Food apartheid, a term that describes the deliberate nature of food insecurity in the US, is a bioethical issue because people need access to nutritious foods to help sustain a healthy lifestyle, but not all people have this access. The lack of this ability to easily obtain healthy food has contributed to chronic medical issues that span across generations in urban areas such as North Philadelphia. Hospital systems have an ethical obligation to address food apartheid in order to uphold the urban bioethics principles of social justice, non-maleficence, and solidarity. There have been many solutions implemented by local and national organizations and governments to try to combat food apartheid, which healthcare institutions can incorporate in order to benefit their patients. In this thesis, I will discuss some of these solutions and whether they have been shown to be effective in combatting food insecurity. These solutions include fresh food financing initiatives, which aim to open more grocery stores carrying fresh produce in areas affected by food apartheid, and healthy Corner Store Initiatives, which try to increase produce availability in existing corner stores. I will also discuss produce subsidy programs, which discount the price of fresh fruits and vegetables, and urban agriculture, which is usually a community-based initiative to increase access to fresh produce. After a description of the solutions, I will discuss the efficacy of examples of each of these types of programs, and if applicable, will mention if these programs have worked to address food apartheid in Philadelphia. Then I will discuss how well each solution incorporates Urban Bioethics principles. Finally, I will conclude with an analysis on which method may be most sustainable in combatting food apartheid and will explore why healthcare institutions must incorporate these methods in order to improve the effectiveness of the care they provide patients. / Urban Bioethics

Violence is a pervasive public health issue that disproportionately affects certain populations, particularly young black males in urban settings. Though this population experiences higher rates of violent victimization and perpetration, race should not be analyzed as an isolated variable. The social disorganization theory posits that social, cultural, and structural environmental factors shape a person’s behavior; this theory would suggest that higher rates of violence in young black men can be attributed to environmental factors rather than intrinsic traits like race. Young black males in urban settings experience high rates of poverty and institutional oppression, which primes these communities for excessive psychological trauma. The lasting effects of trauma, through Adverse Childhood Experiences and post-traumatic stress disorder, increase a person’s risk of violent victimization and perpetration, creating a cycle of violence in the community. Likewise, the high rates of firearm ownership create more opportunity for violent confrontation, especially in impoverished areas where joining a gang is perceived as one of the only options for economic and social survival as per the “Code of the Street.” In order to alleviate the burden of violence on this population, the root causes of violence, such as socioeconomic inequity and under-resourcing of disadvantaged communities, must be addressed by providing appropriate social services to those whom are most affected. / Urban Bioethics

There are about 2 million adults incarcerated. Of those, approximately 62% of women and 51% of men have a child less than 18 years old—that is about 4% of the US population (Ghandnoosh, Trinka, and Barry 2024; Glaze and Maruschak 2010; Turney and Goodsell 2018). In fact, if parental incarceration was considered a chronic health condition, it would be the second most prevalent childhood chronic condition in the U.S. (Axelson and Boch 2019). These children often already live in impoverished areas and the parental incarceration worsens their financial, educational, physical, and mental situations, forcing them to grow up faster and work harder (Miller 2006). They are at increased risk of facing more ACEs in childhood and by extension, at increased risk of morbidity and mortality in childhood and adulthood. I did a literature review on the various physical and mental health inequalities these children face. Using that as the foundation, I highlight the social responsibility towards these children. The literature review showed that children are more likely than their peers without incarcerated parents to have higher rates of infant mortality, increased BMI, hypercholesterolemia, asthma, migraines, hypertension, high-sensitivity-c-reactive-protein, ADHD, ODD, conduct and substance use disorder, and lower life expectancy (Holaday et al. 2023; Austin, White, and Kim 2022; Roettger and Boardman 2012; Lee, Fang, and Luo 2013a; Tung et al. 2023; Sundaresh et al. 2021; Gifford et al. 2019). I believe there are many players responsible for the physical and mental well-being of these children: themselves, family, society, and government. They are responsible for seeking help, and family members should prioritize their individual well-being. Society should encourage destigmatization, and the government should decrease costs for communication, and increase access to healthcare for the children and caregivers. These various agents need to work together to ensure the best health for the children of our future. / Urban Bioethics

Moral distress in the healthcare field includes feelings of frustration, anger, guilt, anxiety, depression, despair, and powerlessness to carry out ethically appropriate actions to patients in line with personal values in the setting of external constraints. Psychiatry residents are particularly vulnerable to experiencing moral distress due to the coercive aspects of psychiatric treatment, constraints in the medical system, and the internal conflicts caused by a resident’s identity as a trainee physician and competing duties to an individual patient, healthcare organizations, health care professionals, and society. Psychiatrists make complex assessments that often cannot be made with absolute certainty, but regardless, they are tasked with the duty to identify and ultimately act on their risk assessments. These unrealistic societal expectations are especially difficult for psychiatry residents who have not yet had the experience to grow their knowledge and confidence in their decision-making skills yet still must make difficult decisions in their new role as physicians. Ethical decision-making can be used to alleviate moral distress, and a consistent utilization of an ethical decision-making framework can help guide decisions that are both objective and thoughtful. The ethical framework proposed includes considerations of the patient's capacity to consent or refuse medical treatment, the urgency of the medical condition, the feasibility of the actions needed to address the medical condition, and the countertransference of the treatment team. This framework helps guide clinicians by ensuring they understand and address the ethical considerations involved in treating patients and the moral distress that arises from these difficult choices. / Urban Bioethics

Interpreter services play an integral role in ensuring equity in healthcare for patients with limited English proficiency (LEP), whose language barrier places them at increased risk for healthcare disparities. Even with the growing number of non-English-speaking patients, a sizeable number being Spanish-speaking, and although such training leads to more culturally competent care with better patient outcomes, there is little curricular time during medical school devoted to effectively using interpreters. This study aimed to understand better how medical education prepares future physicians for their encounters with LEP patients and what experiences they would appreciate in their medical training. Temple LKSOM student from the class of 2024-2027 (M1-M4s), were recruited through flyers and educator announcements to participate in three virtual focus groups with a total of 26 participants. Qualitative data analysis resulted in five themes which were: students felt that interpreters were integral to culturally competent care, students who speak another language have the undue burden of interpreting even when not comfortable doing so, students felt that there was not enough training in medical school regarding various types of interpreters, how to reach them or how to use them properly, students are open to doctoring sessions or simulations with non-English speaking standardized patients and interpreters, and the final theme was that there mixed feelings amongst students regarding the desire to have OSCEs with non-English speaking standardized patients and interpreters. / Urban Bioethics

Opioid use in pregnancy is the latest in a long list of social issues in the United States that is being addressed with punitive policies that disproportionately affect women of color and their families and do not focus on environmental factors contributing to increasing drug use in pregnancy. Evidence is emerging demonstrating that these punitive policies are not achieving their intended goals. Additionally, these policies continue a trend of pitting maternal and fetal interests against each other. Historically, bioethics has divided conversations on biomedical and environmental ethics. However, recent merging of these fields may facilitate the biopolitical translation of emerging epigenetics research of substance use in pregnancy. This paper reviews the ineffectiveness of punitive policies in reducing drug use in pregnancy and related negative health outcomes for both mothers and infants. It demonstrates how these policies perpetuate racial injustice through existing systemic oppressive structures. Leveraging epigenetics to draw a link between the environment and the maternal-fetal dyad can help members of the scientific community advocate for policies that promote equitable and justice-based public health interventions as well as relieve the maternal fetal conflict. / Urban Bioethics

The discourse surrounding medical error and its ethical implications has become a pivotal focus within healthcare. Thus, this thesis aims to delve into the multifaceted aspects of and influences on medical error and its disclosure, with each chapter progressively shedding light on their complexities and ethical considerations. The overarching argument posits that despite society’s general intolerance for errors and a recognized aim for perfection, error remains an unavoidable and inevitable aspect of the practice of medicine and medical training. There exists an inherent fallibility in healthcare juxtaposed against the gravity of the profession and its consequent medical and legal ramifications when something goes awry. The following ten chapters collectively highlight the intricacies of error management in healthcare through discussions on societal expectations, medical training, error analysis, accountability, systemic influences, patient-provider relationships, legal implications, and bioethical tenets. Ultimately, advocating for a cultural shift towards greater transparency, collective accountability, systemic quality improvement, and support for healthcare professionals to address errors effectively while upholding patient safety and trust. This thesis also recognizes the ethical imperative of error disclosure and the importance of fostering a balanced approach that acknowledges both the inevitability of errors in healthcare and the significant physical, emotional, and financial burdens caused by medical errors. / Urban Bioethics

This thesis is predicated on two ideas: that physical activity is a social determinant of health; and that the American mass incarceral system is a product of structural racism. First, I review the well-known benefits of physical activity and examine the very sparse existent literature on women exercising in American jails and prisons. I then address health disparities for incarcerated populations, exploring historical policies and laws that shaped the current climate of incarceral health. Next, I discuss my motivations and the challenges associated with starting the wellness program I created at a local jail where I lead a workout and meditation class for the female population. I utilize a bioethical lens to compare similarities between my experience in the hospital as a medical student and as a physical fitness instructor at the correctional facility. Finally, I use behavioral theories to highlight the impact exercise can have on individuals and the benefits that extend beyond the bodily and can translate into the increased life skills and personal development needed to impact social change. I conclude with an analysis of how community- based interventions that allow for meaningful engagement, such as exercise programming, can alleviate the stressors associated with incarceration — a physical and metaphorical opportunity for renewal and transformation. / Urban Bioethics

Purpose: The Standardized Patient [SP] Program is a potential avenue through which students from races and ethnicities underrepresented in medicine [URiM] experience bias, due in part to the inherent subjectivity of an SP’s evaluation of the doctor-patient interaction. In most training programs, medical students are assessed on their clinical and interpersonal skills via simulated encounters where students assume the doctor role and SPs act as patients. Researchers conducted this qualitative study to (1) understand the SPs’ perception of their role within the Objective Structured Clinical Exam and medical school education, (2) investigate biases that medical students may experience during SP evaluations of simulated clinical encounters.Methods: Participants were recruited from Lewis Katz School of Medicine at Temple University. Interviews and focus groups were conducted between August through October of 2022. A total of 14 medical students, 11 of which self-identified as URiM, were distributed into 6 focus groups. A total of 9 SPs were interviewed, 3 of which self-identified as non-white ethnic minorities. All interviews were then transcribed and analyzed using a combination of first-cycle coding methods. In the final stages of analysis, we examined the data to determine frequent themes across the study populations. Results: The results demonstrated conflicting sentiments between SPs and students. Although SPs described an intensive training process that promoted standardization of DPI scoring across SPs, URiM students reported high interrater variability, referring to the variation in the interpretation of a student’s communication skills by SPs. The consensus amongst minority students was that SPs evaluate students more leniently in interactions where the SP and student share ethnic identities. The themes present in the resulting data aligned closely with a social determinants of health conceptual framework, illustrating how disregarding the topic of implicit bias in the SP Program leads to a downward trajectory of differential attainment. Conclusion: Although medical education administrators have begun shifting their attention towards diversity, equity, and inclusion initiatives, there has been minimal focus on the key perspectives necessary to navigate this space. Our research analyzes those perspectives as an important first step towards acknowledging and effectively mitigating bias in medical education programs. / Urban Bioethics

BACKGROUND: For years, the trauma of acute inpatient psychiatric treatment has been studied. Trauma-informed models have been created to reduce the trauma of receiving care. These models primarily focus on patient-provider relationships and not the interpersonal dynamics between patients on acute psychiatric units. METHODS: A literature review via Temple University Library and Google Scholar databases as well as interviews with mental health professionals were conducted on the current trauma prevention initiatives in mental healthcare and on strategies to strengthen interpersonal relationships between patients in acute psych units and to quell patients’ perceived risk of harm from one another. RESULTS: A set of five principles is proposed for fostering community and safety in acute adult inpatient psychiatric units as it pertains to the interpersonal relationships between patients. These principles include: 1) Fostering a sense of community within the patient population 2) Rethinking the physical space to reduce patient stress and therefore reduce patient aggression 3) Providing a mentorship program led by peer mentors from the community 4) Providing better mental health education and awareness within society 5) Bridging the gap between the community and inpatient psychiatry. CONCLUSION: The five principles of this thesis can aid in positively transforming patients’ experiences in acute psychiatric units. This transformation requires a significant amount of activism and collaboration in order to stop repeating the cycles of trauma seen within the psychiatric field. / Urban Bioethics