Welcome to Fireside Chats! Social Justice: Is this an essential item for the new Core Competencies? Friday November 10, 2006 1:00 2:30 PM Eastern time Advisor on Tap: Dr. Nancy Edwards
Housekeeping Telephone: *6 to mute/unmute if your line is bad hang up and call back in Visual Presentation via Bridgit internet conference or use the PPT presentation link posted on www.chnet-works.ca Fireside Chat page Agenda: 1:00 PM welcome and introductions 1:05 PM Presentation and discussions 2:00 formal closure 2:00 2:30 PM informal discussions 2:30 PM closure Remember to exit Bridgit at the end of the chat
Introductions: Core Competencies and Skills Claire Betker, Coordinator Pan Canadian Consultation on the core Competencies for Pubic Health Public Health Agency of Canada
Introductions: Dr. Nancy Edwards, Professor School of Nursing and Department of Epidemiology and Community Medicine CHSRF/CIHR Nursing Chair Director, Community Health Research Unit
Objectives Social justice a core value of public health Compare how social justice is reflected in CHN standards and core competencies Review development and application of Canadian Nurses Association social justice gauge Discuss next steps
Social Justice A founding pillar of public health A critical goal of social progress
Social Justice Core Value Early on public health was closely allied to social reform, openly, without any apologies (B. Rosenkrantz, Historian) Justice is so central to the mission of public health, it has been described as the field s core value (Gostin & Power, 2006)
Social Justice - Philosophy Social justice is inextricably linked to public health. It is the philosophy behind public health (Foege, 1987) The time has come to herald human rights as both the foundation of public health and the compass of public health (JAPHA, 2000)
Social Justice and Public Health Under social justice, all groups and individuals are entitled equally to important rights such as health protection and minimal standards of income. The goal of public health, to minimize preventable death and disability, is a dream of social justice. (Levy & Sidel, 2006)
Do the Community Health Nursing Standards of Canada incorporate principles of social justice?
Community Health Nursing Values & Beliefs Are based on the CNA s Code of Ethics for RN s - interpreted from the CHN perspective.
Community Health Nursing CARING Values & Beliefs: Essential & universal Based on the principle of social justice awareness of equity Expressed through competent practice & the development of relationships Acknowledges physical, spiritual, emotional and cognitive aspects Preserve, protect & enhance human dignity in all interactions
Community Health Nursing Empowerment Values & Beliefs: An active, involved process Movement towards increased individual & community control, political efficacy, improved quality of life & social justice Involves people discovering & using their own strengths
CHN Practice Standards: 2. Building Individual/Community Capacity Indicator examples: The Community Health Nurse: Uses community development principles. Applies principles of social justice & engages in advocacy in support of those who are as yet unable to take action for themselves. Supports community action to influence policy change in support of health.
From. professional code of ethics to community health nursing standards to public health core competencies
Core Public Health Competencies (from DRAFT) No explicit reference to social justice The terms social justice and inequities are not used in the list of core competencies
There are some implicit references (hints) Examples: Analysis and assessment domain: Recognize how the data illuminates ethical, political, scientific, economic and overall public health issues Policy development and program planning domain: Articulate the health, economic, administrative, legal, social and political implications of each policy option
Implicit References cont d Leadership & Systems Approaches Domain: Ethically manage self, people and resources
Some additional wording for consideration Core public health sciences Analysis & assessment Policy Development Describe public health s explicit role in righting social injustices (Kass, 2001) Use data to describe health inequalities and health inequities State the expected ways in which each policy option may reduce or increase social and health inequities
Some additional wording for consideration Partnership & collaboration Socio-cultural Solicit input from individuals and organizations to address inequities Support governments and community partners to build just institutions Facilitate dialogue about the fair allocation of resources Understand and apply the Universal Declaration on Human Rights
Your Turn Are these suggestions: Practical? Readily understood? Politically acceptable? Consistent with social justice principles?
Your Turn Why are there no explicit references to social justice in the core competencies? What would be the advantages and disadvantages of making the references to social justice more explicit?
Too often, public health agencies use the language of social determinants of health and the need to reduce health disparities but do not internally transform in ways that would allow for the nontraditional actions required to address social injustice as a risk to the public s health (Plough, p. 423; In Levy and Sidel, 2006)
If social justice is to become a core competency Public health agencies need to support these functions Social justice needs to be translated into action, not just by practitioners but by their employing organizations and partner organizations
Some history. June 2002: Canadian Nurses Association Board of Directors signaled the organization s commitment to advancing social justice June 2003: CNA Board educational workshop Social Justice Initiative commenced: investigate the adoption of social justice as an applicable policy means as well as a valid and achievable policy goal. Our team: June Webber, Colleen Davison, Nancy Edwards, Sheila Robinson
Objective & Methods - Phase 1 Objective: Describe how organizations define and monitor social justice Methods: Search strategy 7 health and social science databases Sample search terms social justice, fairness, equity with gauge, criteria, measure, guideline 109 English language articles 1998-2004 Semi-structured key informant interviews & review of organizational websites Decision tree developed Applied by senior staff to current issues
Literature Review Findings Phase 1 Social justice linked with social progress, social determinants, social development, social responsibility, human rights, equity, poverty reduction, just institutions, ethical practice, advocacy Approaches to assess alignment of an organization with gender equality, social responsiveness, fairness, equity Scorecards Assessment frameworks Benchmarks and report cards
Key Informant Interview Findings Phase 1 16 key informant interviews 13 organizational websites reviewed 4 organizational tools identified Limited applicability to nursing and/or to social justice
Social Justice the fair distribution of society s benefits, responsibilities and their consequences. It focuses on the relative position of one social group in relationship to others in society as well as on the root causes of disparities and what can be done to eliminate them. (Canadian Nurses Ass n)
Decision Tree Inequalities or Inequities? 1. Are there INEQUALITIES / DISPARITIES in health status? 2. Are there inequalities of HEALTH DETERMINANTS? 3. Does government legislation exist that creates or impacts inequality? If so, legislation is examined; if not, 4. Is there freedom of choice? If so, these are Elective Inequalities; if not, 5. Can these circumstances be controlled by a community or institutions? If not, these are unavoidable inequalities; if so, SOCIAL INEQUITIES exist
Objective & Methods - Phase 2 Objective: Develop a social justice gauge and test its utility with board members of Canadian Nurses Association Methods: Social justice gauge developed Gauge applied to position papers of Association and to issue of euthanasia Gauge applied to Code of Ethics
Social Justice Gauge Guiding Principles: Recognition Organization must understand and be able to describe inequities that exist, reasons for their presence and how they affect population sub-groups, including nurses Responsible action Organization must take action on inequities, advocate for the reduction of sources of oppression and work towards parity and fairness
Social Justice Gauge Defining attributes of social justice: Equity including health equity Human rights including right to health Democracy and civil rights Capacity building Just institutions Enabling environments Ethical practice Advocacy Partnerships
Social justice attributes Equity & health equity Just institutions Recognition Nurses recognize and respect the inherent worth of each person Responsible action Nurses should seek ways to improve access to health care
Social justice attributes Enabling environments Recognition Nurses acknowledge their responsibility in contributing to quality practice settings Responsible action All nurses must contribute to a safe and supportive work environment Partnerships Nurses responsibilities to enact values of the code cannot be separated from responsibilities of other health care providers Nurses are encouraged to work individually as citizens or collectively to bring about social change
Applying the social justice gauge Readily used across position papers on diverse subjects and on code of ethics Gauge helps identify: gaps in recognition and responsible action use of passive language relative strengths and weaknesses of document with respect to defining attributes of social justice
Canadian Nurses Association SOCIAL JUSTICE a means to an end, an end in itself CNA Board of Directors, June 2005 http://www.cnaaiic.ca/cna/documents/pdf/publication/social_justice_e.pdf
Conclusion Social justice gauge is a guide for policy review and a springboard for reflection and discussion for an organization Further applications of the gauge to relevant policy documents would be useful
Next Steps Would you be interested in providing additional input on the social justice gauge? If so, please contact Nancy Edwards Nedwards@uottawa.ca
Canadian Nurses Association Department of International Policy and Development 50 Driveway Ottawa ON Canada K2P 1E2 Telephone: 1-800-361-8404 or (613) 237-2133 Fax: (613) 237-3520 E-mail: info@cna-aiic.ca Web site: www.cna-aiic.ca
References Public health ethics: Mapping the terrain. J Law Med Ethics. 2002; 30(2): 170-8. Kass NE. An ethics framework for public health. AJPH 2001; 91;11. Levy BS, Sidel VW (Eds). Social Injustice and public health. Oxford University Press. 2006. Social Justice..a means to an end, an end in itself. Canadian Nurses Association, 2006. www.can-aiic.ca Davison C, Edwards, N, Webber J, Robinson S. The development of a social justice gauge and its use to review the Canadian Nurses Association s code of ethics for registered nurses. (In press). Advances in Nursing Science.
Equity Effectiveness Loop Tugwell, de Savigny, Hawker, Robinson BMJ 2006;332;358-361
Core Competencies Survey Information from Claire Betker
Thanks for joining in! For more information: www.chnet-works.ca Next Fireside Chat: Friday November 17 th Using Technology in Health Promotion Back by popular demand.
CHNET-Works! Contacts Dot Bonnenfant, Animateur, (animateur@chnet-works.ca) Alex Budgell, Administrator, (info@chnet-works.ca) Dr. Nancy Edwards and Dr. Anita Kothari, Project Directors