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Brown et al (1), in their article published in this issue of Critical Care Medicine, describe a concerning finding: a linear relationship exists between neighborhood poverty and distance to critical care services such that children in the least affluent neighborhoods need to travel nearly three times as far to reach a PICU as those in the most affluent. Strikingly, this disparity in access to critical care services holds true within urban and suburban areas as well as rural regions of the United States, and disproportionately impacts Black children, who are more likely to live in disadvantaged areas across both urban and rural settings. Unfortunately, Brown et al (1) conducted only a very limited racial analysis and chose not to assess ethnicity at all, preventing a clear understanding of how these patterns impact the 4.3 million Latino children living in poverty in this country (2). Other investigators have shown that Hispanic/ Latino children, particularly those living in predominantly Latino neighborhoods, are more likely to present with higher severity of illness on PICU admission, suggesting access barriers that may be partially explained by distance (3).Brown et al (1) conclude that geographic disparities in access to pediatric critical care services are fueled by two phenomena: 1) the physical concentration of pediatric critical care services and 2) the growing number of suburban poor. They correctly point out that these disparities lead to increased morbidity and mortality for critically ill and injured children. We argue that unequal access to pediatric critical care constitutes injustice.Rawls (4) defined a just society as one where citizens' basic needs for primary goods are met and where individuals have fair equality of opportunity; any inequalities in distributed goods should benefit those who are least well off. Justice as a principle of medical ethics is articulated in the Hippocratic Oath and other professional codes as providing treatment based on need, without regard to morally irrelevant characteristics (5). By any of these standards, it is unjust that poor children experience worse health outcomes due to living at increased distance from a PICU, and it is especially unjust that this disadvantage disproportionately affects children of color, who already face systemic disadvantage. Several questions then present themselves: Is regionalization of pediatric critical care a threat to justice? What obligation do healthcare providers and organizations have to address contributing factors? What can be done to mitigate harm and restore justice to these vulnerable children?In January 2000, a task force assembled by the American Academy of Pediatrics and the Society of Critical Care Medicine issued recommendations for developing regionalized integration of pediatric critical care, based on their

During a student teaching experience, teacher education candidates affiliated with an urban School of Education school–university partnership witnessed a disturbing interaction between an early career White male teacher and a first-grade Black male student at an assigned elementary school. The subsequent interactions among the teacher, principal, district administrators, and university partners illumine the racial implications at varying levels from the individual to the structural level. The ways in which race is centered, yet is evaded by school actors, raises important considerations for leadership. Authors suggest combining critical race theory with organizational narratives to explore the dilemmas at various structural levels, but in particular for the principal and district-level administrators.