Ethical challenges in health care during collective hunger strikes in public or occupied spaces

Public collective hunger strikes take place in complex social and political contexts, require medical attention and present ethical challenges to physicians. Empirical research, the ethical debate to date and existing guidelines by the World Medical Association focus almost exclusively on hunger strikes in detention. However, the public space differs substantially with regard to the conditions for the provision of health care and the diverse groups of healthcare providers or stakeholders involved. By reviewing empirical research on the experience of health professionals with public collective hunger strikes, we identified the following ethical challenges: (1) establishment of a trustful physician-striker relationship, (2) balancing of medico-ethical principles in medical decision-making, (3) handling of loyalty conflicts and (4) preservation of professional independence and the risk of political instrumentalization. Some of these challenges have already been described and discussed, yet not contextualized for public collective strikes, while others are novel. The presence of voluntary physicians may offer opportunities for a trustful relationship and, hence, for ethical treatment decisions. According to our findings, it requires more attention to how to realise autonomous medical decisions in the complex context of a dynamic, often unstructured and politically charged setting, which ethical norms should shape the professional role of voluntary physicians, and what is the influence of the hunger strikers' collective on individual healthcare decisions. Our article can serve as a starting point for further ethical discussion. It can also provide the basis for the development of potential guidelines to support health professionals involved in public collective hunger strikes.

"A prison is no place for a pandemic": Canadian prisoners' collective action in the time of COVID-19

Since the onset of COVID-19, social protest has expanded significantly. Little, however, has been written on prison-led and prison justice organizing in the wake of the pandemic-particularly in the Canadian context. This article is a case study of prisoner organizing in Canada throughout the first 18 months of COVID-19, which draws on qualitative interviews, media, and documentary analysis. We argue that the pandemic generated conditions under which the grievances raised by prisoners, and the strategies through which they were articulated, made possible a discursive bridge to the anxieties and grievances experienced by those in the community, thinning the walls of state-imposed societal exclusion. We demonstrate that prisons are sites of fierce contestation and are deeply embedded in, rather than separate from, our society. An important lesson learned from this case study is the need for prison organizing campaigns to strategically embrace multi-issue framing and engage in sustained coalition building.

The delivery of health services as resistance

In this article, I will argue that the delivery of healthcare could be an act of resistance, that is, day-to-day, routine and perhaps mundane acts, undertaken in the course of the delivery of health services, which for many could also be considered otherwise routine care. I first consider how resistance has been conceptualised. How we understand resistance will determine if we believe healthcare could be conceptualised this way. I will show how resistance has been applied to day-to-day struggles elsewhere and argue that it can clearly encompass open, collective dissent and more subtle, day-to-day action that does not necessarily make clear political demands. I go on to introduce some examples, where the delivery of health services could be conceptualised as resistance. While I advocate for a broad understanding of resistance, clearly not every act could be considered resistance; I will consider some points of tension and contention in utilising resistance to describe the delivery of health services, in particular discussing the issue of intent and opposition as they relate to resistance. Finally, while I hope that I make a convincing case, one final issue remains, namely, why turn to resistance at all, when many of the examples that I provide could be labelled using concepts that are more widely utilised. I will offer some general reflections on this point, speaking to the benefits and potential of resistance.

A deliberative framework to assess the justifiability of strike action in healthcare

Healthcare strikes have been a remarkably common and varied phenomenon. Strikes have taken a number of forms, lasting from days to months, involving a range of different staff and impacting a range of healthcare systems, structured and resourced vastly differently. While there has been much debate about strike action, this appears to have done little to resolve the often polarising debate that surrounds such action. Building on the existing normative literature and a recent synthesis of the empirical literature, this paper will present a deliberative framework to assess the justifiability of strike action. I will first review the empirical literature that explores the impact of strike action, on patient outcomes and healthcare delivery. I will then discuss the debates that have occurred in this area, including an existing deliberative framework proposed by Selemogo (2014). I will argue that this framework is overly restrictive in that it could lead us to find otherwise justified strike action, unjust. I will then propose a framework that remedies these shortcomings. The framework outlines two broad conditions that should be met if strike action is to be justified. It then goes on to outline two deliberative, interrelated questions that should be used to assess whether strike action meets these conditions. For the purposes of this framework, healthcare strike action is justified when 1) it makes demands or raises grievances about some form of injustice, unfairness or threat to health and when 2) the risks in striking are proportionate to its demands or grievances. These two conditions should be considered in light of two further questions, namely, the 3) social and political context of the strike and 4) the characteristics of the strike. I will offer some further reflections on the application of this framework and its shortcomings.

Facultative symbiont virulence determines horizontal transmission rate without host strain specificity

In facultative symbioses, only a fraction of hosts are associated with a symbiont. Understanding why specific host and symbiont strains are associated can inform us of the evolutionary forces affecting facultative symbioses. Possibilities include ongoing host-symbiont coevolution driven by reciprocal selection, or priority effects that are neutral in respect to the host-symbiont interaction. We hypothesized that ongoing host-symbiont coevolution would lead to higher fitness estimates for naturally co-occurring (native) host and symbiont combinations compared to nonnative combinations. We used the Dictyostelium discoideum - Paraburkholderia bonniea system to test this hypothesis. P. bonniea features a reduced genome size relative to another Paraburkholderia symbiont of D. discoideum, indicating a significant history of coevolution with its host. Facultative symbionts may experience continued genome reduction if coevolution is ongoing, or their genome size may have reached a stable state if the symbiosis has also stabilized. Our work demonstrates that ongoing coevolution is unlikely for D. discoideum and P. bonniea. The system instead represents a stable facultative symbiosis. Specifically associated host and symbiont strains in this system are the result of priority effects, and presently unassociated hosts are simply uncolonized. We find evidence for a virulence-transmission trade-off without host strain specificity, and identify candidate virulence factors in the genomes of P. bonniea strains that may contribute to variation in benevolence.

Exploring the concept of non-violent resistance amongst healthcare workers

BACKGROUND

Non-violent resistance which has involved healthcare workers has been instrumental in securing a number of health-related gains and a force in opposing threats to health. Despite this, we know little about healthcare workers who have engaged in acts of non-violent resistance.

RESEARCH AIM

Amongst a sample of healthcare workers who had engaged in acts of resistance this study sought to explore their understanding of non-violent resistance and how or whether they felt healthcare workers made a distinct contribution to such action.

RESEARCH DESIGN

Cross-sectional survey.

PARTICIPANTS AND RESEARCH CONTEXT

Healthcare workers (doctors, nurses, academics and others) from the UK and Europe who had engaged in acts of non-violent resistance.

ETHICAL CONSIDERATIONS

Ethical approval for this study was granted by the University of Greenwich Human Research Ethics Committee (UREC/20.5.6.11).

FINDINGS/RESULTS

Most participants spoke about the nature of non-violent resistance, its oppositional, didactic and symbolic functions and the role of violence or harm. While most people understood non-violent resistance as a public, oppositional and collective act, many identified more subtle everyday acts in the workplace that undermined policy or procedures they saw as harmful. When asked about distinctions in non-violent resistance carried out by healthcare workers, most participants referred to their standing in society, noting that healthcare works were a trusted and authoritative source. Some identified an ethical imperative to act while others identified the risks that came with such action, noting their accountability and responsibility they had to patients. About a quarter of participants felt that such action was no different to others carrying out non-violent resistance or dependent on the issue or nature of the action.

CONCLUSIONS

These findings speak to the complex and multifaceted nature of non-violent resistance. Additionally our findings suggest healthcare workers have a distinct role to play in leading and supporting non-violent actions.

Anarchy and Its Overlooked Role in Health and Healthcare

In this paper, I will argue that a number of well-known health interventions or initiatives could be considered anarchist, or at the very least are consistent with anarchist thinking and principles. In doing this I have two aims: First, anarchism is a misunderstood term-by way of example, I hope to first sketch out what anarchist solutions in health and healthcare could look like; second, I hope to show how anarchist thought could stand as a means to improve the health of many, remedying health inequalities acting as a buffer for the many harms that threaten health and well-being. On this second point, I will argue that there are a number of theoretical and instrumental reasons why greater engagement with anarchism and anarchist thinking is needed, along with how this could contribute to health and in addressing broader injustices that create and perpetuate poor health.

In sight, in mind: Spatial proximity to protest sites and changes in peoples' political attitudes

Occupying public spaces can be an effective tactic for conveying a semantic message of protest and gaining wider support; however, it may also severely disrupt the everyday lives of non-participants and causes a backfire. Therefore, it remains unclear whether and how the occupy movements have shifted political attitudes among the general public. Bringing a social-spatial perspective to the case of the Occupy Central Movement (OCM) in Hong Kong, this study investigates how the attitudinal impact of occupation has varied according to people's spatial proximity to the protest sites. Using two waves of individual-level panel data collected right before and after the OCM and detailed geo-information on the respondents' home addresses and the occupied areas, we apply a difference-in-differences (DIDs) design to identify the causal link between space and attitudes. In addition, propensity score matching (PSM) methods are used to ensure the comparability of nearby and faraway residents. The results show that after the OCM, residents living near the occupied areas not only maintained their support for the pro-democracy camp but also became more liberal as compared to faraway residents. This phenomenon can be explained by the "on-site" effect, which suggests that the direct exposure to protestors' solidarity and the repressive actions of authorities arouse bystanders' sympathy for the protestors and support for their political cause. Such influence appears to be long-lasting and can be evidenced by the local election results after the protest.

The impact of strike action on healthcare delivery: A scoping review

BACKGROUND

Strike action carried out by healthcare workers raises a range of ethical issues. Most fundamentally, as a strike is designed to disrupt, it has the potential to impact patient outcomes and healthcare delivery. This paper synthesises and analyses the empirical literature that details the impact of strike action on healthcare delivery.

METHODS

A systematic scoping review was utilised to examine the extent, range and nature of research activity. Embase, Medline, CINAHL, Bioethicsline, EconLit and Web of Science were searched, yielding 5644 results. Papers were included if they examined the impact that strike action had on healthcare delivery (i.e., admissions, presentations, waiting time). After screening, 43 papers met inclusion criteria.

RESULTS

Nineteen studies explored presentations to emergency or admissions to hospital. Both dropped dramatically when comparing non-strike to strike periods. Ten studies examined length of stay in hospital and waiting times. No clear relationship was found with strike action, with some studies showing that wait times decreased. Nine studies examined the impact of strike action in facilities that were not on strike, but were impacted by nearby strike action along with the impact that strike action had on treatment seeking. Hospitals dealing with these upstream impacts often saw increase in presentations at hospitals, but results relates to treatment seeking during strike action were mixed.

CONCLUSION

Strike action can have a substantial impact on the delivery of healthcare, but this impact is not felt uniformly across services. While many services are disrupted, a number are not, with several studies reporting increased efficiency.

The impact of health care strikes on patient mortality: A systematic review and meta-analysis of observational studies

OBJECTIVE

This study sought to evaluate the impact of health care strike action on patient mortality.

DATA SOURCES

EMBASE, PubMed CINAHL, BIOETHICSLINE, EconLit, WEB OF SCIENCE, and grey literature were searched up to December 2021.

STUDY DESIGN

A systematic review and meta-analysis were utilized.

DATA COLLECTION/EXTRACTION

Random-effects meta-analysis was used to compare mortality rate during strike versus pre- or post-strike, with meta-regression employed to identify factors that might influence the potential impact of strike action. Studies were included if they were observational studies that examined in-hospital/clinic or population mortality during a strike period compared with a control period where there was no strike action.

PRINCIPAL FINDINGS

Seventeen studies examined mortality: 14 examined in-hospital mortality and three examined population mortality. In-hospital studies represented 768,918 admissions and 7191 deaths during strike action and 1,034,437 admissions and 12,676 deaths during control periods. The pooled relative risk (RR) of in-hospital mortality did not significantly differ during strike action versus non-strike periods (RR = 0.91, 95% confidence interval 0.63, 1.31, p = 0.598). Meta-regression also showed that mortality RR was not significantly impacted by country (p = 0.98), profession on strike (p = 0.32 for multiple professions, p = 0.80 for nurses), the duration of the strike (p = 0.26), or whether multiple facilities were on strike (p = 0.55). Only three studies that examined population mortality met the inclusion criteria; therefore, further analysis was not conducted. However, it is noteworthy that none of these studies reported a significant increase in population mortality attributable to strike action.

CONCLUSIONS

Based on the data available, this review did not find any evidence that strike action has any significant impact on in-hospital patient mortality.

The squeaky wheel gets the grease: Violent civil unrest and global social assistance provision

What are the contemporary determinates of social assistance provision? What is the role of contentious politics? Social assistance literature is dominated by economic and demographic accounts, which under-examine the possibility that governments extend social assistance to contain social unrest. We test factors associated with these "structuralist" and "political" theories on a new panel dataset which includes 54 OECD and emerging market countries between 2002 and 2015. The results indicate social assistance coverage has a significant positive relationship with riots. We explain this outcome as policymakers expanding social assistance as a means of containing violent civil unrest. This effect is more significant in emerging markets, suggesting that the domination of structural explanations is a result of sample bias toward the OECD. Finally, we find that governments consider World Bank social policy recommendations only insofar as there is violent unrest.

Aftermath of anti-police protests in Nigeria: Burden and predictors of psychiatric morbidity among protesters and non-protesters

OBJECTIVES

Anti-police (#EndSARS) protests took place in October 2020 across several Nigerian cities, resulting in deaths, injuries and loss of property, but the psychological sequelae of these protests have not been studied.

METHOD

In a cross-sectional online survey, we collected data on psychiatric morbidity and potential risk factors from 426 Nigerian social media users, who self-identified as participants or non-participants in a recent anti-police protest.

RESULTS

We found elevated rates of psychiatric morbidity, with worse outcomes for protesters compared to non-protesters (psychological distress [44.2% vs 29.8%], depression [26.0% vs 14.9%], anxiety [51.0% vs 29.8%], post-traumatic stress disorder [7.4% vs 1.8%], current substance use [11.2% vs 4.5%] and suicidal ideation [7.1% vs 4.4%], respectively). After adjusting for the effects of COVID-19 pandemic and previous mental health diagnosis, the predictors of poor mental health among non-protesters were being unmarried (odds ratio = 7.4, p = 0.01) and low resilience (odds ratio range = 4.1-5.4, p < 0.03) while for the protesters, the predictors were low resilience (odds ratio range = 2.9-4.7, p < 0.01), being from Northern Nigeria (odds ratio = 4.7, p < 0.01) or residing in Northern Nigeria (odds ratio = 2.8, p = 0.03), being under-/unemployed (odds ratio range = 2.1-2.5, p < 0.04), holding the view that the protest was caused by the state of the economy (odds ratio = 2.0, p = 0.01), belief that the protest had a direct negative impact on the protester (odds ratio = 2.3, p = 0.04) and willingness to participate in future protests (odds ratio = 4.13, p = 0.02).

CONCLUSION

We conclude that participating in the #EndSARS protest was associated with significant psychiatric morbidity. There is need to recognise and address the mental health sequelae of collective actions, and invest in programmes that build resilience and address socio-political determinants of mental health, especially with a focus on youth.

Discursive Strategies of Blaming: The Language of Judgment and Political Protest Online

Modern politics is permeated by blame games-symbolic struggles over the blameworthiness or otherwise of various social actors. In this article, we develop a framework for identifying different strategies of blaming that protesters use on social media to criticize and delegitimize governments and political leaders. We draw on the systemic functional linguistic theory of Appraisal to distinguish between blame attributions based on negative judgments of the target's (1) capacity, such as references to their incompetence and policy failures; (2) veracity, questioning their truthfulness or honesty via references to deceitful character or dishonest acts and utterances; (3) propriety, questioning their moral standing by references to, for instance, corruption; and (4) tenacity, suggesting that the politicians are not dependable due to, for example, dithering. We add to this a further threefold distinction based on whether blaming is focused on the target's (1) bad character, (2) bad behavior, or (3) negative outcomes that the target either caused or did not prevent from happening. To illustrate the approach, we analyze a corpus of replies by Twitter users to tweets by British government ministers about two highly contentious issues, Covid-19 and Brexit, in 2020-2021. We suggest that the methodology outlined here could provide a useful avenue for systematically revealing and comparing a variety of realizations of blaming in large datasets of online conflict talk, thereby providing a more fine-grained understanding of the practices of protest and delegitimation in modern politics.

Legislation, activism and power play - Medical education policies in colonial and post-colonial India

Colonial medical education and public health policies emerged from an intriguing discourse of negotiation between the government and the people. These 'structured conflicts', rooted in the politics and the debates of the colonial institutions not only provided opportunities for creative thinking about public health but also for imposing constraints. The colonial and post-colonial India medical legislative debates revealing a new language of protest, assumed greater significance with the growing nationalist movement and the general (though variegated) intellectual polarisation - western and indigenous systems of medicine. Problematising the historiographic assertion of medical modernisation in colonial India to be a part of 'civilising mission', this paper argues that legislature emerged as a platform of activism and protest against the colonial and post-colonial State's appropriation of modernity. While some members appealed for extending the benefit of 'modern' western medicine to the general Indian population, some debated in favour of introducing the indigenous medical systems to the terms of modern professionalisation. The post-colonial policies reveal the true significance of the legislative debates in reviving the position of indigenous systems of medicine in the context of professional modernity.

Intersectionality within the racial justice movement in the summer of 2020

In an environment that is high in racial justice saliency, how do identities inform motivation for supporting specific issues in the crowd? This study examines the role that intersectionality played in mobilizing participants to join the mass demonstrations sparked by the murder of George Floyd. Building on recent studies that show how protest participants connect issue-based concerns with their identities to boost support for movements, we analyze data collected through surveys with a random sample of activists participating in the protests after George Floyd's death in Washington, DC, in 2020. We find that intersectional motivations played a significant role in mobilizing protest participants. Analysis of these factors helps explain the diversity of the crowd and provides insights into how the movement may contribute to greater success for racial justice and the degree to which the movement has staying power.

Applying the Dynamic Dual Pathway Model of Approach Coping to Collective Action Among Advantaged Group Allies and Disadvantaged Group Members

We apply the dynamic dual pathway model of approach coping to understanding the predictors of future collective action among a sample of advantaged group allies and disadvantaged group members who were attending a protest. We propose that problem-focused approach coping (i.e., group efficacy beliefs) would be a stronger predictor of future collective action among disadvantaged compared to advantaged group members, and emotion-focused approach coping (i.e., group-based anger) would be a stronger predictor of future collective action among advantaged compared to disadvantaged group members. Data was collected from LGBTIQ+ and heterosexual people (N = 189) protesting as part of the 2019 Christopher Street Day Parade in Cologne, Germany. We found that increased group efficacy predicted intentions to engage in future collective action for the rights of sexual minorities among LGBTIQ+ but not heterosexual participants. Increased group-based anger was a predictor of future collective action intentions regardless of which group the participants belonged to. Our findings extend the dynamic dual pathway model by applying it to a sample of advantaged group allies and disadvantaged group members attending a protest using a multiple perspectives approach.

Intolerance of Transgressive Protest Actions: The Differential Roles of Deontological and Utilitarian Morality

The current research examines intolerance of protest actions by focusing on two major questions: (a) How intolerant are people of transgressive protest actions of their least-liked versus most-liked groups? and (b) how do individual differences in deontological and utilitarian moral predisposition relate to intolerance of transgressive protest actions by these two groups? In two survey-embedded experiments using nationally representative samples from two West European countries (Germany, Netherlands), we found that people were overwhelmingly intolerant of morally transgressive protest actions by both their most-liked and least-liked groups, although slightly less so for the former. In addition, deontological moral predisposition was related to increased intolerance of protest actions regardless of whether it was committed by a most-liked or least-liked group. Individual difference in utilitarian moral predisposition was related to increased acceptance of protest actions regardless of group, but especially when the actions were perceived as serving the greater good.

The language of less-lethal weapons

It has been over 1 year since we observed the policing of the George Floyd protests in the United States [R. R. Hardeman, E. M. Medina, R. W. Boyd, N. Engl. J. Med. 383, 197-199 (2020)]. Multiple injury reports emerged in medical journals, and the scientific community called for law enforcement to discontinue the use of less-lethal weapons [E. A. Kaske et al., N. Engl. J. Med. 384, 774-775 (2021) and K. A. Olson et al., N. Engl. J. Med. 383, 1081-1083 (2020)]. Despite progress in research, policy change has not followed a similar pace. Although the reasoning for this discrepancy is multifactorial, failure to use appropriate language may be one contributing factor to the challenges faced in updating policies and practices. Here, we detail how language has the potential to influence thinking and decision-making, we discuss how the language of less-lethal weapons minimizes harm, and we provide a framework for naming conventions that acknowledges harm.

Psychosocial Correlates of Reactive and Proactive Aggression among Protesters during the Social Movement in Hong Kong

This pioneering study examined how psychosocial factors predicted reactive and proactive aggression among adolescents and young adults in Hong Kong during the Anti-Extradition Bill Movement. A total of 1027 local secondary and tertiary students (578 male, 449 female) aged from 12 to 25 years (M = 16.95, SD = 3.30) completed a questionnaire measuring political participation and attitudes, victimization experiences, aggression, life satisfaction, moral disengagement, and psychopathic traits. ANCOVA and multiple linear regression analyses were performed. The results revealed that compared with non-protesters, protestors had more negative traits and poorer well-being (higher levels of reactive aggression, moral disengagement, narcissism, and impulsivity; lower life satisfaction; more experiences of victimization by strangers related to political disputes). Nonetheless, protesters had similar psychosocial correlates of reactive and proactive aggression when compared to the non-protesters. Among the protesters, reactive aggression was positively predicted by anger towards the government, moral justification, diffusion of responsibility, impulsivity, and narcissism and negatively predicted by satisfaction with the government, advantageous comparison, and dehumanization. Furthermore, proactive aggression was positively predicted by narcissism, euphemistic language, and advantageous comparison and negatively predicted by moral justification. The implications of the findings for psychotherapy, school education, parenting, and social policies are discussed.

The justification for strike action in healthcare: A systematic critical interpretive synthesis

Strike action in healthcare has been a common global phenomenon. As such action is designed to be disruptive, it creates substantial ethical tension, the most cited of which relates to patient harm, that is, a strike may not only disrupt an employer, but it could also have serious implications for the delivery of care. This article systematically reviewed the literature on strike action in healthcare with the aim of providing an overview of the major justifications for strike action, identifying relative strengths and shortcomings of this literature and providing direction for future discussions, and theoretical and empirical research. Three major themes emerged related to (1) the relationship between healthcare workers, patients and society; (2) the consequences of strike action; and (3) the conduct of strike action. Those who argue against strike action generally cite the harms of such action, particularly as it relates to patients. Many also argue that healthcare workers, because of their skills and position in society, have a special obligation to their patients and society more generally. Those who see this action as not only permissible but also, in some cases, necessary have advanced several points in response, arguing that healthcare workers do not necessarily have any special obligation to their patients or society, and even if so, this obligation is not absolute. Overwhelmingly, when talking about the potential risks of strike action, authors have focused on patient welfare and the impact that a strike could have. Several directions for future work are identified, including greater explorations into how structural and systemic issues impact strike action, the need for greater consideration about the contextual factors that influence the risks and characteristics of strike action and finally the need to tie this literature to existing empirical evidence.

The impact of strike action on patient morbidity: A systematic literature review

Strike action in healthcare has been common over the last several decades. The overarching aim of this systematic review was to synthesise and analyse the empirical literature that examines the impact of strike action on patient morbidity, that is, all patient outcomes except mortality. After conducting a search and apply eligibility criteria, 15 studies were included in this review. These articles included a variety of outcomes from hypertension control to rates of chlamydia. Strikes ranged from 13 to 118 days, with a mean strike length of 56 days. A textual narrative synthesis was employed to arrange studies by whether they had a positive, mixed or neutral or negative impact on patient morbidity. Results suggest that strike action has little impact on patient morbidity. The majority of studies reported that strike action had a neutral or mixed impact of strike action on patient morbidity. One study reported positive outcomes and three studies reported negative outcomes, however in both cases, the impact that the strike had was marginal.

The strategy of protest against Covid-19 containment policies in Germany

OBJECTIVES

The article analyzes the epidemiological and political logics of protest against containment policies in Germany. To maximize the mobilization potential, protest organizers organize more protest events when Covid-19 mortality rates are low, the stringency of containment policies is high, and in districts in which the vote share of mainstream parties is traditionally low.

METHOD

Using a negative binomial model, we analyze the number of protest events in a sample of 401 German districts over the period from March to May 2020.

RESULTS

We find robust positive predicted effects of the stringency of containment policies and negative predicted effects for the mortality rate and the strengths of mainstream parties.

CONCLUSION

We interpret these findings as evidence of the strategic behavior of protest organizers that target protest participation and mobilization to keep the movement alive and potentially grow it.

The Psychological Burden of the COVID-19 Pandemic Is Associated With Antisystemic Attitudes and Political Violence

What are the consequences of the COVID-19 pandemic for people's political attitudes and behavior? We tested, specifically, whether the psychological burden of the COVID-19 pandemic relates to antisystemic attitudes (dissatisfaction with the fundamental social and political order), peaceful political activism, and political violence. Nationally representative two-wave panel data were collected via online surveys of adults in the United States, Denmark, Italy, and Hungary (ns = 6,131 and 4,568 in Waves 1 and 2, respectively). Overall, levels of antisystemic attitudes were low, and only a small share of interviewees reported behavioral intentions to participate in and actual participation in political violence. However, preregistered analyses indicated that perceived COVID-19 burden was associated with antisystemic attitudes and intentions to engage in political violence. In the United States, the burden of COVID-19 was also associated with self-reported engagement in violence surrounding the Black Lives Matter protests and counterprotests. We found less robust evidence that perceived COVID-19 burden was associated with peaceful activism.

Medicine in Unplanned Mass Gatherings: A Qualitative Study of Health-Care Providers' Response and Recommendations to Beirut's Protests

OBJECTIVE

This study aims at exploring the dynamics of health-care provision during recent unplanned public mass gatherings in Beirut, and how the health-care system adapts to mass movements in protests.

METHODS

A qualitative study was conducted using semi-structured interviews with 12 health-care providers who volunteered at medical tents set during protests in Beirut, Lebanon. Responses were transcribed and coded.

RESULTS

Three themes were noted: preparedness and logistics, encountered cases, and participants' proposed recommendations. In terms of preparedness and logistics, participants lacked knowledge of field medicine protocols and an organizational structure. They faced difficulties in securing equipment and advertising their services. Most encountered cases were physical injuries rather than mental health problems. The participants proposed both short-term recommendations, including advice on how to boost care provided, and long-term recommendations on structuring the health-care system to be better prepared.

CONCLUSIONS

On-site health-care provision during unplanned mass gatherings is a vital need. We recommend forming a task force of health-care workers from various fields led by the Ministry of Public Health in every respective country to plan protocols, train personnel, and secure resources beforehand.

Resistance in health and healthcare

In this article I will introduce and outline the concept of resistance as it relates to health and healthcare. Starting with a number of examples of action, I will then turn to the broader literature to discuss some conventional definitions and related concepts, outlining debates, controversies and limitations related to conceptualizing resistance. I conceptualize resistance broadly, as any act, performed by any individual (or collective) acting as or explicitly identifying as a healthcare professional, that is a response to power, most often in opposition to contentious, harmful or unjust rules, practices, policies or structures. Practically this could account for any public action, marches, sit-ins and civil disobedience, but also forms of 'everyday resistance', such as working slowly, feigning sickness, or even providing care for marginalized groups that would otherwise not have access. Such action could go unrecognized by those in power and perhaps more contentiously, those resisting needn't even recognize their actions as resistance. I will then apply this conceptualization to explain action that has been undertaken by healthcare professionals, identifying its key features. I will briefly discuss future directions for inquiry that appear particularly pressing. These including ongoing conceptual development, identifying the functions of resistance in health and healthcare along with what makes it distinct from healthcare as usual and other forms of resistance and finally, the range of normative questions resistance raises.

Populism and Protest

The essay considers populism in the present moment in relation to Black Lives Matter as a popular protest movement. Popular protest movements demand that government change; populism in the present moment seeks to act extra-governmentally, and to this end relies on violence in the face of peace protest movement. This violence demonstrates the white patriarchalism of contemporary populism. I argue that peaceful, popular protest is an important tool to resist white patriarchal populist authoritarianism.

Beyond Allyship: Motivations for Advantaged Group Members to Engage in Action for Disadvantaged Groups

White Americans who participate in the Black Lives Matter movement, men who attended the Women's March, and people from the Global North who work to reduce poverty in the Global South-advantaged group members (sometimes referred to as allies) often engage in action for disadvantaged groups. Tensions can arise, however, over the inclusion of advantaged group members in these movements, which we argue can partly be explained by their motivations to participate. We propose that advantaged group members can be motivated to participate in these movements (a) to improve the status of the disadvantaged group, (b) on the condition that the status of their own group is maintained, (c) to meet their own personal needs, and (d) because this behavior aligns with their moral beliefs. We identify potential antecedents and behavioral outcomes associated with these motivations before describing the theoretical contribution our article makes to the psychological literature.

Living in a Multi-Risk Chaotic Condition: Pandemic, Natural Hazards and Complex Emergencies

Humans are living in an uncertain world, with daily risks confronting them from various low to high hazard events, and the COVID-19 pandemic has created its own set of unique risks. Not only has it caused a significant number of fatalities, but in combination with other hazard sources, it may pose a considerably higher multi-risk. In this paper, three hazardous events are studied through the lens of a concurring pandemic. Several low-probability high-risk scenarios are developed by the combination of a pandemic situation with a natural hazard (e.g., earthquakes or floods) or a complex emergency situation (e.g., mass protests or military movements). The hybrid impacts of these multi-hazard situations are then qualitatively studied on the healthcare systems, and their functionality loss. The paper also discusses the impact of pandemic's (long-term) temporal effects on the type and recovery duration from these adverse events. Finally, the concept of escape from a hazard, evacuation, sheltering and their potential conflict during a pandemic and a natural hazard is briefly reviewed. The findings show the cascading effects of these multi-hazard scenarios, which are unseen nearly in all risk legislation. This paper is an attempt to urge funding agencies to provide additional grants for multi-hazard risk research.

Splintered politics of memory and community resistance

Oral history presents an especially effective way of exploring the multitudinous, contradictory, and contextual meanings that are attached to the notion of community. In this study, we argue for narrative-discourse analysis as a critical means of studying contested community memories. We rely on focus group discussions and individual interviews to explore oral histories of state-sanctioned relocation of residents of Thembelihle, a low-income community in Johannesburg, South Africa. Our analysis revealed the sharply splintered politics that characterizes oral histories of this community. We argue that oral histories, in their contradictory and visceral fullness, are able to point toward a politics of resistance that is sensitive to inequalities, and that are willed toward emancipatory future-building. We conclude by underlining the need for community psychologists to engage with a politics of memory that is sensitive to power differentials, historiography, and broader currents of oppression.

The Harmful Side of Thanks: Thankful Responses to High-Power Group Help Undermine Low-Power Groups' Protest

Giving thanks has multiple psychological benefits. However, within intergroup contexts, thankful responses from low-power to high-power group members could solidify the power hierarchy. The other-oriented nature of grateful expressions could mask power differences and discourage low-power group members from advocating for their ingroup interests. In five studies (N = 825), we examine the novel idea of a potentially harmful side of "thanks," using correlational and experimental designs and a follow-up. Across different contexts, expressing thanks to a high-power group member who transgressed and then helped undermined low-power group members' protest intentions and actual protest. Thus, the expression of thanks can pacify members of low-power groups. We offer insights into the underlying process by showing that forgiveness of the high-power benefactor and system justification mediate this effect. Our findings provide evidence for a problematic side of gratitude within intergroup relations. We discuss social implications.

'Embarrassing the State': The 'Ordinary' Prisoner Rights Movement in Ireland, 1972-6

This article explores the early years of the campaign for 'ordinary', not politically-aligned, prisoners' rights in Ireland. It argues that this campaign has often been overshadowed by the activities of 'political prisoners', who only constituted a small minority of prisoners in the period. The article follows the development and changing tactics of the ordinary prisoners' movement, through the rise and fall of the Prisoners' Union (PU) (1972-3) and into the early years of the Prisoners' Rights Organisation (PRO) (1973-6), which would become the longest-lasting and most vocal penal reform organisation in Ireland, until the formation of the Irish Penal Reform Trust in 1994. It argues that the movement constantly adapted its tactics to address emerging issues and opportunities. Ultimately, it contends that by 1976 the PRO was an increasingly legitimate voice in Ireland's public discourse on prisons. It shows that, although the campaign did not achieve any major penal reforms in this period, it had a significant impact on public debates about prisons, prisoners' mental health, the failures of the penal system, and prisoners' entitlement to human rights.

Cultures of conflict: Protests, violent repression, and community values

What are the cultural origins of societal conflicts that revolve around democratization, women's rights, and modern libertarian values? We propose that deep‐seated differences in community‐based collective values (at the micro‐level) may be related to why people support anti‐government protest and why they support repression of such protests (at the macro‐level). The hypothesis was examined among residents of Turkey (N = 500). Cultural values, measured at the individual level and community level with the community collectivism scale, correlated with political orientation and emotions, as well as with subsequent support for anti‐governmental protest or its repression. The main conclusions are that both support for protest and support for repression are related to the cultural values people hold and their subsequent political orientations and emotions. Micro‐level cultural values in local communities may thus play a role in explaining macro‐level socio‐political divides.

Explaining different orientations to the 2013 Gezi Park demonstrations in Istanbul, Turkey

Although a notable minority orient to real-world demonstrations by actively participating, other less involved, safer, orientations are more frequent. Thus, in the context of anti-government demonstrations in Gezi Park/Taksim Square in Istanbul, Turkey, in 2013, we distinguished between the orientations of participating, visiting, and watching. Study 1 (N = 359) and Study 2 (N = 327) confirmed that participating was characterized by greater experience of police violence and feelings of collective empowerment (Drury & Reicher, European Journal of Social Psychology, 35, 2005, 35) than visiting and watching the demonstrations. Expanding upon and replicating the findings from Study 1, Study 2 examined identification with protestors and left-wing ideology, along with constructs (social support, anger at the government, protestor's efficacy, endorsement of protestors) from the dynamic dual pathway model (van Zomeren et al., Personality and Social Psychology Review, 16, 2012, 180) as predictors of the three different orientations to the demonstrations. As expected, the dynamic dual pathway model predicted reported participation via endorsement of protestors, independent of identification with protestors and left-wing ideology.

Contesting the deportation state? Political change aspirations in protests against forced returns

Deportation of immigrants is a high-ranking issue on political agendas across Europe. Political authorities, however, face a challenge regarding forced returns: affected migrants, organized activists and concerned citizens are standing up for deportees. Do these protests contest the nation state's sovereignty, expressed in the right to carry out deportations of foreign citizens? How far-reaching are protesters' ambitions for political changes? Based on a developed typology of change aspirations, this article explores this topic by studying anti-deportation protests in Austria. It combines qualitative data from interviews with protesters with longitudinal data covering protest events from 1993 to 2013. Expanding previous research, the study finds that protests often refrain from demanding fundamental political change, instead they demonstrate overt conformism for tactical purposes. At the same time, protesters develop grievances about deportation policies and practices in the course of protest developments - they have covert reformist ambitions.

Advancing the social psychology of rapid societal change

In this introduction to the special section on rapid societal change, we highlight the challenges posed by rapid societal changes for social psychology and introduce the seven papers brought together in this special section. Rapid societal changes are qualitative transformations within a society that alter the prevailing societal state. Recent such changes include the election of right-wing populist governments, the Arab Spring revolutions, and devastating civil wars in the Middle East. Conceptually, such events require consideration of how societal-level events relate to more proximal psychological processes to bring about the often abrupt, non-linear (as opposed to incremental and linear) nature of rapid societal change. They also require empirical approaches that allow such qualitative transformations to be captured and studied. This is true both in terms of directly addressing rapidly unfolding societal events in research, and in terms of how rapid, discontinuous change can be analysed. The papers in the special section help to address these issues through introducing novel theoretical and methodological approaches to studying rapid societal change, offering multiple perspectives on how macro-level changes can both create, and be created by, micro-level social psychological phenomena.

Strongly Participatory Science and Knowledge Justice in an Environmentally Contested Region

This article draws insights from a case study examining unanswered health questions of residents in two polluted towns in an industrial region in southern France. A participatory health study, as conducted by the author, is presented as a way to address undone science by providing the residents with relevant data supporting their illness claims. Local residents were included in the health survey process, from the formulation of the questions to the final data analysis. Through this strongly participatory science (SPS) process, the townspeople offered many creative ideas in the final report for how the data could be used to assist in improving their health and environment and policy work is already in evidence, resulting from the study. Drawing from the literature on participatory science and expertise as well as from the initial outcomes of the local health study, I propose that SPS produces a form of knowledge justice. Understanding knowledge and its making as part of a social justice agenda aligns well with environmental justice frames. Through SPS, local residents have a hermeneutical resource to make sense of their embodied lives and augment their claims with strong data supporting actions for improving their health and environment.

Mikomeseng: Leprosy, Legitimacy and Francoist Repression in Spanish Guinea

The Mikomeseng leprosy settlement in Spanish Guinea (present-day Equatorial Guinea) was widely promoted during the 1940s and 1950s as the embodiment of the Francoist 'civilizing mission' in Africa. Its prominence reflected the important role which colonial health and social policy played in establishing the legitimacy of the Franco regime, and particularly in helping to overcome its international isolation in the immediate post-war era. But a major protest by leprosy sufferers in 1946 revealed the everyday violence underpinning life in Mikomeseng, showing how the language of welfare and social justice which pervaded Francoist propaganda masked the reality of a coercive colonial system. The image of Mikomeseng as the embodiment of benevolent colonial rule was constructed by Francoist experts and officials around a brutally repressive institution, one which encapsulated the violence of Spanish colonial rule in West Africa and of the Franco regime as a whole.

Authoritarianism, Institutional Confidence, and Willingness to Engage in Collective Action: A Multinational Analysis

The antecedents of collective action have received considerable attention in psychology, political science, and sociology. However, few studies have addressed the extent to which individual differences in psychological needs, motives, and traits predict collective action tendencies. In the present study, we focus on an especially important individual difference: authoritarianism. We examined three key hypotheses: (1) that authoritarianism would be associated with lower willingness to engage in collective action (net of other factors known to predict protest), (2) that the negative relationship between authoritarianism and collective action would be stronger among the politically engaged; and (3) that the negative relationship between authoritarianism and collective action would be weaker among those who lacked confidence in major social institutions. Using data from three independent waves of the World Values Survey, we find cross-national evidence supporting all three hypotheses.

The Importance of Protesters' Morals: Moral Obligation as a Key Variable to Understand Collective Action

Collective action and protest have become a normalized political behavior that in many cases defines the political agenda. The reasons why people take to the streets constitute a central subject within the study of social psychology. In the literature, three precedents of protest that have been established as central to the study of this phenomenon are: injustice, efficacy, and identity. But political action is also deeply related to moral values. This explains why in recent years some moral constructs have also been pointed out as predictors of collective action. Moral variables have been introduced into the literature with little consideration to how they relate to each other. Thus, work in this direction is needed. The general aim of this research is to differentiate moral obligation from moral norms and moral conviction, as well as to compare their ability to predict collective action. In order to do so, the research objectives are: (a) conceptualize and operationalize moral obligation (Study 1, N = 171); (b) test its predictive power for intention to participate in protests (Study 2, N = 622); and (c) test moral obligation in a real context (Study 3, N = 407). Results are encouraging, showing not only that moral obligation is different to moral conviction and moral norm, but also that it is a more effective predictor working both for intention and real participation. This work therefore presents moral obligation as a key precedent of protest participation, prompting its future use as a variable that can enhance existing predictive models of collective action. Results regarding other variables are also discussed.

The pros and cons of researching events ethnographically

Events (remarkable, disruptive happenings) are important subjects of study for understanding processes of change. In this essay, I reflect upon the issue of what the ethnographic method has to offer for the analysis of this social phenomenon. To do so, I review three recently published ethnographic studies of events. My conclusion is that it is indeed a very useful method for understanding the feelings and ideas of people who are experiencing eventful situations, for instance around protests or natural disasters. However, using this method also brings about practical difficulties, such as the 'luck' that an event occurs at the ethnographic fieldwork site. Next, as transformative responses to events are not bound by the place or time of the happening, other methods (interviews, discourse analysis, surveys) that make it easier to follow them in varying locations and periods might be more suitable for getting a comprehensive picture of their meaning-making dynamics.

Political motivations for intra-European migration

Motivations for migrating within the European Union have mainly been attributed to economic, career and lifestyle choices. This article suggests that political dissatisfaction is also an important motivator of recent intra-European migration. In our analysis of in-depth interviews with Romanian migrants in Spain and with Spanish migrants in Norway, we found a common emphasis on the political dimensions of their decision to migrate. In the interviews, the economic component of migration was often related to bad governance and negative perceptions of the state. The similarities of Spanish and Romanian migration narratives are especially striking because Spain and Romania represent substantially different migratory, political and economic contexts. However, migration is more obviously intertwined with conventional acts of political protest in the Spanish case. We suggest that differences in democratic contexts are pivotal in people's reactions to and framing of their deep dissatisfaction with domestic politics, as found in many European countries today.

Using the SIRDE model of social change to examine the vote of Scottish teenagers in the 2014 independence referendum

Five hundred and seventy-three Scottish high school students were surveyed in the 2 months following the 2014 referendum on Scotland's independence. We used the Social Identity, Relative Deprivation, collective Efficacy (SIRDE) model of social change to examine the social psychological factors that should have influenced the voting choices of these teenagers. Structural equation modelling indicated that the SIRDE model fit the data and largely supported four sets of hypotheses derived from the model. Specifically, (1) those with a stronger Scottish identity, (2) those who felt frustrated and angry that Scottish people are discriminated against in British society, and (3) those who believed that Scottish people are not able to improve their relatively poor social conditions within the United Kingdom (a lack of collective efficacy) were more likely to hold separatist beliefs. Further, the relationships between identity, relative deprivation, and collective efficacy, on the one hand, and voting for Scotland's independence, on the other, were fully mediated by separatist social change beliefs. Consistent with the specificity of the model, neither political engagement nor personal relative deprivation were associated with voting choice, whereas the latter was associated with lower life satisfaction. The implications and limitations of these findings are discussed.

Direct Participation in and Indirect Exposure to the Occupy Central Movement and Depressive Symptoms: A Longitudinal Study of Hong Kong Adults

Despite the extensive history of social movements around the world, the evolution of population mental health before, during, and after a social movement remains sparsely documented. We sought to assess over time the prevalence of depressive symptoms during and after the Occupy Central movement in Hong Kong and to examine the associations of direct and indirect exposures to Occupy Central with depressive symptoms. We longitudinally administered interviews to 909 adults who were randomly sampled from the population-representative FAMILY Cohort at 6 time points from March 2009 to March 2015: twice each before, during, and after the Occupy Central protests. The Patient Health Questionnaire-9 was used to assess depressive symptoms and probable major depression (defined as Patient Health Questionnaire-9 score ≥10). The absolute prevalence of probable major depression increased by 7% after Occupy Central, regardless of personal involvement in the protests. Higher levels of depressive symptoms were associated with online and social media exposure to protest-related news (incidence rate ratio (IRR) = 1.28, 95% confidence interval (CI): 1.06, 1.55) and more frequent Facebook use (IRR = 1.38, 95% CI: 1.12, 1.71). Higher levels of intrafamilial sociopolitical conflict was associated with more depressive symptoms (IRR = 1.05, 95% CI: 1.01, 1.09). The Occupy Central protests resulted in substantial and sustained psychological distress in the community.

Metatranscriptome of the protistan community in Reticulitermes flaviceps

The hindgut of lower termites harbors various symbiotic protists, which perform varied functions in lignocellulose decomposition. As termites are social insects, the species and numbers of these flagellated protists in the termite gut vary among the different castes. Juvenile hormones (JHs) can regulate caste differentiation in termites. In this study, we used the juvenile hormone analog fenoxycarb to induce termite workers (Reticulitermes flaviceps) to differentiate into pre-soldiers. A metatranscriptomic investigation of the protistan community was then performed by 454 pyrosequencing. From a thorough analysis based on 597 312 generated reads, we found that the starch and sucrose metabolism pathway was the most abundant pathway across the metatranscriptome. The current study demonstrates that the metatranscriptome of the protistan community in termites contains an abundance of lignocellulase, which plays a vital role in termite nutrition.

Selective social buffering of behavioral and endocrine responses and Fos induction in the prelimbic cortex of infants exposed to a novel environment

In mammals, the presence of the mother can reduce or "buffer" stress responses of her young in threatening conditions. We compared the effect of the mother, a familiar littermate, and an unfamiliar adult male on three classes of response shown by guinea pig pups in a novel environment: short latency active behaviors, particularly vocalizing; slower developing passive behaviors that appear mediated by inflammatory mechanisms; and hypothalamic-pituitary-adrenal activity. We also examined Fos induction in the prelimbic cortex, a region hypothesized to mediate buffering effects. Only the mother significantly suppressed all classes of behavior. The greatest selectivity was observed for passive behavioral responses. Contrary to expectations, the adult male reduced plasma cortisol levels of pups as effectively as did the mother. The presence of the male also resulted in increased Fos induction in the prelimbic cortex and high levels of social interaction. Maternal buffering was not associated with prelimbic activity. These results confirm the ability of the mother to reduce active behavioral and HPA responses and suggest a specific maternal buffering effect on the later developing passive behavioral responses. The findings also demonstrate an unexpected ability of adult males to reduce HPA responses and raise the possibility that different social partners buffer HPA activity through different underlying processes.

The neural basis of perceived unfairness in economic exchanges

Human decision making in situations of inequity has long been regarded as a competition between the sense of fairness and self-interest, primarily based on behavioral and neuroimaging studies of inequity that disfavor the actor while favoring others. Here, we use functional magnetic resonance imaging experiments to study refusals and protests using both favoring and disfavoring inequity in three economic exchange games with undercompensating, nearly equal, and overcompensating offers. Refusals of undercompensating offers recruited a heightened activity in the right dorsolateral prefrontal cortex (dlPFC). Accepting of overcompensating offers recruited significantly higher node activity in, and network activity among, the caudate, the cingulate cortex, and the thalamus. Protesting of undercompensating fixed offers activated the network consisting of the right dlPFC and the left ventrolateral prefrontal cortex and midbrain in the substantia nigra. These findings suggest that perceived fairness and social decisions are the results of coordination between evaluated fairness norms, self-interest, and reward.

Organizational respect dampens the impact of group-based relative deprivation on willingness to protest pay cuts

Although group-based relative deprivation predicts people's willingness to protest unfair outcomes, perceiving that one's subgroup is respected increases employees' support for organizations. An integration of these perspectives suggests that subgroup respect will dampen the impact of group-based relative deprivation on workers' responses to unfair organizational outcomes. We examined this hypothesis among university faculty (N = 804) who underwent a system-wide pay cut. As expected, group-based relative deprivation predicted protest intentions. This relationship was, however, muted among those who believed university administrators treated their area of expertise (i.e., their subgroup) with a high (vs. low) level of respect. Moderated mediation analyses confirmed that group-based relative deprivation had a conditional indirect effect on protest intentions via participants' (dis)identification with their university at low to moderate, but not high, levels of subgroup respect. Our finding that satisfying relational needs can attenuate responses to group-based relative deprivation demonstrates the benefits of integrating insights from distinct research traditions.

Genomic Justice for Native Americans: Impact of the Havasupai Case on Genetic Research

In 2004, the Havasupai Tribe filed a lawsuit against the Arizona Board of Regents and Arizona State University (ASU) researchers upon discovering their DNA samples, initially collected for genetic studies on type 2 diabetes, had been used in several other genetic studies. The lawsuit reached a settlement in April 2010 that included monetary compensation and return of DNA samples to the Havasupai but left no legal precedent for researchers. Through semistructured interviews, institutional review board (IRB) chairs and human genetics researchers at US research institutions revealed their perspectives on the Havasupai lawsuit. For interviewees, the suit drew attention to indigenous concerns over genetic studies and increased their awareness of indigenous views. However, interviewees perceived no direct impact from the Havasupai case on their work; if they did, it was the perceived need to safeguard themselves by obtaining broad consent or shying away from research with indigenous communities altogether, raising important questions of justice for indigenous and minority participants. If researchers and IRBs do not change their practices in light of this case, these populations will likely continue to be excluded from a majority of research studies and left with less access to resources and potential benefit from genetic research participation.

Genomic Justice for Native Americans: Impact of the Havasupai Case on Genetic Research

In 2004, the Havasupai Tribe filed a lawsuit against the Arizona Board of Regents and Arizona State University (ASU) researchers upon discovering their DNA samples, initially collected for genetic studies on type 2 diabetes, had been used in several other genetic studies. The lawsuit reached a settlement in April 2010 that included monetary compensation and return of DNA samples to the Havasupai but left no legal precedent for researchers. Through semistructured interviews, institutional review board (IRB) chairs and human genetics researchers at US research institutions revealed their perspectives on the Havasupai lawsuit. For interviewees, the suit drew attention to indigenous concerns over genetic studies and increased their awareness of indigenous views. However, interviewees perceived no direct impact from the Havasupai case on their work; if they did, it was the perceived need to safeguard themselves by obtaining broad consent or shying away from research with indigenous communities altogether, raising important questions of justice for indigenous and minority participants. If researchers and IRBs do not change their practices in light of this case, these populations will likely continue to be excluded from a majority of research studies and left with less access to resources and potential benefit from genetic research participation.