Health Justice As a Tool to Fight Existing and Future Pandemics

The impact of the COVID-19 pandemic exposed the nation’s glaring health disparities, highlighting how the communities hit the hardest by the pandemic already had long suffered the impact of structural inequities. From the Syphilis Study at Tuskegee to the disproportionate impact of the HIV/AIDS crisis on members of the LGBTQ+ community, the history of discrimination in public health has created valid reasons for collective mistrust. We need to restore patient trust by communicating honestly and effectively on complex medical issues and by developing the capacity to reach a broad range of patients. To accomplish this, I believe we must embrace the concept of health justice.

What is Health Justice?

Health justice is a tool we can use to meet the nation’s health equity goal. If we want everyone to have a fair opportunity to achieve health, we must address the harms of the past while looking ahead to what is now possible in public health. This means we must value human rights just as much as we allocate resources in a way that allows communities to thrive. A health justice lens addresses the underlying social and structural factors that actually determine health, such as community safety, education, housing, and access to healthy food, to name a few.

What We’re Doing

George Washington University School of Medicine and Health Sciences launched a new program to educate primary care practitioners (PCPs) about how to deliver culturally responsive and nonjudgmental communications with all patients about COVID vaccines and HIV screening and testing. Our Two in One: HIV + COVID Screening and Testing Model, a national research-informed effort, aims to equip PCPs with the ability to recognize population preferences for inclusive messaging when talking with any patient about HIV, PrEP or COVID vaccines. Our nine-month training series also promotes culturally responsive communication with racial, ethnic, sexual, and gender minoritized patients.

Examining Mistrust

Our project identifies the common roots of mistrust for COVID-19 and HIV, which both impact the same minoritized patient populations and carry societal stigmas that can preclude them from seeking necessary medical attention. Our nation’s history of scientific and medical racism, along with the persistent fear of exposure-based judgement, creates a hostile environment that often discourages people from seeking the care they need.

How PCPs Can Use Principles of Health Justice to Communicate Effectively with Patients

The Association of American Medical Colleges’ health justice framework and their Principles of Trustworthiness, is a valuable resource which lays out how stakeholders, like medical professionals, can build trust within diverse communities. AAMC’s principles emphasize that “mistrust is a rational response to actual injustice.” And that “the community knows what it doesn’t know and will ask when it thinks you have answers it can trust.”

To pursue health justice for their patients, PCPs can learn to practice active listening, collaboration, and transparency. It all begins with listening.  AAMC emphasizes that “people closest to injustice are also those closest to the solutions to that injustice.” So, practitioners must learn to listen skillfully to their patients when they are describing their experiences and conditions. This forms the basis for clinicians to collaborate and share power with patients to take an active role in their own care, and to make informed decisions about their treatment options. When patients feel that they are being heard and respected, they are more likely to trust their PCP and feel confident in their care options.

In April, the Two in One: HIV + COVID Screening and Testing Model hosted a webinar on this topic with Dr. Philip M. Alberti, the AAMC’s founding director of their Center for Health Justice. You can view the webinar here.

We are excited by the potential of this program. We hope that you share our commitment to collaboration, understanding and transparency that can create the basis of strengthening our public health response to existing and future pandemics.

Dr. Maranda C. Ward is the principal investigator of the Two in One: HIV + COVID Screening and Testing Model, director of equity and assistant professor of clinical research and leadership at The George Washington University’s School of Medicine and Health Sciences.