Heart failure is a disease that affects millions of Americans, but has a disproportionate impact on underserved, minority communities. Over the coming decade, heart failure will become a chronic disease for more Americans as treatments improve, but the disease cannot be cured. Minority populations are, and will continue to be, disproportionately impacted by heart failure due in large part to their increased risk factors, which stem from social and structural determinants of health. Palliative care services offer incredible benefits for patients and caregivers covering a variety of areas, such as goals of care discussions, shared decision-making, and psychosocial support. Providing early palliative care services to underserved heart failure patients offers extra resources to effectively manage their disease and lifestyle in a personalized fashion, and aligns with the urban bioethical principles of agency, social justice, and solidarity. / Urban Bioethics

In 1976, the legal ruling of the case Estelle v Gamble established the precedence of evaluating unjust healthcare practices and violation of Eight Amendment rights to prisoners with application of a test of deliberate indifference. Since this ruling, many more cases have emerged which present the complexity in application of the deliberate indifference test involving incarcerated pregnant women specifically. The practice of mass incarceration within this country has contributed greatly to the number of women and pregnant women incarcerated, without the necessary advancements or even establishment of healthcare standards within prisons to provide necessary care. Shackling of pregnant incarcerated in the course of their pregnancy and the practice of separating mother and child immediately at birth evidence the continuation of unacceptable practices occurring in the United States of America. To understand this topic and the issues involved, an understanding must be gained of the history, legal course, and healthcare practices faced by pregnant women and mothers who are incarcerated. / Urban Bioethics

Organ transplantation has the potential to improve and prolong the lives of many chronically ill people. However, organs are a scarce resource and a commodity to which not everyone has equal access. Equity issues are particularly evident amongst African Americans concerning kidney donation and transplantation. In this paper, I discuss the history of kidney transplantation and the disparities that exist in the African American community for both organ donation and transplantation. I explain how the organ allocation system has structural barriers that do not account for the social determinants of health. Then I explore the significant barrier of African Americans’ mistrust of the health care system and its role in kidney donation and transplantation. I use the principles of urban bioethics to discuss possible solutions to mistrust including community engagement, diversifying the physician work force, and concepts that move beyond cultural competency to cultural humility and structural competency. / Urban Bioethics

This thesis is centered around Black maternal health disparities and the impact of Roe v Wade being overturned on the future of Black maternal health. I start off by first looking at the facts of maternal health disparities and how Black women are dying at a higher rate than their White counterparts. Then I draw on social determinants of health and how systemic racism plays a role in the health disparities we see today. I bring in literature that discusses different frameworks created to reduce the maternal health disparities gap. I use the literature to argue that more initiatives need to be done since the gap is still increasing. My intention for this thesis is to bring light to some solutions that may help decrease the maternal health disparities and highlight how Roe v Wade being overturned can cause a larger harm in Black maternal health. / Urban Bioethics

The health benefits of nature are numerous, wide-ranging, and often overlooked. An ever-growing body of research has started to document, substantiate, and even in some cases quantify the significance of interacting with nature and its effect on human health and well-being. These directly measurable health benefits are also compounded in urban environments by environmental and social benefits. For example, the inclusion of green spaces in urban communities has been shown to reduce violence. Green spaces are important for overall health, but also specifically for healing. The benefits of natural spaces in hospitals has been explored in the literature and shown to benefit not only patients but also family and visitors, as well as staff, by creating a healing and restorative environment that helps to reduce stress and alleviate anxiety. Lack of green space in urban communities is creating and exacerbating health disparities. Urban hospitals are often limited in their ability to include extra space, and particularly green space, in their campus, yet it is their patients who need these healing benefits the most. Particularly urban communities of low socioeconomic status are often those with the least access to green spaces, or only have access to low-quality, poorly maintained, unsafe green spaces. Yet the residents of these communities are those who stand to benefit the most from access to nature and a greener environment. Improving the accessibility, quality, safety, and square footage of natural green spaces in urban environments will help improve health equity by mitigating negative effects of the urban built environment on health and well-being, increasing the agency of these communities to live healthier lives, and allow them to reap the physical, emotional, and social benefits of green spaces. / Urban Bioethics

Social determinants of health have become a bit of a buzzword in today’s discussion of healthcare inequities. Social determinants of health are broadly defined as conditions in the places where people live, learn, work and play that affect a wide range of health and quality-of-life risks and outcomes. These factors almost always include education access and quality, health care access and quality, neighborhood and built environment, economic stability and social and community context. All of these factors play a role in how individuals and communities maintain their health. Social determinants of health plays into the black experience within healthcare, which is a factor in the increase in black maternal morbidity and mortality. An important note to highlight in the increase in black maternal morbidity and mortality is the growing public knowledge of the racial history within Obstetrics and Gynecology. We have these disparities and more and more Americans are learning about this health disparity, yet there are not many articles that highlight the ways to save black women from being just another statistic. I propose that if we focus on improving the public intellectualism of our country through social media, we are then all fighting for the survival of black women throughout pregnancy and post-partum. / Urban Bioethics

The field of bioethics originated from failures in medical research and provided a framework for medical decision-making and research ethics with the advent of its four core principles (justice, autonomy, non-maleficence, and beneficence). However, these core principles often overlook more complex issues related to health. In this thesis I take a critical look at traditional bioethics to demonstrate why more specific fields of bioethics, like public health ethics and urban bioethics, are necessary. I then look at the origins of urban bioethics to better understand the necessity for the field and the principles necessary for its implementation. Solidarity and agency are established principles of urban bioethics, and I will argue the need to add respect for community to the urban bioethics toolbox. Based on these principles; I argue the urban bioethicist has to understand the context of individuals and communities to properly apply agency, solidarity, and respect for community. The most appropriate way to build this context is through qualitative research. Qualitative research is uniquely suited for this task based on the nature of the field and the information it offers related to each of the principles of urban bioethics. / Urban Bioethics

Many women at academic medical centers experience gender-based microaggressions and sexual harassment during their careers. Women in surgical specialties experience a particularly high rate of these incidents, but these incidents occur across medical fields. As a result of microaggresions and sexual harassment in the workplace, women physicians experience a higher rate of burnout and moral injury, have fewer opportunities for promotion, and experience difficulty finding mentors when compared with their male colleagues. I argue that for these and myriad other reasons, microaggressions and sexual harassment of women physicians by their physician colleagues violates the bioethical principles of beneficence and non-maleficence. I also explore the importance of mentorship of women physicians by women physicians for navigating a career in academic medicine. / Urban Bioethics

Posthumous assisted reproduction (PAR), or conception after death, is of significant ethical debate. This thesis seeks to explore and evaluate the major ethical considerations concerning PAR. Autonomy, considered the most important ethical principle, holds a majority of the weight in this evaluation; it is not the sole topic on deciding whether to permit a request for PAR. In addition to the autonomy of the deceased, the discussion focuses on stakeholders, justice, and welfare of the child in regard to PAR. Application of these ethical principles allows for a holistic review of a PAR request, and ensures the best possible outcome for each request. / Urban Bioethics

Health literacy is not only the ability to read, but also the ability of an individual to obtain, process, and understand the basic health information needed to make appropriate health decisions. Over time the concept of health literacy has evolved from considering it a risk factor to be managed to considering it an asset which can be continually built upon. With this in mind health professionals should continue to communicate in simple language, but should also provide their patients with high-quality educational materials and aid them in making the best choices about their health. One way to do this could be with the use of symptom-checking and decision-aiding smartphone apps. In this study, the primary caretakers of children aged 30 months and younger with publicly funded health insurance will be randomized to receive a pediatric symptom-checking smartphone app or a developmental milestone smartphone app. Caretaker health literacy will be measured, and data will be collected on emergency department and primary care office sick visits. It is hypothesized that the use of the pediatric symptom-checking smartphone app will decrease non-urgent visits to the pediatric emergency department. / Urban Bioethics