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

As a healthcare provider focused on women’s health, injustice is something that I see in my patients’ experiences daily. The reasons behind the injustice go far beyond the walls of the hospital. They are related to provider awareness and training, patient access and cultural ideals, as well as structural bias against women, specifically non-English speaking women and women of color. They exist in an entangled web, in which the compilation of multiple factors results in further bias and further distance between the actual care the patient is in need of and the care they receive. My planned future role is to be a provider in Urogynecology, and I will be starting my fellowship in July 2024. This field has a unique lens into the care of women, spanning all ages, races, ethnicities, and education levels. So many women experience incontinence and prolapse, yet so few get help and present to care. Often in the literature, there is documentation that Black and Brown women do not have these issues as frequently as White women. However, there is little acknowledgment of the role that race and culture plays in obtaining care, and how this view could be distorted given so few women feel comfortable speaking on the topic of incontinence and prolapse. This thesis investigates the possible reasons associated with either no presentation or late presentation to care for incontinence and prolapse, and questions whether the captured prevalence in the literature is the true prevalence in our population. I review the research that exists, both quantitative and qualitative, regarding care patterns, patient attitudes and cultural factors, provider knowledge and awareness, and structural factors that facilitate and hinder access to urogynecologic care. I then use an urban bioethical lens to further identify structural bias and racism within healthcare, and inform strategies that may be used to better patient knowledge and education, to allow for more comprehensive and equitable care for women within the field of urogynecology. / Urban Bioethics

Patients with opioid use disorder (OUD) are at a high risk of a patient directed discharge (PDD) from the hospital and subsequent readmission, which is a significant detriment to their health. Qualitative studies have shown that, amidst myriad other reasons, patients with OUD leave the hospital due to undertreatment of their withdrawal and pain. Current guidance for the inpatient medical management of both withdrawal and, more broadly, OUD is initiation of opioid agonist therapy in the form of methadone or buprenorphine. While both have been shown to be highly effective for maintaining remission from OUD, there exist a myriad of barriers to enacting and maintaining this therapy. One approach to address this gap is expanding the array of opioid medications available to patients in withdrawal to include long and short acting opioids. There is limited data on the patient reported outcomes and perspectives of such an approach. This thesis draws from qualitative interviews of patients with OUD about their experiences being treated with this expansive protocol in order to characterize the attributes of successful withdrawal management for this population. Being treated by an addiction medicine team has already been shown to successfully reduce premature discharge. I argue that this approach, considered unorthodox by some, centers a patient's agency in making the decisions that are best for their situation and reduces harm to patients. The current standards of care do a disservice to patients with opioid use disorder, and this is a more progressive and ethical approach to inpatient addiction medicine that should be applied to other hospitals with high volumes of patients with OUD. / Urban Bioethics

Palliative care is a specialty focused on improving the quality of life for patients with serious illnesses through symptom management and emotional/spiritual support. Despite its documented benefits, it remains largely underutilized among head and neck cancer patients, especially those in urban environments. This thesis reviews obstacles to accessing care in these environments and proposes practical solutions to enhance palliative care accessibility and effectiveness. Disparities in the access and utilization of palliative care are largely influenced by socio-economic status, cultural discrepancies, and healthcare infrastructure, with limited patient awareness further impacting its use. Addressing these challenges requires a comprehensive strategy that includes policy reform, educational outreach, and localized community interventions. Such approaches should be culturally sensitive and tailored to local needs to bridge the gap between medical services and community expectations. By working with patients to recognize palliative care as an integral part of comprehensive cancer care, rather than merely an end-of-life option, we can improve the quality of life for patients with head and neck cancer. / 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