“The health equity curse”: ethical tensions in promoting health equity

Pauly, Bernie; Revai, Tina; Marcellus, Lenora; Martin, Wanda; Easton, Kathy; MacDonald, Marjorie

doi:10.1186/s12889-021-11594-y

Cited by 8 publications

(9 citation statements)

References 59 publications

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“…This type of advocacy for experiential voices that are often excluded to be included is consistent with key strategies for promoting health equity through client and community engagement and social inclusion [ 11 ].…”

Section: Resultsmentioning

confidence: 71%

“…We briefly introduce four core ethical tensions here and describe these in more depth elsewhere [ 11 ]. The tensions were: 1) biomedical versus social determinants of health agenda, 2) systems driven care versus situational care, 3) systemic stigma and discrimination versus respect for persons, and 4) trust and autonomy versus surveillance and control.…”

Section: Resultsmentioning

confidence: 99%

“…For example, there is considerable work related to advocacy for and integration of health equity in various areas of public health practice but little focus on the ethical issues associated with implementation and integration [ 7 – 10 ]. In previous work, we identified and named a range of ethical tensions encountered by public health practitioners working in mental health promotion and prevention of harms of substance use [ 11 ]. The purpose of this article is to report a grounded theory study of PH practitioners and their processes of navigating ethical issues related to health equity in PH practice of mental health promotion and prevention of harms of substance use in Canada.…”

Section: Introductionmentioning

confidence: 99%

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Navigating conflicting value systems: a grounded theory of the process of public health equity work in the context of mental health promotion and prevention of harms of substance use

et al. 2022

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Background Promoting health equity and reducing heath inequities is a foundational aim and ethical imperative in public health. There has been limited attention to and research on the ethical issues inherent in promoting health equity and reducing health inequities that public health practitioners experience in their work. The aim of the study was to explore how public health providers identified and navigated ethical issues and their management related to promoting health equity within services focused on mental health promotion and preventing harms of substance use. Methods Semi-structured individual interviews and focus groups were conducted with 32 public health practitioners who provided public-health oriented services related to mental health promotion and prevention of substance use harms (e.g. harm reduction) in one Canadian province. Results Participants engaged in the basic social process of navigating conflicting value systems. In this process, they came to recognize a range of ethically challenging situations related to health equity within a system that held values in conflict with health equity. The extent to which practitioners recognized, made sense of, and acted on these fundamental challenges was dependent on the degree to which they had developed a critical public health consciousness. Ethically challenging situations had impacts for practitioners, most importantly, the experiences of responding emotionally to ethical issues and the experience of living in dissonance when working to navigate ethical issues related to promoting health equity in their practice within a health system based in biomedical values. Conclusions There is an immediate need for practice-oriented tools for recognizing ethical dilemmas and supporting ethical decision making related to health equity in public health practice in the context of mental health promotion and prevention of harms of substance use. An increased focus on understanding public health ethical issues and working collaboratively and reflexively to address the complexity of equity work has the potential to strengthen equity strategies and improve population health.

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Section: Resultsmentioning

confidence: 71%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Navigating conflicting value systems: a grounded theory of the process of public health equity work in the context of mental health promotion and prevention of harms of substance use

et al. 2022

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“…This might be the case when staff members at shelters only allow access to what the participants called “good homeless” and left out those who are intoxicated and exhibit problematic behaviors, excluding those who need help the most. Moreover, as Bernie Pauly and colleagues have shown in a recent study about ethical tensions in public health systems, the ability of practitioners to disrupt stigma and discrimination is constrained by embedded patterns of exclusion that are part of the system itself [ 59 ]. Thus, despite being entitled to public services, structurally vulnerable individuals who are alcohol dependent repeatedly fall through the cracks of the health and social policy safety net.…”

Section: Discussionmentioning

confidence: 99%

“A place to be safe, feel at home and get better”: including the experiential knowledge of potential users in the design of the first wet service in Montreal, Canada

et al. 2022

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Background The harmful use of alcohol is one of the leading health risk factors for people’s health worldwide, but some populations, like people who experience homelessness, are more vulnerable to its detrimental effects. In the past decades, harm reduction interventions that target these complex issues has been developed. For example, wet services include a wide range of arrangements (wet shelters, drop-in centers, transitory housing, etc.) that allow indoor alcohol use and Managed Alcohol Programs provide regulated doses of alcohol in addition to accommodation and services. Although the positive impacts of these interventions have been reported, little is known about how to integrate the knowledge of people experiencing homelessness and alcohol dependence into the design of such programs. The aim of this study is to present the findings of such an attempt in a first wet service in Montreal, Canada. Methods Community based participatory research approach and qualitative methods—including semi-structured interviews and focus groups—were used to collect the knowledge of potential users (n = 34) of the wet service. The data collected was thematically analyzed. Results Participants reported experiencing harsh living conditions, poverty, stigmatization and police harassment, which increased their alcohol use. The intersection between participants’ alcohol dependence and homelessness with the high barriers to access public services translated into their exclusion from several of such services. Participants envisioned Montreal’s wet service as a safe space to drink, a place that would provide multiple services, a home, and a site of recovery. Conclusions Integrating the knowledge of potential users into the design of harm reduction interventions is essential to develop better and more adapted services to meet complex needs. We propose that it could fosters users’ engagement and contribute to their sense of empower, which is crucial for a group that is typically discriminated against and suffers from marginalization.

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“…The core values of community health nursing practice are rooted in the SDOH and social justice (Community Health Nurses of Canada [CHNC], 2019; Pauly et al, 2021). Moral considerations within these values are often complex and involve the balance of benefits and harms for individuals and populations (Weijer et al, 2013).…”

mentioning

confidence: 99%

Health Inequities and Moral Distress Among Community Health Nurses During the COVID-19 Pandemic

Baxter

Schofield

Betker³

et al. 2022

CJCND

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The core values of community health nursing practice are rooted in the social determinants of health, health equity and social justice. Throughout the COVID-19 pandemic, community health nurses (CHNs) witnessed first-hand the impact on individuals in situations of marginalization. This research inquiry explored how health inequities among client populations contributed to experiences of MD among CHNs in Canada during the pandemic. A total of 245 CHNs from across Canada participated in an online survey. Participants reported that during the pandemic individuals living in situations of marginalization were disproportionately impacted. CHNs were unable to provide the necessary health promotion interventions and experienced high levels of moral distress. The negative impact of the pandemic on individuals living in situations of marginalization illuminated the intersecting social and structural inequities that drive negative health outcomes and emphasized the need to adopt an equity focus for current and future pandemic planning, response, and recovery.

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“The health equity curse”: ethical tensions in promoting health equity

Cited by 8 publications

References 59 publications

Navigating conflicting value systems: a grounded theory of the process of public health equity work in the context of mental health promotion and prevention of harms of substance use

Navigating conflicting value systems: a grounded theory of the process of public health equity work in the context of mental health promotion and prevention of harms of substance use

“A place to be safe, feel at home and get better”: including the experiential knowledge of potential users in the design of the first wet service in Montreal, Canada

Health Inequities and Moral Distress Among Community Health Nurses During the COVID-19 Pandemic

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