K, Armoundas AA, Arnaout R, Hall JL, Yeager McSwain B, Knowles JW, Price WN, Rawat DB, Riegel B, Wang TY, Wiley K, Chung MK. Principles for Health Information Collection, Sharing, and Use: A Policy Statement From the American Heart Association. Circulation 2023; 148:1061-1069. [PMID: 37646159 PMCID: PMC10912036 DOI: 10.1161/cir.0000000000001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
The evolution of the electronic health record, combined with advances in data curation and analytic technologies, increasingly enables data sharing and harmonization. Advances in the analysis of health-related and health-proxy information have already accelerated research discoveries and improved patient care. This American Heart Association policy statement discusses how broad data sharing can be an enabling driver of progress by providing data to develop, test, and benchmark innovative methods, scalable insights, and potential new paradigms for data storage and workflow. Along with these advances come concerns about the sensitive nature of some health data, equity considerations about the involvement of historically excluded communities, and the complex intersection of laws attempting to govern behavior. Data-sharing principles are therefore necessary across a wide swath of entities, including parties who collect health information, funders, researchers, patients, legislatures, commercial companies, and regulatory departments and agencies. This policy statement outlines some of the key equity and legal background relevant to health data sharing and responsible management. It then articulates principles that will guide the American Heart Association's engagement in public policy related to data collection, sharing, and use to continue to inform its work across the research enterprise, as well as specific examples of how these principles might be applied in the policy landscape. The goal of these principles is to improve policy to support the use or reuse of health information in ways that are respectful of patients and research participants, equitable in impact in terms of both risks and potential benefits, and beneficial across broad and demographically diverse communities in the United States.
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Platt J, Nong P, Merid B, Raj M, Cope E, Kardia S, Creary M. Applying anti-racist approaches to informatics: a new lens on traditional frames. J Am Med Inform Assoc 2023; 30:1747-1753. [PMID: 37403330 PMCID: PMC10531112 DOI: 10.1093/jamia/ocad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/22/2023] [Accepted: 06/28/2023] [Indexed: 07/06/2023] Open
Abstract
Health organizations and systems rely on increasingly sophisticated informatics infrastructure. Without anti-racist expertise, the field risks reifying and entrenching racism in information systems. We consider ways the informatics field can recognize institutional, systemic, and structural racism and propose the use of the Public Health Critical Race Praxis (PHCRP) to mitigate and dismantle racism in digital forms. We enumerate guiding questions for stakeholders along with a PHCRP-Informatics framework. By focusing on (1) critical self-reflection, (2) following the expertise of well-established scholars of racism, (3) centering the voices of affected individuals and communities, and (4) critically evaluating practice resulting from informatics systems, stakeholders can work to minimize the impacts of racism. Informatics, informed and guided by this proposed framework, will help realize the vision of health systems that are more fair, just, and equitable.
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Affiliation(s)
- Jodyn Platt
- Department of Learning Health Sciences, University of Michigan Medical School, 300 North Ingalls, Suite 1161, Ann Arbor, Michigan, USA
| | - Paige Nong
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Beza Merid
- School for the Future of Innovation in Society, Arizona State University, Tempe, Arizona, USA
| | - Minakshi Raj
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana Champaign, Champaign, Illinois, USA
| | | | - Sharon Kardia
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Melissa Creary
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Galasso I, Geiger S. Genetic research and the collective good: participants as leaders to reconcile individual and public interests. JOURNAL OF MEDICAL ETHICS 2023:jme-2022-108867. [PMID: 37673669 DOI: 10.1136/jme-2022-108867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 08/12/2023] [Indexed: 09/08/2023]
Abstract
This paper problematises the notions of public or common good as weighed against individual sovereignty in the context of medical research by focusing on genetic research. We propose the notion of collective good as the good of the particular collective in which the research was conducted. We conducted documentary and interview-based research with participant representatives and research leaders concerned with participant involvement in leading genetic research projects and around two recent genetic data controversies: the case of the UK Wellcome Sanger Institute, accused of planning unauthorised commercialisation of African DNA samples, and the case of the company Genuity Science, which planned genetic research on brain tumour samples in Ireland with no explicit patient consent. We advocate for greater specificity in circumscribing the collective to which genetic research relates and for greater efforts in including representatives of this collective as research coleaders in order to enable a more inclusive framing of the good arising from such research. Such community-based participant cogovernance and coleadership in genetic research is vital especially when minorities or vulnerable groups are involved, and it centrally requires community capacity building to help collectives articulate their own notions of the collective good.
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Affiliation(s)
- Ilaria Galasso
- School of Business, UCD, Dublin, Ireland
- Institute of History and Ethics in Medicine, Technical University of Munich, Munich, Germany
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Creary M, Gerido LH. The Public Performativity of Trust. Hastings Cent Rep 2023; 53 Suppl 2:S76-S85. [PMID: 37963054 PMCID: PMC10810237 DOI: 10.1002/hast.1527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Building trust between academic medical centers and certain communities they depend on in the research process is hard, particularly when those communities consist of minoritized or historically marginalized populations. Some believe that engagement activities like the creation of advisory boards, town halls, or a research workforce that looks more like community members will establish or reestablish trust between academic medical centers and racialized communities. However, without systematic approaches to dismantle racism, those well-intended actions become public performativity, and trust building will fail. In this essay, we draw upon foundational ethical principles of trust, distrust, and trust building; apply the concept of bounded justice to performative trust acts; and center the works of Black and Indigenous feminist bioethicists to revisit some of the wisdom and valuable lessons they have contributed. Rebuilding trust is hard to do because people and institutions are often not honest about how hard it is and there is no simple box-checking task that can disentangle our society's injustices, but there are steps to take in this direction. Individuals and institutions can recognize valuable relevant work that has already been written, partake in critical reflection, and then apply insights gained to take both small and sustainable steps toward transformational change and deeper trust.
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Affiliation(s)
- Melissa Creary
- University of Michigan, School of Public Health, Ann Arbor, MI, USA
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Abstract
Biomedical research recruitment today focuses on including participants representative of global genetic variation-rightfully so. But ethnographic attention to practices of inclusion highlights how this agenda often transforms into "predatory inclusion," simplistic pushes to get Black and brown people into genomic databases. As anthropologists of medicine, we argue that the question of how to get from diverse data to concrete benefit for people who are marginalized cannot be presumed to work itself out as a byproduct of diverse datasets. To actualize the equitable translation of genomics, practitioners need to place the impacts of ancestral genetic difference in the scope of much more impactful social determinants. For this to happen, multidisciplinary expertise needs to be leveraged, and current, structurally unequal health care systems ultimately need to transform. As modest steps toward this goal, new models for benefit-sharing must be developed and implemented to mitigate existing inequality between data donors and the entities profiting from that data.
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Creary MS. Racism and the Textures of Visibility. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:109-110. [PMID: 37339290 DOI: 10.1080/15265161.2023.2207522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
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Adsit-Morris C, Collins RN, Goering S, Karabin J, Lee SSJ, Reardon J. Unbounding ELSI: The Ongoing Work of Centering Equity and Justice. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:103-105. [PMID: 37339305 PMCID: PMC11034805 DOI: 10.1080/15265161.2023.2214055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
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Hull SC, Brody LC, Sterling R. Getting It Right: How Public Engagement Might (and Might Not) Help Us Determine What Is Equitable in Genomics and Precision Medicine. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:5-8. [PMID: 37339317 DOI: 10.1080/15265161.2023.2215154] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Affiliation(s)
| | - Lawrence C Brody
- National Human Genome Research Institute, National Institutes of Health
| | - Rene Sterling
- National Human Genome Research Institute, National Institutes of Health
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Braun M, Bleher H, Hille EM, Krutzinna J. Tackling Structural Injustices: On the Entanglement of Visibility and Justice in Emerging Technologies. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:100-102. [PMID: 37339313 DOI: 10.1080/15265161.2023.2207514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
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Dolan DD, Cho MK, Lee SSJ. Innovating for a Just and Equitable Future in Genomic and Precision Medicine Research. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:1-4. [PMID: 37353052 PMCID: PMC10339710 DOI: 10.1080/15265161.2023.2215201] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Affiliation(s)
- Deanne Dunbar Dolan
- Center for ELSI Resources and Analysis (CERA), Stanford University School of Medicine, Stanford, CA, USA
| | - Mildred K. Cho
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA, USA
| | - Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities & Ethics, Columbia University, New York, NY, USA
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Nong P, El-Azab S. Hypervisibility, Surveillance, and Bounded Justice through Data-Driven Health Equity Efforts. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:115-117. [PMID: 37339315 DOI: 10.1080/15265161.2023.2207516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
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Ferryman K. Bounded Justice, Inclusion, and the Hyper/Invisibility of Race in Precision Medicine. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023:1-7. [PMID: 37220019 DOI: 10.1080/15265161.2023.2207515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
I take up the call for a more nuanced engagement with race in bioethics by using Creary's analytic of bounded justice and argue that it helps illuminate processes of racialization, or racial formation, specifically Blackness, as a dialectical processes of both invisibility and hyper-visibility. This dialectical view of race provides a lens through which the ethical, legal, and social implications (ELSI) of genetics and genomics field can reflect on fraught issues such as inclusion in genomic and biomedical research. Countering or interrupting racialization in precision medicine can involve asking how marginalized groups are made invisible or hyper-visible in various aspects of the research process. Incorporating these kinds of questions into biomedical research inclusion efforts could lead to potentially powerful engagements with marginalized groups and could provide the opportunity for stakeholders to engage with the ways that racialization can happen in real-time and might undermine good intentions.
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Farrell TW, Greer AG, Bennie S, Hageman H, Pfeifle A. Academic Health Centers and the Quintuple Aim of Health Care. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:563-568. [PMID: 36255204 DOI: 10.1097/acm.0000000000005031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The Quintuple Aim of health care adds health equity to the existing Quadruple Aim of improving the individual experience of care for patients, improving the health of populations, reducing the per capita cost of care, and improving the experience of health care professionals. Health equity has previously been subsumed within the other 4 aims. Elevating health equity to the status of a distinct aim is necessary to address persistent health inequities that disproportionately affect underrepresented and minoritized groups. Academic health centers (AHCs) bear a unique responsibility to advance health equity due to the societal importance of their 4 missions: patient care, education, research, and community collaboration. Interprofessional education and practice provide natural connection points that enable AHCs to prepare both health professions students and practicing health care professionals to address all 5 aims. AHCs are well positioned to assess health outcomes related to health equity, develop a health care workforce that is representative of their communities, develop innovative research questions regarding health equity, and engage and invest in the communities they serve.
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Affiliation(s)
- Timothy W Farrell
- T.W. Farrell is professor of medicine and associate chief for age-friendly care, Division of Geriatrics, Department of Internal Medicine, Spencer Fox Eccles School of Medicine at the University of Utah, and physician investigator, VA Salt Lake City Geriatric Research, Education, and Clinical Center, Salt Lake City, Utah; ORCID: https://orcid.org/0000-0003-0070-8757
| | - Annette G Greer
- A.G. Greer is associate professor and vice chair of diversity, equity, and inclusion, Department of Bioethics and Interdisciplinary Studies, Brody School of Medicine, East Carolina University, Greenville, North Carolina; ORCID: https://orcid.org/0000-0002-2868-0306
| | - Scott Bennie
- S. Bennie is dean of academic affairs, Kettering College, Kettering, Ohio; ORCID: https://orcid.org/0000-0001-7601-452X
| | - Heather Hageman
- H. Hageman is director, Center for Interprofessional Practice and Education, Washington University Medical Center, a collaboration between Goldfarb School of Nursing at Barnes-Jewish College, the University of Health Sciences and Pharmacy in St Louis, and Washington University School of Medicine, St Louis, Missouri
| | - Andrea Pfeifle
- A. Pfeifle is professor of family and community medicine and associate vice chancellor for interprofessional practice and education, The Ohio State University and Wexner Medical Center, Columbus, Ohio
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22
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Peoples WA, Fleming PJ, Creary MS. Working Toward Health Equity Requires Antiracist Teaching. Am J Prev Med 2023; 64:604-608. [PMID: 36690544 DOI: 10.1016/j.amepre.2022.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 01/22/2023]
Affiliation(s)
- Whitney A Peoples
- School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Paul J Fleming
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Melissa S Creary
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan
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23
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Hendy K, Mauri AI, Creary M. "Bounded Equity: The Limits of Economic Models of Social Justice in Cannabis Legislation". CONTEMPORARY DRUG PROBLEMS 2023; 50:121-135. [PMID: 37502491 PMCID: PMC10373104 DOI: 10.1177/00914509221147133] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Social equity provisions in cannabis legislation are premised on the hope that the profit generated around adult-use cannabis can be leveraged to ameliorate the damage done by racially biased enforcement of prohibition in black and brown communities. As such, they encapsulate an attempt to reconcile the history of racism in the enforcement of cannabis law through its new future as a profit generating commodity. These programs are gaining traction, but with minimal empirical examination. The development and implementation of these programs raises a number of questions in need of study that we outline in this paper. We argue that Creary's concept of bounded justice-which critiques the inherent limitations of social justice projects that ignore structural forms of social exclusion-can provide a framework for critical understanding of the limitations of such programs, ethnographically grounded empirical research, and a framework for evaluating the justice impacts of legislation. Specifically, we argue that in order to interrogate the possibilities for social justice projects around cannabis, we must address equity at a deeper level by working with communities to investigate hyper-localized and historical factors that have influenced systems and structures.
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Affiliation(s)
- Katherine Hendy
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Amanda I. Mauri
- Department of Political Science, University of Michigan, Ann Arbor, MI, USA
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Melissa Creary
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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24
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Byams VR, Baker JR, Bailey C, Connell NT, Creary MS, Curtis RG, Dinno A, Guelcher CJ, Kim M, Kulkarni R, Lattimore S, Norris KL, Ramirez L, Skinner MW, Symington S, Tobase P, Vázquez E, Warren BB, Wheat E, Buckner TW. Building the foundation for a community-generated national research blueprint for inherited bleeding disorders: research priorities in health services; diversity, equity, and inclusion; and implementation science. Expert Rev Hematol 2023; 16:87-106. [PMID: 36920863 PMCID: PMC11075128 DOI: 10.1080/17474086.2023.2183836] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/20/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND The National Hemophilia Foundation (NHF) conducted extensive all-stakeholder inherited bleeding disorder (BD) community consultations to inform a blueprint for future research. Sustaining and expanding the specialized and comprehensive Hemophilia Treatment Center care model, to better serve all people with inherited BDs (PWIBD), and increasing equitable access to optimal health emerged as top priorities. RESEARCH DESIGN AND METHODS NHF, with the American Thrombosis and Hemostasis Network (ATHN), convened multidisciplinary expert working groups (WG) to distill priority research initiatives from consultation findings. WG5 was charged with prioritizing health services research (HSR); diversity, equity, and inclusion (DEI); and implementation science (IS) research initiatives to advance community-identified priorities. RESULTS WG5 identified multiple priority research themes and initiatives essential to capitalizing on this potential. Formative studies using qualitative and mixed methods approaches should be conducted to characterize issues and meaningfully investigate interventions. Investment in HSR, DEI and IS education, training, and workforce development are vital. CONCLUSIONS An enormous amount of work is required in the areas of HSR, DEI, and IS, which have received inadequate attention in inherited BDs. This research has great potential to evolve the experiences of PWIBD, deliver transformational community-based care, and advance health equity.
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Affiliation(s)
- Vanessa R. Byams
- Division of Blood Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Judith R. Baker
- Center for Inherited Blood Disorders, Western States Regional Hemophilia Network, Orange, California, USA
| | - Cindy Bailey
- Los Angeles Orthopaedic Hemophilia Treatment Center, Los Angeles, California, USA
| | - Nathan T. Connell
- Boston Hemophilia Center, Division of Hematology, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa S. Creary
- American Thrombosis and Hemostasis Network, Rochester, New York, USA
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Randall G. Curtis
- Hematology Utilization Group Study (HUGS), University of Southern California, Los Angeles, California, USA
- Hemophilia Foundation of Southern California, Pasadena, California, USA
| | - Alexis Dinno
- The Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Christine J. Guelcher
- Hemostasis and Thrombosis Program, Children’s National Hospital, Washington, DC, USA
| | - Michelle Kim
- The Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
| | - Roshni Kulkarni
- MSU Center of Bleeding and Clotting Disorders, Department Pediatrics and Human Development, Michigan State University, East Lansing, Michigan, USA
| | - Susan Lattimore
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
- Mountain States Regional Hemophilia Network, Portland, Oregon, USA
| | | | - Lucy Ramirez
- Rush Hemophilia and Thrombophilia Treatment Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Mark W. Skinner
- Institute for Policy Advancement, Washington, DC, USA
- Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Patricia Tobase
- University of California San Francisco Hemophilia Treatment Center, University of California San Francisco, San Francisco, California, USA
| | | | - Beth B. Warren
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Hemophilia and Thrombosis Center, Division of Hematology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Emily Wheat
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Hemophilia and Thrombosis Center, Division of Hematology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Tyler W. Buckner
- Hemophilia and Thrombosis Center, Division of Hematology, University of Colorado School of Medicine, Aurora, Colorado, USA
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25
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Fleming PJ, Stone LC, Creary MS, Greene-Moton E, Israel BA, Key KD, Reyes AG, Wallerstein N, Schulz AJ. Antiracism and Community-Based Participatory Research: Synergies, Challenges, and Opportunities. Am J Public Health 2023; 113:70-78. [PMID: 36516389 PMCID: PMC9755941 DOI: 10.2105/ajph.2022.307114] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 12/15/2022]
Abstract
Structural racism causes stark health inequities and operates at every level of society, including the academic and governmental entities that support health research and practice. We argue that health research institutions must invest in research that actively disrupts racial hierarchies, with leadership from racially marginalized communities and scholars. We highlight synergies between antiracist principles and community-based participatory research (CBPR), examine the potential for CBPR to promote antiracist research and praxis, illustrate structural barriers to antiracist CBPR praxis, and offer examples of CBPR actions taken to disrupt structural racism. We make recommendations for the next generation of antiracist CBPR, including modify health research funding to center the priorities of racially marginalized communities, support sustained commitments and accountability to those communities by funders and research institutions, distribute research funds equitably across community and academic institutions, amplify antiracist praxis through translation of research to policy, and adopt institutional practices that support reflection and adaptation of CBPR to align with emergent community priorities and antiracist practices. A critical application of CBPR principles offers pathways to transforming institutional practices that reproduce and reinforce racial inequities. (Am J Public Health. 2023;113(1):70-78. https://doi.org/10.2105/AJPH.2022.307114).
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Affiliation(s)
- Paul J Fleming
- Paul J. Fleming, Melissa S. Creary, Barbara A. Israel, and Amy J. Schulz are with the School of Public Health, University of Michigan, Ann Arbor. Lisa Cacari Stone and Nina Wallerstein are with the College of Population Health, University of New Mexico, Albuquerque. Ella Greene-Moton is with Community Based Organizations Partners, Flint, MI. Kent D. Key is with the Division of Public Health, Michigan State University, East Lansing. Angela G. Reyes is with the Detroit Hispanic Development Corporation, Detroit, MI
| | - Lisa Cacari Stone
- Paul J. Fleming, Melissa S. Creary, Barbara A. Israel, and Amy J. Schulz are with the School of Public Health, University of Michigan, Ann Arbor. Lisa Cacari Stone and Nina Wallerstein are with the College of Population Health, University of New Mexico, Albuquerque. Ella Greene-Moton is with Community Based Organizations Partners, Flint, MI. Kent D. Key is with the Division of Public Health, Michigan State University, East Lansing. Angela G. Reyes is with the Detroit Hispanic Development Corporation, Detroit, MI
| | - Melissa S Creary
- Paul J. Fleming, Melissa S. Creary, Barbara A. Israel, and Amy J. Schulz are with the School of Public Health, University of Michigan, Ann Arbor. Lisa Cacari Stone and Nina Wallerstein are with the College of Population Health, University of New Mexico, Albuquerque. Ella Greene-Moton is with Community Based Organizations Partners, Flint, MI. Kent D. Key is with the Division of Public Health, Michigan State University, East Lansing. Angela G. Reyes is with the Detroit Hispanic Development Corporation, Detroit, MI
| | - Ella Greene-Moton
- Paul J. Fleming, Melissa S. Creary, Barbara A. Israel, and Amy J. Schulz are with the School of Public Health, University of Michigan, Ann Arbor. Lisa Cacari Stone and Nina Wallerstein are with the College of Population Health, University of New Mexico, Albuquerque. Ella Greene-Moton is with Community Based Organizations Partners, Flint, MI. Kent D. Key is with the Division of Public Health, Michigan State University, East Lansing. Angela G. Reyes is with the Detroit Hispanic Development Corporation, Detroit, MI
| | - Barbara A Israel
- Paul J. Fleming, Melissa S. Creary, Barbara A. Israel, and Amy J. Schulz are with the School of Public Health, University of Michigan, Ann Arbor. Lisa Cacari Stone and Nina Wallerstein are with the College of Population Health, University of New Mexico, Albuquerque. Ella Greene-Moton is with Community Based Organizations Partners, Flint, MI. Kent D. Key is with the Division of Public Health, Michigan State University, East Lansing. Angela G. Reyes is with the Detroit Hispanic Development Corporation, Detroit, MI
| | - Kent D Key
- Paul J. Fleming, Melissa S. Creary, Barbara A. Israel, and Amy J. Schulz are with the School of Public Health, University of Michigan, Ann Arbor. Lisa Cacari Stone and Nina Wallerstein are with the College of Population Health, University of New Mexico, Albuquerque. Ella Greene-Moton is with Community Based Organizations Partners, Flint, MI. Kent D. Key is with the Division of Public Health, Michigan State University, East Lansing. Angela G. Reyes is with the Detroit Hispanic Development Corporation, Detroit, MI
| | - Angela G Reyes
- Paul J. Fleming, Melissa S. Creary, Barbara A. Israel, and Amy J. Schulz are with the School of Public Health, University of Michigan, Ann Arbor. Lisa Cacari Stone and Nina Wallerstein are with the College of Population Health, University of New Mexico, Albuquerque. Ella Greene-Moton is with Community Based Organizations Partners, Flint, MI. Kent D. Key is with the Division of Public Health, Michigan State University, East Lansing. Angela G. Reyes is with the Detroit Hispanic Development Corporation, Detroit, MI
| | - Nina Wallerstein
- Paul J. Fleming, Melissa S. Creary, Barbara A. Israel, and Amy J. Schulz are with the School of Public Health, University of Michigan, Ann Arbor. Lisa Cacari Stone and Nina Wallerstein are with the College of Population Health, University of New Mexico, Albuquerque. Ella Greene-Moton is with Community Based Organizations Partners, Flint, MI. Kent D. Key is with the Division of Public Health, Michigan State University, East Lansing. Angela G. Reyes is with the Detroit Hispanic Development Corporation, Detroit, MI
| | - Amy J Schulz
- Paul J. Fleming, Melissa S. Creary, Barbara A. Israel, and Amy J. Schulz are with the School of Public Health, University of Michigan, Ann Arbor. Lisa Cacari Stone and Nina Wallerstein are with the College of Population Health, University of New Mexico, Albuquerque. Ella Greene-Moton is with Community Based Organizations Partners, Flint, MI. Kent D. Key is with the Division of Public Health, Michigan State University, East Lansing. Angela G. Reyes is with the Detroit Hispanic Development Corporation, Detroit, MI
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26
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Willison CE, Falkenbach M, Greer SL, Singer PM. Backsliding among indicators of democratic stability relevant to public health: Risks in OECD nations. WORLD MEDICAL & HEALTH POLICY 2022. [DOI: 10.1002/wmh3.558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Charley E. Willison
- Department of Public and Ecosystem Health Cornell University Ithaca New York USA
| | - Michelle Falkenbach
- Department of Public and Ecosystem Health Cornell University Ithaca New York USA
| | - Scott L. Greer
- Department of Health Management and Policy University of Michigan Ann Arbor Michigan USA
| | - Phillip M. Singer
- Department of Political Science University of Utah Salt Lake City Utah USA
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27
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Pecker LH, Nero A, Christianson M. No crystal stair: supporting fertility care and the pursuit of pregnancy in women with sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:459-466. [PMID: 36485154 PMCID: PMC9821326 DOI: 10.1182/hematology.2022000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Growing recognition that the ovary is an end organ in sickle cell disease (SCD), advances in SCD treatment and cure, and innovations in assisted reproductive technologies invite progressive challenges in fertility care for women with SCD. The reproductive life span of women with SCD may be reduced because ovarian reserve declines more rapidly in people with SCD compared to unaffected people. Some young women have diminished ovarian reserve, a risk factor for infertility. Referrals for fertility preservation may be offered and anticipatory guidance about when to seek infertility care provided. For a subset of people with SCD, this information is also applicable when pursuing in vitro fertilization with preimplantation genetic testing to avoid implantation of an embryo with SCD. Here we explore the dimensions of SCD-related fertility care illustrated by the case of a 28-year-old woman with hemoglobin SS disease who initially presented for a hematology consultation for preconception counseling. This case highlights the complexity of preconception SCD management and care and the need to partner with patients to help align pregnancy hopes with SCD treatment and the many associated uncertainties.
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Affiliation(s)
- Lydia H. Pecker
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Reproductive Endocrinology and Infertility, Johns Hopkins University School of Medicine, Baltimore, MD
- Correspondence Lydia H. Pecker, 720 Rutland Ave, Ross Bldg 1025, Johns Hopkins University School of Medicine, Baltimore, MD 21205; e-mail:
| | - Alecia Nero
- Division of Hematology-Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Mindy Christianson
- Division of Reproductive Endocrinology and Infertility, Johns Hopkins University School of Medicine, Baltimore, MD
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28
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Galasso I. Inequalities in the Challenges Affecting Children and their Families during COVID-19 with School Closures and Reopenings: A Qualitative Study. Public Health Ethics 2022; 15:240-255. [PMID: 36727102 PMCID: PMC9883729 DOI: 10.1093/phe/phac030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Indexed: 12/15/2022] Open
Abstract
School closure is one of the most debated measures undertaken to contain the spread of the Coronavirus disease (COVID-19) pandemic. The pandemic has devastating health and socio-economic effects and must be contained, but schools play a vital role in present and future well-being, capabilities and health of children. We examine the detrimental consequences of both the closure and reopening of schools, by focusing on inequalities in the challenges affecting children and their families. This paper is grounded on Irish and Italian data from a multi-national longitudinal qualitative interview study. Research participants articulated a variety of issues and challenges that highlight inequalities in access to education during school closures, in the supportiveness of home setting, and in school preparedness to reopen, often mirroring or exacerbating pre-existing inequalities. The reported unequal lived experiences indicate that some harms are actionable, and already suggest some potential harm mitigation strategies. We conclude by advocating for enhanced public consultation to help mitigate the consequences of public dilemmas in general, and to help detect and tackle inadequacies and inequalities for school children through and beyond the pandemic, by learning from the experience of the concerned actors.
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29
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Rubyan M, Trinidad MG, Ryan KA, Spiroff M, Goold S, Burns J, Calhoun K, Rowe Z, Büyüktür AG, Piechowski P, Platt J. A conceptual framework for clinical and translational virtual community engagement research. J Clin Transl Sci 2022; 6:e136. [PMID: 36590362 PMCID: PMC9794960 DOI: 10.1017/cts.2022.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction The COVID-19 pandemic accelerated a trend for clinical and translational community-engaged research in adapting to an increasingly virtual landscape. This requires a framework for engagement distinct from in-person research and program activities. We reflect on four case studies of community engagement activities that inform a conceptual framework to better integrate the virtual format into community-engaged research reflecting key tenets of health equity and antiracist praxis. Methods Four projects were selected by community-engaged research stakeholders for an in-depth review based on how much the virtual transition impacted activities such as planning, recruitment, and data collection for each project. Transitions to virtual engagement were assessed across ten areas in which community engagement has been demonstrated to make a positive impact. Results Our analysis suggests a conceptual evaluation framework in which the ten community engagement areas cluster into four interrelated domains: (1) development, design, and delivery; (2) partnership and trust building; (3) implementation and change; and (4) ethics and equity. Conclusions The domains in this conceptual framework describe critical elements of community engaged research and programs consistent with recommendations for health equity informed meaningful community engagement from the National Academy of Medicine. The conceptual framework and case studies can be used for evaluation and to develop guidelines for clinical and translational researchers utilizing the virtual format in community-engaged research.
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Affiliation(s)
- Michael Rubyan
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI, USA
| | - M. Grace Trinidad
- National Hemophilia Program Coordinating Center, American Thrombosis & Hemostasis Network, Rochester, NY, USA
| | - Kerry A. Ryan
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Meghan Spiroff
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - Susan Goold
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jade Burns
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI, USA
- School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Karen Calhoun
- Michigan Institute for Clinical & Health Research, University of Michigan, Ann Arbor, MI, USA
| | | | - Ayşe G. Büyüktür
- Michigan Institute for Clinical & Health Research, University of Michigan, Ann Arbor, MI, USA
- School of Information, University of Michigan, Ann Arbor, MI, USA
| | - Patricia Piechowski
- Michigan Institute for Clinical & Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Jodyn Platt
- Institute for Healthcare Policy & Innovation, University of Michigan, Ann Arbor, MI, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
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30
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Valentino LA, Witkop ML, Santaella ME, DiMichele D, Recht M. Building the blueprint: Formulating a community-generated national plan for future research in inherited bleeding disorders. Haemophilia 2022; 28:760-768. [PMID: 35700441 PMCID: PMC9546016 DOI: 10.1111/hae.14588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/13/2022] [Accepted: 05/01/2022] [Indexed: 11/28/2022]
Abstract
Introduction Decades of inherited bleeding disorders (BD) research transformed severe haemophilia from a childhood killer to a disorder managed across a full lifespan for many in economically developed countries. Health equity, a life unimpaired by disease complications, however, remains unimaginable for most people with an inherited BD (PWIBD). Aim The National Hemophilia Foundation (NHF) and American Thrombosis and Hemostasis Network (ATHN) undertook the development of a community‐driven United States (US) National Blueprint for Inherited Bleeding Disorders Research to transform the experience of all PWIBD and those who care for them. Methods Extensive community consultations were conducted to identify the issues most important to PWIBD and those who love and care for them. Expert multidisciplinary teams distilled these key areas of need into prioritised research questions, and identified the resources and infrastructure required to pursue them. A summit was held to gather feedback and inform the detailed blueprint. Results Community‐prioritised research areas fell into three broad categories: issues common across inherited BDs, those specific to individual disorders, and issues of infrastructure and capacity. NHF State of the Science Research Summit discussions of the research questions derived from the community priorities by six working groups provided important input for the drafting of the research blueprint for the coming decades. Conclusion The inherited BD community came together to develop the US National Blueprint for Inherited Bleeding Disorders Research dedicated to transforming the lives of all PWIBD including innovating solutions for the rarest disorders and under‐represented populations.
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Affiliation(s)
- Leonard A Valentino
- National Hemophilia Foundation, New York, New York, USA.,Internal Medicine and Pediatrics, Rush University, Chicago, Illinois, USA
| | | | | | - Donna DiMichele
- Donna DiMichele Consulting, LLC, Washington, D.C., USA.,Department of Pediatrics, Weill Cornell Medical College, New York, New York, USA
| | - Michael Recht
- American Thrombosis and Hemostasis Network, Rochester, New York, USA
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31
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Merid B, Cielito Robles M, Nallamothu BK, Newman MW, Skolarus LE. Viewing Mobile Health Technology Design Through the Lens of Amplification Theory. JMIR Mhealth Uhealth 2022; 10:e31069. [PMID: 35687411 PMCID: PMC9233258 DOI: 10.2196/31069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 03/31/2022] [Accepted: 04/29/2022] [Indexed: 12/03/2022] Open
Abstract
Digital health interventions designed to promote health equity can be valuable tools in the delivery of health care to hardly served patient populations. But if the design of these technologies and the interventions in which they are deployed do not address the myriad structural barriers to care that minoritized patients, patients in rural areas, and patients who have trouble paying for care often face, their impact may be limited. Drawing on our mobile health (mHealth) research in the arena of cardiovascular care and blood pressure management, this viewpoint argues that health care providers and researchers should tend to structural barriers to care as a part of their digital health intervention design. Our 3-step predesign framework, informed by the Amplification Theory of Technology, offers a model that interventionists can follow to address these concerns.
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Affiliation(s)
- Beza Merid
- School for the Future of Innovation in Society, Arizona State University, Tempe, AZ, United States
| | - Maria Cielito Robles
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Brahmajee K Nallamothu
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Mark W Newman
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Lesli E Skolarus
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, United States
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32
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Washburn L, Norman-Burgdolf H, Jones N, Kennedy LE, Jarvandi S. Exploring Extension Agent Capacity and Readiness to Adopt Policy, Systems and Environmental Change Approaches. Front Public Health 2022; 10:856788. [PMID: 35719657 PMCID: PMC9200894 DOI: 10.3389/fpubh.2022.856788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Enhanced Extension outreach strategies combine traditional direct education programs with public health approaches like policy, systems, and environmental (PSE) change. However, the Cooperative Extension system and county-based Family and Consumer Sciences (FCS) Extension agents have historically prioritized direct education programming and diffusion of enhanced outreach strategies has varied. Extension personnel may lack capacity and readiness for successful PSE change implementation. This study explored perceived acceptability, capacity, and readiness for PSE change work among FCS Extension agents in two states. Method A survey was developed framed by selected domains from the Consolidated Framework for Implementation Research: Intervention Characteristics, Inner Setting, Characteristics of Individuals, and Process. All questions utilized a 5-point Likert scale, except for an item examining respondents' stage of change regarding PSE change strategies. Descriptive statistics and response frequencies for all variables were calculated. Results Survey responses (n = 116) indicated PSE change work was perceived as valuable. Potential barriers included perceived complexity, organizational readiness issues (e.g., reporting and evaluation structures; performance incentives), and worries about stakeholder responses in shifting away from direct education. Responses indicated self-efficacy for skills important in implementing PSE change. Most respondents (53%) indicated being at the pre-contemplation or contemplation stage of change in pursuing PSE change work. Discussion Combining PSE change strategies and direct education programming allows Extension to do what it does best – provide effective programs to improve and sustain health and wellbeing of individuals and families. Findings are informative for others aiming to build capacity within community educators, Extension and public health professionals to implement PSE change.
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Affiliation(s)
- Lisa Washburn
- Department of Family and Consumer Sciences, Institute of Agriculture, University of Tennessee, Knoxville, TN, United States
- *Correspondence: Lisa Washburn
| | - Heather Norman-Burgdolf
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY, United States
| | - Natalie Jones
- Family and Consumer Sciences Extension, University of Kentucky, Lexington, KY, United States
| | - Lauren E. Kennedy
- Health and Nutrition Institute, Michigan State University Extension, East Lansing, MI, United States
| | - Soghra Jarvandi
- Department of Family and Consumer Sciences, Institute of Agriculture, University of Tennessee, Knoxville, TN, United States
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Michener J, LeBrón AMW. Racism, Health, and Politics: Advancing Interdisciplinary Knowledge. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2022; 47:111-130. [PMID: 34522971 DOI: 10.1215/03616878-9517149] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Spector-Bagdady K, Tang S, Jabbour S, Price WN, Bracic A, Creary MS, Kheterpal S, Brummett CM, Wiens J. Respecting Autonomy And Enabling Diversity: The Effect Of Eligibility And Enrollment On Research Data Demographics. Health Aff (Millwood) 2021; 40:1892-1899. [PMID: 34871076 DOI: 10.1377/hlthaff.2021.01197] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Many promising advances in precision health and other Big Data research rely on large data sets to analyze correlations among genetic variants, behavior, environment, and outcomes to improve population health. But these data sets are generally populated with demographically homogeneous cohorts. We conducted a retrospective cohort study of patients at a major academic medical center during 2012-19 to explore how recruitment and enrollment approaches affected the demographic diversity of participants in its research biospecimen and data bank. We found that compared with the overall clinical population, patients who consented to enroll in the research data bank were significantly less diverse in terms of age, sex, race, ethnicity, and socioeconomic status. Compared with patients who were recruited for the data bank, patients who enrolled were younger and less likely to be Black or African American, Asian, or Hispanic. The overall demographic diversity of the data bank was affected as much (and in some cases more) by which patients were considered eligible for recruitment as by which patients consented to enroll. Our work underscores the need for systemic commitment to diversify data banks so that different communities can benefit from research.
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Affiliation(s)
- Kayte Spector-Bagdady
- Kayte Spector-Bagdady is an assistant professor of obstetrics and gynecology and an associate director of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan Medical School, in Ann Arbor, Michigan. Spector-Bagdady, Shengpu Tang, and Sarah Jabbour are co-first authors
| | - Shengpu Tang
- Shengpu Tang is a PhD candidate in computer science and engineering at the University of Michigan, in Ann Arbor, Michigan
| | - Sarah Jabbour
- Sarah Jabbour is a PhD candidate in computer science and engineering at the University of Michigan
| | - W Nicholson Price
- W. Nicholson Price II is a professor of law at the University of Michigan Law School, in Ann Arbor, Michigan
| | - Ana Bracic
- Ana Bracic is an assistant professor of political science and a member of the Minority Politics Initiative at Michigan State University, in East Lansing, Michigan
| | - Melissa S Creary
- Melissa S. Creary is an assistant professor of health management and policy at the University of Michigan School of Public Health, in Ann Arbor, Michigan, and the senior director for the Office of Public Health Initiatives at the American Thrombosis and Hemostasis Network (ATHN), in Rochester, New York
| | - Sachin Kheterpal
- Sachin Kheterpal is a professor of anesthesiology and the associate dean for research information technology at the University of Michigan Medical School
| | - Chad M Brummett
- Chad M. Brummett is a professor of anesthesiology and senior associate chair for research at the University of Michigan Medical School
| | - Jenna Wiens
- Jenna Wiens is an associate professor of computer science and engineering, associate director of the Artificial Intelligence Lab, and codirector for Precision Health at the University of Michigan
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Sullivan LS, Sade RM. INTRODUCTION: Race and Ethnicity in 21st Century Health Care. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2021; 49:165-167. [PMID: 34924054 DOI: 10.1017/jme.2021.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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