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  11. According to the definition of social justice in Almgren’s chapter it is predicted on the basis of social contract which sells out benefits, rights and obligations of social membership. But still it argues that there is no absolute generally agreed-upon to whether define it as a process or outcome (p.1-2). Almgren in page-3 classifies the “distributive social justice” as one out of three types social justice which concerns about just allocation of limited benefits and resources – this type of justice, I guess, is what I/all citizens in post conflict countries are more witness of its violation – violation of women’s rights, children’s rights, and so on.

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  13. Thanks for your share!
    I read the Reimaging Global Health (Farmer, 212) as part of weekly readings in another course this week in which focus on social determinants of health is continuously encouraged in order to succeed in improving global health. Surprisingly my attention was drawn by the similar viewpoint in Powers & Faden (p. 86) which emphasizes that to improve the human condition and make a difference in global health it is essential to consider political, economic development and social justice as well. That said, the theories discussed in this week’s readings are important to be considered when interventions are developed to address social justice pertaining concerns in local/global communities.
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  24. First, in reference to the video that we watched in class last week, I thought that was a huge eye-opener. When we hear of private schools, we usually think of the best, and no matter what race the child is that attends, that they will have a more successful life afterwards. But even in a setting where they were put to succeed, they still faced more challenges than students who were not black. Within this movie, the identity struggle between the two males the movie followed was the most important concept that I noticed. Friends and relationships are critical in the developmental stages during the early teenage years, and both of the guys had issues. I was glad that the guy with dreads ended up leaving. Even though it may not be better for him academically, he felt more comfortable, which I would assume had an effect on his confidence and increased academic success. I don’t feel that I will ever want my children to go to public school. Other than the price, i think it is critical that they are more aware of who they are within society and feel comfortable within their own skin.

    As far as the readings, I especially enjoyed reading the chapter from Beauchamp and I agree with his opinions as it reminded me of why I chose this major for graduate school in the first place. particularly his sections of collective actions and fair-sharing of burdens. When I was reading those, I thought about healthcare in the U.S. and how Obama has been at the fore-front of raising taxes for the wealthy so that healthcare can be accessible for more people, if not all. I agree that it should be that way. But, then I thought about what about in a few years when I’m making more money (hopefully) and we are still faced with the same situation. The situation of people knowing of health hazards and ways to prevent it (such as not smoking to avoid cancer), but they still decide to do it. I would not want to pay more if that is that situation. So I can see both sides. But this is public health, and will be a field in high demand specifically because of those reasons, right?

    It is surprising to me to realize that as a country, we have come so far, but yet, we have so much further to go… In all areas. Justice, equal rights, & liberty were used hundreds of years ago and it seems that to this day, there is no clear definition and how it pertains to the people that they are referring to.

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  25. I have to say that reading and understanding Almgren’s chapter was a little complicated for me. The vocabulary was dense and the reading had so many new terms that were not that easy to comprehend. Therefore, I’m going to reflect on what I could learn and understand through the reading. For instance, when Almgren expressed in page 7: “…if it is presumed that individuals have a natural right to live as they choose (as long as their actions are not harmful to the natural rights of others), and that society is comprised of individuals having diverse preferences and beliefs about what constitutes personal security and the requisites of happiness, then how is it possible to sustain a form of government that serves all individual ideologies and preferences?” I could feel related with something we have heard for ages: “Your rights end where mine begin”. First, we are all raised with the belief that we have to be good and do well; but sometimes that means to step aside your feelings or values to don’t harm others. Second, expecting that the governments fight for or accept each individual’s beliefs and/or values is, in some way, naïve and not intelligent at all. Indeed, Almgren reinforced this point as he keeps talking about utilitarianism in page 10: “…governments are not ethically obligated to respect any aspect of individual autonomy, happiness, or well-being that runs counter to the maximization of the general good of all”. So, governments are supposedly entitled, but not ethically obligated, to ensure our well-being, thus we also have to put our part in the pursuit of happiness we live for. Activism and empowerment are essentials to give any community the tools to fight for their rights and find that state of wellness. However, I couldn’t be the naïve and not point out that to engage in those actions is a long process that could either be influenced by the mal-functioning of a government or the injustice present in that community. But those actions could also be avoided if people feel unsecure about their future if they react to any way of discrimination.

    The other two readings, Beauchamp and Powers’, were much easier to understand, in terms of what is justice and why social justice could bring a change in public health approaches. However, these readings also made me to realize that what we consider or visualize as just or fair is not close of what it should be or represent. There are so many things happening in our “exterior” and sometimes we (I have to include myself, sadly) just look to the other side and pretend that nothing is happening. As a public health professional I don’t want to “grow up” and feel that I didn’t make a contribution to the society. Still, even though I, as an individual, could make a difference, there is no way to achieve what is just or fair if I don’t work as a team with my counterparts in this place that we call world.

    Hence, this week’s readings made me reflect on why I left my Island and ended living in Massachusetts. Even though, some people regretted when I left to do a doctoral degree, when I could contribute to my country working there, I strongly believe that I would be trained to one day be back and work harder for them. Currently, Puerto Rico is not in its better conditions, social and economically. Sadly, even when we are a US territory, we are struggling with the worst financial scenario in the history, given that its credit rating has been downgraded to junk. As a consequence, even when the mal-functioning of the present and past governments are the responsible for this situation, the ones that are going to suffer the consequences are the people who, ironically, put those governments in charge. Some are considering this situation unfair, others don’t even know what is happening or they, simply, don’t care. The truth is that, even when it has happened since forever, migration to US from the main Island has become more existent, in terms of education and job opportunities, and to get a better quality of life. That’s my story too…

  26. Week 3: Theory Week Reflection
    Video: I found myself getting more and more frustrated as the movie progressed. I was not particularly angry at anyone rather the circumstance seemed so hopeless. Just too often I have seen circumstances play out this way where parents endlessly work to provide a better future for this kids. In the documentary we saw parents from both of the families doing this. They were there to support their kids whether it was basketball practice or karate training. One of the boys’ Mom was working an overnight shift so she could look after kids. So if in the night time she is working and in the day time catering to their children…when does she sleep? How does that impact her wellbeing? They do so much that their own wellbeing is compromised (ie. they end up loosing it and being frustrated with their children).
    Efforts from the kids also were not lacking. The two boys were doing everything they could to succeed, both in school and socially. Seeing the amount of pressure and burden that the kids are carrying hurts the heart. I am referring to one of the boys saying he was invited to parities but it’s not the same for him, he can not dance with the girls. Can you imagine how such instances must make him feel about himself? Now can you imagine trying to live in two worlds, trying to succeed in school and have to hear and experience things like that?
    What really sucks the most is the families in the documentary are doing everything right…as right as one could get with their efforts but there is still that gap. I mean clearly the parents had to take time away from their responsibilities to make it to go and support their kids (and we know for some families this is more difficult than for others). Watching the documentary was too painful as it brought back up many of my past experiences…but I am glad documentary like these exist. This story needed to be told. There are too many people in our society who would look at the life of the two boys and say they had every chance just like his peers and say they were given the chance they did not succeed…it’s their fault. But for now, I find myself saying, I hope seeing the documentary chances people’s perspective that achieving success and wellbeing consist of various components. I think this message from the documentary connects really well with the message from the Social Justice and Public Health Chapter from the Social Justice: The Moral Foundation of Public Health and Health Policy. “Public health historically, and public health today, recognizes that there are multiple causes of all ill and good health… our account emphasizes the importance of recognizing how each dimension of well-being is affected by multiple, overlapping determinants, as well as how the different dimensions affects one another” (82).
    With regards to the other reading, they were quiet difficult to comprehend (they were so densed). While I think now I am able to describe the various theories of social justice, I do not think I would be able to recognize a theory being practice. I think being able to distinguish theories is very important for a public health professional. I don’t think I would have really considered that important in the past but one of my classes this semester has really been challenging me to think critically about my own values. We all have our own values and principles (though we may not recognize it) and we function based on those values therefore, it is important understand what they are. I am really looking forward to Dr. Bucchan’s lecture on Friday so I can better understand the theories of social justice.

    The Moral Foundation of Public Health and Health Policy Chapter says “…whom fall the duties entailed by a right to health” (85)… thoughts?

  27. I concur with Molly that these articles were dense, but interesting. I found Almgren’s breakdown of the types of social justice to be particularly poignant, as it helped me to delineate the concepts in my mind. Distributive justice, to me, seems like the most common form that comes to mind when focusing on the issues in our communities. However, I found Rohina’s perspective quite intriguing as she explained that in a post conflict setting there is violation of this distributive justice–this allowed me to sit back and consider the violations that take place here in the U.S. regarding the allocation of limited benefits and resources. Despite the fact that we may not be post conflict and the nature of such violations may be different–it is such a valid point to highlight that this distributive justice is significantly lacking. The variations and degree to which these injustices occur may vary, but regardless it is still happening.

    Furthermore, I found Dr.Buchanan’s synopsis of the multiple theories to be particularly helpful in understanding each one and evaluating my personal stance regarding the respective theories. Utilitarianism, Egalitarianism, Capabilities, Desert, Luck Egalitarianism, and Procedural Justice all contain frameworks for beliefs surrounding social justice. What stuck out to me the most about this was the gleaning fact that there were six distinct approaches, I found myself picking and choosing from 2-3 to formulate my opinions; however, when you think about everyone in the nation doing this–many varying opinions occur. This is what makes our country so great, yet so confusing, this expansive and diverse belief system, yet when it comes to making great change, these same beliefs can muddy the waters. Combining Buchanan’s interpretation of the Capabilties Approach with the evaluation from Almgren–I would have to agree with Molly, that Rawlsian LIberalism seems to be the most advanced theory at the moment. However, with that being said, I also believe that a successful theory of social justice combines aspects of all theories of social justice, but also has its shortcomings. Just as Rawlsian Liberalism pulls from the Capabilities Approach, it would be remiss not to examine how the capabilities approach does not factor for those who are institutionally incapable of achieving a specific outcome. This is a perfect example of the idea that there is no perfect theory out there. That’s what makes social justice a living breathing entity that will grow and morph overtime throughout the course of political and social changes.

    Beauchamp mentioned in his article the concept of Collective Action. “[The] principle of the public health ethic is that the control of hazards cannot be achieved through voluntary mechanisms but must be undertaken by governmental or non-governmental agencies through planned, organized and collective action that is obligatory or non-voluntary in nature.” The author goes on to identify ‘protections of all persons against preventable death and disability’ as one of these hazards. However, there are so many representatives out there against universal health care, considering this to be a Socialist movement. In reading for another class, from Giroux’s book Zombie Politics (2011), there is discussion of how megacorporations that are whispering in the ear of the government, are against the idea of collective action, or as it’s called “big government.” This includes the concept of the welfare state, WIC, etc. It is difficult to theorize with these substantial issues surrounding political capital; how one would achieve the collective action necessary for change. But that may be another conversation for another day…

  28. From the Beauchamp’s article, I learned that market-justice can create individual isolation to the goal of protecting all human life (Beauchamp, p.13) because the market-justice is based on personal efforts to survive. We as a public health professionals, have difficulties that pursuit the social justice in place where the market-justice is pervasive. Market-justice is pervasive in U.S. health care system. We already know lots of negative things in U.S. health care system. I think our goal is announcing people about concept of social justice, which is focusing on common goods for everyone, and how to carry out this ideal knowledge to the real world.

    In Powers’ article, it emphasizes that improving the human condition is not possible by improving health alone. Underlying public health practice is the value of human right (Powers, p. 86). This should be complex process because public health practice is associated with political and economic developments. Focusing on respect is important in public health directed at disadvantaged groups, such as women and children in developing countries.

    Almgren’s article has broad scope of social justice. Through the article, libertarian theory looks like a market-justice, and utilitarian theory and Marxist theory tend to advocate social justice. Also, in liberal perspective, health is considered as a basic human right. In capabilities approach, health is defined as the ability to achieve vital goals for human life. These theories of social justice can overcome if public health professionals understand deeply. What we need is that considering a real world with theories, and how we apply the theories.

  29. From Mim: I truly enjoyed the readings for this week. In many ways they compliment the reading that I’ve been doing for my Community Development course, where we’ve been discussing the roles of both social and political capital. In the Beauchamp reading I was struck by the question as to whether “merit, equality or need” should be the focus of public health as it intersects with a social justice framework (Beauchamp, 2012:12). The further exploration of the ways in which political and social barriers impact individual health as well as the ability for health promotion to take off on a larger scale were similarly striking. Similar to the readings for Community Development, this question as to whether market justice and social justice can co-exist, or perhaps is market justice can be amended to allow for the commonality that social justice requires was central to my processing of the rest of the chapter. Many of the concepts that Beauchamp presented were basic to public health, but named them as being [social] justice driven in a way that I though was compelling. By looking at the classic upstream versus downstream analogy in public health and naming that as an act of common goals towards equity and accessing equality he pulls in a concrete way of explain how social justice and public health must work together. In comparing this reading to both the film Escape Fire and the Primer on Theories of Social Justice Theories and Defining the Problem of Health Care chapter I appreciated the way in which the lack of social justice is connected to the limitation in services to select groups and is named as a reason for fueling our disease management system, which is so often called health care.

    Perhaps put best is the Beauchamp quote “ Public Health should be a way of doing justice, a way of asserting the value and priority of all human life” (2012:18) which in essence names the importance of a justice framework. For the ways in which this particular description is a little vague the chapter from Populations: Public Health and Social Justice fills in more concrete definitions and calls out the importance of using the correct vocabulary when discussing and implementing programming. Paralleling this chapter is the Social Justice and Public Health one which articulates a need in public health to understand that not everything is immediately outcome driven, and that creating means of helping people live dignified lives that are healthy on emotional, physical and community levels involves more than the standard intervention approach and connects deeply to social and political strategy as well. In imagining revitalization that would promote the “upward flow of obligations” as mentioned in Populations: Public Health and Social Justice social capital as well as community understanding of issues (particularly those connected to structural or systematic oppressions) would be a natural place to start for long-term, justice based programming.

  30. My superficial knowledge about some of the theories made a foundation to further sharpen it by a very in-depth and comprehensive content of the readings this week. According to the definition of social justice in Almgren’s chapter it is predicted on the basis of social contract which sells out benefits, rights and obligations of social membership. But still it argues that there is no absolute generally agreed-upon to whether define it as a process or outcome (p.1-2). Almgren in page-3 classifies the “distributive social justice” as one out of three types social justice which concerns about just allocation of limited benefits and resources – this type of justice, I guess, is what I/all citizens in post conflict countries are more witness of its violation – violation of women’s rights, children’s rights, and so on.

    It was interesting to me when I compared the last weeks reading which talked about neo-liberalism in comparison to what I read today from Almgren about laissez-fair market/liberal market and its advantages and disadvantages. In the last week’s chapters we noticed that the liberal public policies had numerous failures; however, more optimistic focus is given towards liberal market in Almgren’s discussions this week.

    Based on liberation philosophy mentioned in Almgren individuals have a “full-self-ownership”/moral right to grant or deny use of any aspect of their person on whatever basis they determine aligns with their preference or self-interest, as long as the individual violates the rights of others…” (p. 5) What I have always been curious to know is that how it is determined that the life of “others” are not violated by what “I” am preferring as an individual within the society – in other word, how the border between my preference and societies interest is set. That said, I get more confused when I read what John Locke’s suggests: governments that exceeds their protectionist role and impinge on individual rights lose their basis of legitimacy. In contrary to what Almgren emphasizes upon, Beauhamp (p. 13) states the “self-interest” theory of market-justice as a public health barrier: “…despite the fact that this role of self-interest predictably fails to protect adequately the safety of our workplace, our modes of transportation, physical environment,…” (p.13).

    How to control hazards which is threatening both individuals and societies? Beauhamp emphasizes that behavioral models of public health problems are rotted in the tradition of market-justice (p.15). In here, it might be relevant if we talk about the drug, opiate and narcotics production in low-income countries as an example. As it is obvious to everyone it has become a devastating business. It is unlikely to effectively minimize the damage of such a disaster until and unless the principles of market-justice is modified. From the cost-effective analysis point of view, it might be more cost-efficient if local producers are financially and technically supported by a replacement cultivation instead of spending millions of dollars on destroying already cultivated products.

    I read the Reimaging Global Health (Farmer, 212) as part of weekly readings in another course this week in which focus on social determinants of health is continuously encouraged in order to succeed in improving global health. Surprisingly my attention was drawn by the similar viewpoint in Powers & Faden (p. 86) which emphasizes that to improve the human condition and make a difference in global health it is essential to consider political, economic development and social justice as well. That said, the theories discussed in this week’s readings are important to be considered when interventions are developed to address social justice pertaining concerns in local/global communities.

  31. This readings for this week were dense but interesting! Almgren’s article presented the main theories of social justice- as he mentions most students in public health and other related fields do not often have a full understanding of these theories and how health care is situated within them. I certainly could relate to this, although I was familiar with many of the terms and concepts, much of the information was new. The main theories presented were Libertarianism, Utilitarianism, Marxism, the Capabilities Approach and the Rawslian Approach (the chapter uses this approach to frame healthcare). Almgren describes these approaches as a “progression of moral improvements” and although the Capabilities approach may seem like the theory that has progressed above the rest- the Rawlsian approach is chosen for several reasons including it’s inclusion of aspects of the Capabilities approach. The quote given at the end by Norman Daniels sums up the approach well, “In general, meeting health needs, however they arise, is important to protecting opportunity, and thus important to sustaining the capabilities of free and equal citizens (pg. 41).

    Similar to Alice, I was a little confused on Faden and Powers differentiation on what is “morally urgent” especially when considering groups vs individuals. It seems like depending on who is control or who has power, the process of discerning what is urgent and what is not could become complicated?

    Both Faden and Powers and Beauchamp talk about Public Health as a matter of social justice and call for a restructuring of society and a rise of collective action.
    Both also emphasize the importance of the unfair protection or advantage (especially in regards to health) of those in power and those that are not.

    The Market Justice model clearly explains how the dominant perspective of individual freedom and responsibility prevents us from protecting and securing the health of all individuals equally. Beauchamp calls for new “public health ethic” that “highlights the social justice influences at work behind pre-existing principles” (pg. 15).

    At then end of Beauchamps article, he asks “…the concept of freedom as become a defense against nearly every attempt to extend equal health protection to all persons” (pg. 19). All of these readings certainly made me reflect on my position as a future public health “professional” and also a citizen of the world. I certainly have comforts that I have become used to at the expense of others. I wonder if/when the day will come when we as a society can/will change our expectations and idea of freedom.

  32. In the chapter by Almgren, he discusses the challenge of approaching and defining social justice in a pluralist democracy in which a range of people with varying beliefs, attitudes, and lived experiences coexist. As a framework for analyzing this approach, Almgren focuses on the concept of distributive justice, or just allocation of benefits within a society. This discussion builds on last weeks discussion of Sen’s Capabilities Approach to conceptualizing social justice, and the idea that it is more relevant to focus on ends versus means when assessing equality. The libertarian philosophy he discusses reminds me of the concept of healthcare that Safeway promotes (in the movie Escape Fire), and which its CEO stated that he hoped could be used on a larger scale (scaling cost of care based on BMI and other personal factors). Ultimately this theory is flawed, as it is grounded in the concept of “full self ownership” (Almgren, p. 5), which we know to be a simplistic viewpoint. On page 12, Almgren discusses Peffer’s interpretation of a Marxist approach to social justice, and identifies the right for citizens to rebel if government fails in providing “maximum equal liberty.” I watched the movie The Butler last night, and was thinking a lot about the absence of large-scale protests evident in the last few decades, and how essential civil rights activism and protests were to changing policy and lived experience.

    Rawls’ theory of social justice identifies the “Difference Principle”, which states that “privilege in status and power cannot be just if inherited or otherwise conferred in a process that does not provide equality of opportunity for all persons” (p. 20). This idea represents the stark differences between market justice and social justice, as discussed by Beauchamp. It is interesting to read Nussbaum’s list of capabilities, and to see the concept of control repeated, reinforcing the Marmot and Navarro readings from last week. This concept of control was also very evident in Seun’s experience in the private, primarily white school in the movie American Promise. For him in particular, he seemed so defeated as he was captured in the film as a student at Dalton. Part of it was because he was completely unsupported by the administration as a student with a learning disability. I was horrified to watch one of the administrator’s blame his challenges on being a black male (versus her perception of black female students as being better adjusted). As I saw it, she did not even consider what it was like to be an obvious minority in the school, both in terms of skin color and having dyslexia. In contrast, as he was portrayed at the school in Brooklyn, he looked happy, and my sense was that he felt supported and respected enough to participate actively.

    In the list of health needs listed in the Almgren chapter, I would argue that what needs to be prioritized is a life-course approach to health- the concept that those health care needs must be prioritized from the beginning of life. However, as Beauchamp states in his chapter, the prevailing approach to health reflects the prioritization of market justice principles. As he states, “public health should be a way of doing justice, a way of asserting the value and priority of all human life” (p. 18). After reading the Powers & Faden chapter, I still feel like I do not completely grasp the concept of morals versus ethics. I am also not sure that I completely buy into their take on the moral priorities for public health. On page 99 they discuss their opinion about justice. From what I understand, they are talking about impoverished individuals living in Sierra Leone and comparing a person in that situation to a person with Cystic Fibrosis. Perhaps I am missing their point, but the way I interpret it, the authors are stating that it would be more morally just to serve impoverished populations in Sierra Leone. I may have completely missed the mark, but to me this does not read as social justice. Curious if others had the same thoughts.

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