Table Of ContentCamille Burnett
Justice in
Health
Justice in Health
Camille Burnett
Justice in Health
Camille Burnett
Burnett Innovation LLC
Richmond, VA, USA
ISBN 978-3-031-18503-8 ISBN 978-3-031-18504-5 (eBook)
https://doi.org/10.1007/978-3-031-18504-5
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Preface
The greatest opportunity we have to transform health is to democratize and liberate
it through unencumbered imagination, innovation, and, quite frankly, courage. Most
telling of the need to do this is recognizing that what we are doing is not working.
Yet, we are continuing to do it. Evidence of the lack of success in our health “doing”
is increasing health disparities and widening life expectancy gaps and critical sys-
tem failures in capacity and access. We see overt and covert acts of racism (per-
sonal, institutional, structural, and cultural); experience escalating violence in mass
shooting, interpersonally and within neighborhoods; and increasing infringement
on the most basic of human rights (voting, abortion, and dignity). The health of the
nation and our communities is at stake. The health of our patients and clients being
served is at stake. The healthcare profession’s credibility and functionality are at
stake. We are literally in a crisis of health, health integrity, and health consciousness
in this country. We are facing an existential threat to our humanity.
The alarm has been sounded in various ways, and we cannot continue to ignore
it by “back-burnering” these intersectional issues we face. The pandemics
(COVID-19, racism, and social unrest) we have experienced and continue to experi-
ence have spoken loudly. They have told us that there are consequences to inaction
and that there is an interconnectedness of issues and of each other. The conse-
quences of failing to address racism and health disparities exacerbated the preva-
lence, morbidity, and mortality of COVID-19, impacting the health system, the
economy, and our mental health. There will never be an “after COVID” moment.
We crossed an invisible precipice at the height of the pandemics that we cannot
undo, ever. The entire world was simultaneously for the most part under some form
of quarantine that allowed everyone to take a collective pause. During the pause,
people’s attention was captured in ways that the business as usual lifestyle we were
living up to that point did not allow. It opened up space to reflect on life, for self-
examination and for re-invention.
In the United States, this pause also fell during the publicized successive killing
of Black people, and in particular, we watched the murdering of George Floyd,
Breonna Taylor, Ahmaud Arbery and many others. While unjust killing of Black and
Brown bodies has been going on for generations, the actual moments being visually
v
vi Preface
captured and televised rocked our collective souls. For some, unseeing what was
seen has not been possible and this too was the case for the healthcare profession
who also witnessed the disproportionate COVID-19 deaths among First Nations,
Latinx, and Black populations. All of this has been too much. At the same time, the
scourge of racism, health disparities, and inequities are not new. They have been
known. That is the greatest travesty of it all. The decades of inaction and compla-
cency of our systems, institutions, and policies are appalling. Shaming and blaming
at this point is not helpful. People have died and are continuing to die even as this
book is being written. Expeditious solutions and actions are what is needed, which
is what this book hopes to provide. Contextualized knowledge with action to rectify
and transform health care in the United States by providing more than a textbook of
health equity information is what this book is about. Textbooks, although informa-
tive, can feel antiquated and removed from the current reality. Justice in Health is a
guide, a road map, and a strategic manual offering bold thought leadership in deli-
cate but necessary aspects and narratives of health. There is some historically sig-
nificant information provided throughout that serves to situate and explain that
which might seem random. Nothing is random, and the root cause of all health
inequities should be illuminated to build the platform to reform, restore, and rectify.
It is where justice in health begins.
Delving into root causes forces us to reflect on history and narratives that are
foundational to our epistemological and ontological understanding of our profes-
sion and how to move forward in the world we are experiencing now. To get there,
Justice in Health starts the conversation in Chap. 1 with unpacking the most basic,
overused, and arguably least consistently understood term—health. In general,
healthcare providers have simply accepted the idea of a shared understanding of
health either within their discipline or across their discipline. Furthermore, health
disciplines were formed based on previous definitions of what health is while prac-
ticing within very different parameters now. While the meaning of health has
changed, health discipline practices and systems have lagged. Similarly, those out-
side of the health arena have also assumed a shared understanding of health that has
been translated into mandates, policies, and systems. Knowing this is important
because if there is not a collective understanding of health, a disconnect is created
between what we think health is and how it is experienced, which misleads our solu-
tions. Justice in Health attempts to unpack the definition of health, to realign it to
create not only consistency in our understanding of what health is contextualized
within the present but also to inform equitable and just solutions that work.
Workable, equitable, and just solutions are those that speak to structures at the inter-
section of health and humanity and seek to answer questions that this book attempts
to answer such as what it will take from an imagination, innovation, and courageous
perspective to attain justice in health.
Each chapter of this book provides insights toward the achievement of justice in
health, posing thought-provoking considerations of what it could be. Chapter 1 pro-
vides an overview and global introduction to the book’s content. In the introduction,
understanding of core concepts of public health, equity, justice, and health are
established. This chapter centers on unpacking the meaning of health, how health is
Preface vii
understood and misunderstood, and, most importantly, how health is created. Its
impact in producing outcomes across the determinants of health is examined across
an ecological spectrum of the populations, communities, and the system of care.
The conceptual exploration of just health and what the creation of a more just sys-
tem of health means will be introduced and situated in relation to our society and
why health matters.
Chapter 2 helps to contextualize and situate race and health in the United States.
It recognizes that in the United States and even globally, we face ever-increasing
health disparities and widening inequality gaps especially among Black, Brown,
Asian, Latinx, and Indigenous peoples. These populations have historically and
intentionally been subjugated, excluded, and marginalized, causing generational
devastation to their social, economic, and health outcomes. Routinely, racialized
populations disproportionately suffer from higher rates of negative health-related
sequela (health disparities, chronic disease, morbidity, and mortality) and disparate
social consequences (such as poverty, limited access to opportunity, decrease social
mobility, and racism) that diminish life expectancy and quality of life. Direct and
indirect impacts of cumulative and intersecting exposure to these consequences pro-
duce chronic challenges that are further exacerbated by structures (institutions, poli-
cies, practices, and institutional agents), and the inequitable distribution of power
and privilege and the history of race and health in this country are examined.
Chapter 3 delves into frameworks for situating justice in health with a deeply
philosophical introduction and exploration of key theories most critical to meet the
health and well-being challenges we face as a nation in this moment. Highlighted
are discussions of critical theories and perspectives that include but are not limited
to postcolonial and emancipatory inquiry, social justice in nursing practice, struc-
tural violence, and structural justice. Discussions about the social determinants of
health are at the forefront to help introduce the reader to contextual causes that
determine health guided by these various theoretical perspectives. This chapter
serves to synthesize structural and root causes through a theoretical landscape to
expose the hidden realities of power, privilege, and social identity.
In Chap. 4, we dive into health equity and critical health issues by unpacking
critical root causes that perpetuate health disparities such as race, poverty, mass and
youth incarceration, and violence against women, communities, and society. It also
examines issues that determine health such as access to care, food, housing, trans-
portation, and insurance using concrete examples. Beyond identification of these
issues, this chapter makes the connection to earlier perspectives discussed in Chap.
3 to extend and situate health in relation to structural drivers and root causes. It is
connecting the dots beyond the current healthcare orientation that leads to a deepen-
ing of understanding of how health happens across disparate populations and in
aggregate populations. It also begins to frame what a health equity systems approach
could look like and what must be considered.
Chapter 5 starts to explore how to create a healthcare system without walls to
build a culture of healing. This chapter reframes the current beliefs of what a health-
care system is, toward what it could be within the concept of building a system of
care without walls. A healthcare system without walls is discussed by identifying
viii Preface
structural obstacles and gaps within the current structure including their impacts
and introducing new ways to overcome and dismantle these challenges. A core pil-
lar in this discussion is critical conversations about what it means to be a healthcare
provider and how we can better prepare healthcare providers to meet the demands
of a new re-imagined system. To this end, the chapter also introduces trauma-
informed and healing approaches, one of the key professional shifts required in the
routine preparation of healthcare providers. As an overarching mechanism for facil-
itating healing, this chapter covers understanding trauma, its consequences, and its
impacts at an individual and community level. It examines what a culture of healing
looks like through a trauma-informed orientation and explores the healing of indi-
viduals and communities who have experienced trauma. The core elements of a
trauma-i nformed approach and their application across this spectrum, which will
include recommendations and useful approaches to implementing a culture of heal-
ing, are provided.
Chapter 6 advocates leading through just action by introducing readers to com-
munity engagement and partnerships as facilitators to rebuilding and co-creating a
renewed system of care. Understanding community partnerships and their impor-
tance is discussed. Examining practice partnerships and best practice approaches
for engaging with the community to meet their health needs where they are is a
central component of this chapter. The chapter draws on community engagement
and partnership examples from the field that have been used to demonstrate how
communities can mobilize and transform health. It also discusses the use and power
of platforms such as media for advocacy and use of data as tools for change. The
chapter will serve to help health providers, health researchers, and health educators
consider non- traditional approaches to creatively find ways to exchange knowledge,
skills, and expertise needed to reform and redress health disparities. It is a chapter
that encourages healthcare providers to act effectively to create and influence equi-
table health solutions.
The book concludes with Chap. 7, “Just Health,” that serves to summarize and
synthesize the important points, complexitie,s and concepts raised throughout the
previous chapters. It culminates in a discussion that pays particular attention to
upstream versus downstream public and population health approaches to make the
case as to why the reconciliation of public health toward just health cannot wait. Just
health is revisited against this backdrop and summarized at the praxis of theory,
knowledge, and action toward achieving health justice. The chapter concludes with
a call to action and suggested steps to address the urgent and emergent conditions
that mitigate health outcomes and identify opportunities for change that can be lev-
eraged now. It can be used to fuel galvanized action that serves as the impetus for a
new health justice movement in this country.
Revisiting the earlier assertion of this book, its charge is to examine and inter-
rogate the intersection of health and humanity with the anticipation of not only
inspiring minds but also to prepare healthcare providers with fundamental knowl-
edge to transform their practice. It is hoped that students, faculty, and administrators
will reflect on the question of what it will take for us to imagine and innovate some-
thing different and do we have the courage to try. If all of us ask this question, this
Preface ix
book will serve to guide you through options and approaches to help you formulate
your own action plan with a collective aim to achieve justice in health.
Richmond, VA, USA Camille Burnett
Acknowledgments
With gratitude I thank the creative being who inspired my calling and gifted me with
innovative thinking, an astute ability to envision, and humility to learn and embrace
all forms of knowledge for the betterment of humanity.
I am grateful to my beautiful family and circle of colleagues affectionately
known as my tribe both near and far who inspire and amaze me every day.
Thank you to the Springer family for encouraging me and enthusiastically sup-
porting what has been a truly remarkable endeavor, and to my research support
personnel for your contributions in summarizing parts of the US and global health-
care systems’ discussion and history of nursing theory information.
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