Programs, policies, and technologies — particularly those concerned with health equity — are often designed with justice envisioned as the end goal. These policies or interventions, however, frequently fail to recognize how the beneficiaries have historically embodied the cumulative effects of marginalization, which undermines the effectiveness of the intended justice. These well-meaning attempts at justice are bounded by greater socio-historical constraints. Bounded justice suggests that it is impossible to attend to fairness, entitlement, and equity when the basic social and physical infrastructures underlying them have been eroded by racism and other historically entrenched isms. Using the case of Brazil’s National Health Policy for the Black Population, this paper proposes that bounded justice can contribute to justice discourses by serving as a concept, a proffering to a multi-disciplinary conceptual framework, and a potential analytic for those interested in the design of policy, technology, and programmatic interventions towards health equity.
View recent talks that center Bounded Justice here. These talks were made possible by the Center for Bioethics and Social Sciences in Medicine at the University of Michigan and the Center for ELSI Resources and Analysis (CERA)
Environmental and Data Scan of Housing Laws
Racial and ethnic disparities in health are a result of inequalities in access to key resources, such as quality and stable housing. In the past, Robert Wood Johnson Foundation (RWJF) has invested in projects that are focused on improving community-level conditions, such as the availability of affordable housing. Nevertheless, as noted in this call for proposals, “the enactment of new laws—even ones whose language centers health and equity—will not actually advance health or equity if they are not effectively and equitably implemented.”
We plan to use the bounded justice framework created by Professor Melissa Creary and the health justice framework as revised by Ruqaiijah Yearby, Emily Benfer, Lindsay Wiley, and Seema Mohapatra to structure and implement the project.
Bounded justice suggests that it is impossible to attend to fairness, entitlement, and equity when the basic social and physical infrastructures have been eroded by racism and other historically entrenched -isms. Thus, it calls for a systematic process involving the continual interplay between self-reflection and action to help those seeking to eliminate structural inequities as well as those evaluating these actions. The health justice framework provides the four principles guiding this systematic process: (1) structural remediation; (2) financial supports and accommodations; (3) community engagement and empowerment; and (4) truth, reconciliation, and healing.
Thus, our team, in partnership with key community partners, will conduct an initial environmental and data scan of two jurisdictions to understand the gaps in the equitable enforcement of housing laws as a foundation for creating a framework and assessment tool that will inform how RWJF structures and implements a new call for funding concerning the inequitable enforcement of housing laws. As part of the environmental scan, we plan to track legal provisions regarding the enforcement the right to a habitable home, of no cause evictions (i.e. no reason stated to evict, which may hide discrimination and retaliation), and penalties for unlawful eviction. Building on this work, the team, in partnership with key community partners, will conduct an environmental and data scan of the federal level and three additional jurisdictions to test the framework and assessment tool as well as provide best practices for the equitable enforcement of housing laws.
The intertwined pandemics of racism and COVID-19 have been deadly for Black Americans and other communities of color. They have put a spotlight on public health and the important ways that the field must become explicitly anti-racist to advocate for institutional and systemic changes that will facilitate good health. The Washtenaw County Board of Health passed a resolution June 30, 2020 explicitly declaring racism as a public health crisis and confirming our collective commitment to health equity in Washtenaw County. We will use the concept of Bounded Justice to help the health department ask new questions that will lead to anti-racist actions. The concept of Bounded Justice helps us understand that we must assume that deeply entrenched systemic racism undercuts any intended health equity processes. It helps institutions and actors name the limits of what is possible in any given action. By co-creating a model of organizational anti-racist decision making that leads to the development of a Justice Impact Assessment (JIA) tool (see Aim 2), we will move the health department from mere recognition of racism as a public health issue to anti-racist practice. Using the Washtenaw County Health Department (WCHD) as our partner, we propose to implement and evaluate the Anti-Racist County towards Justice (ARC towards Justice) project. Our research proposal aims to:
Aim 1: Conduct formative research to identify community perceptions and baseline knowledge, attitudes, and practices of WCHD staff related to racism at WCHD.
Aim 2a: Co-create with WCHD and WC community members a Justice Impact Assessment.
Aim 2b: Apply the Justice Impact Assessment within WCHD to assess and revise one area of internal policies and practices and one WCHD external community
Aim 3: Conduct a mixed-methods process and impact evaluation