An ethical framework titled “Research for Health Justice” has been developed that provides global health researchers with guidance on how to design their research to promote health equity and global justice. This study sought to test the framework’s guidance by comparing it to the governance and experiences of the “Severe Pre-eclampsia adverse Outcome Triage” (SPOT)-Impact consortium—a transdisciplinary maternal health research consortium. The aim was to identify ways in which the “Research for Health Justice” framework could learn from the consortium’s insights and practices and to identify how the SPOT-Impact consortium could more systematically link its governance and research to health equity. We conducted in-depth interviews with investigators, held a validation/reflection session with the consortium, and read core consortium documents. Our analysis identified areas of alignment, where the consortium’s practices strongly aligned with the framework’s guidance, and we describe how that alignment was achieved. We also identified areas of non-alignment, where the consortium’s governance or practices diverged from the framework’s guidance or where interviewees defined ethical concepts such that they differed from those of the framework. Based on our findings, we suggest several directions for the revision and expansion of the framework as well as lessons for the SPOT-Impact consortium regarding inclusive priority-setting, sharing resources, and research capacity strengthening.

As geopolitical interests increasingly shape global health funding and partnerships, there is a growing need to build solidarity in guiding how resources are shared, decisions are made and health equity is advanced.

An ethical framework titled "Research for Health Justice" has been developed that provides global health researchers with guidance on how to design their research to promote health equity and global justice. This study sought to test the framework's guidance by comparing it to the governance and experiences of the "Severe Pre-eclampsia adverse Outcome Triage" (SPOT)-Impact consortium-a transdisciplinary maternal health research consortium. The aim was to identify ways in which the "Research for Health Justice" framework could learn from the consortium's insights and practices and to identify how the SPOT-Impact consortium could more systematically link its governance and research to health equity. We conducted in-depth interviews with investigators, held a validation/reflection session with the consortium, and read core consortium documents. Our analysis identified areas of alignment, where the consortium's practices strongly aligned with the framework's guidance, and we describe how that alignment was achieved. We also identified areas of non-alignment, where the consortium's governance or practices diverged from the framework's guidance or where interviewees defined ethical concepts such that they differed from those of the framework. Based on our findings, we suggest several directions for the revision and expansion of the framework as well as lessons for the SPOT-Impact consortium regarding inclusive priority-setting, sharing resources, and research capacity strengthening.

Rising interest in solidarity in global health reflects a growing need to understand why and how it can shape global health policy, practice, and research. This study seeks to review existing studies on solidarity in relation to global health and to identify gaps in current knowledge. We conducted a scoping review of papers published between 2007 and 2024 to explore how solidarity is conceptualised and practised in the context of global health. Our search, guided by the key concepts of solidarity and global health, identified 752 studies across four databases: SCOPUS, PubMed, Global Health, and Google Scholar. Following a rigorous screening and full-text review process, 83 peer-reviewed journal articles meeting the inclusion criteria were selected for thematic review. This analysis focused on examining the relationships between solidarity and global health problems, norms, and practices. The majority of the 83 reviewed articles were theoretical or conceptual in nature (63.9

Introduction Solidarity in global health is often invoked as an ethical imperative to guide responses to global health challenges. Its meanings and practices across diverse contexts, however, remain under-explored. Deepening an understanding of how solidarity is conceptualised, enacted and perceived by a diverse array of actors within the global health ecosystem is crucial to advancing meaningful and measurable application of this commitment in global health.Methods and analysis This qualitative study uses interpretive research methodology to explore perspectives on solidarity among key global health stakeholders: community-level leaders in civil society organisations working on global health issues; research institute directors in the Global South; and individuals with experience of funding decision-making with major global health funding and agenda setting organisations (‘global health influencers’). Data will be gathered through semi-structured interviews and analysed using inductive and deductive reflexive thematic analysis, to identify patterns and differences in how these global health stakeholders recognise and define solidarity or its absence in their day-to-day work, while remaining attentive to conceptual tensions, participant interpretations of solidarity that may be unfamiliar to our team, and our role as researchers in shaping what we register and emphasise as significant in our reporting of findings.Ethics and dissemination Ethics approval was obtained from the Western University Health Sciences Research Ethics Board (HSREB) in Ontario, Canada # 2024-123965-87873 and the Ethics Committee for the Humanities, University of Ghana # ECH 163/23–24 and University of Oxford, Oxford Tropical Research Ethics Committee (OxTREC) waiver dated 10 April 2024. Study results will be submitted for peer-reviewed publication. Results will also be summarised in an open access report and presented at various stakeholder meetings and in online webinars.Protocol registration The final protocol was registered with Open Science Framework on 28 October 2023. View only link: https://osf.io/gryp5/?view_only=8baff435a35847f09a342408d38ee35b.

Healthcare systems have an ethical duty to ensure equal access to high-quality healthcare as a matter of social justice. In their pursuit of that duty, they generate substantial environmental harms. For that reason, healthcare systems also have an ethical duty to minimise their environmental impacts as a matter of environmental justice and ecological justice. Many countries are already transitioning to less environmentally harmful healthcare. This study investigates whether the two duties come into tension when designing new green hospitals and how such tensions (if found to eventuate) are navigated in practice. We conducted case study research in collaboration with an Australian hospital network, with one of the network’s new public hospital builds comprising our case of focus. We undertook semi-structured interviews between March and June 2023 with those responsible for making design decisions in relation to the new public hospital being built. We analysed interview data thematically and report three main themes: separating the clinical and the environmental; tensions; and addressing tensions. We conclude by providing analysis of what is at stake in identified tensions using theories of justice, offering lessons that can help other hospitals mitigate against such tensions arising, and considering whether and when the moral reasoning employed in the case-under-study should be used to navigate the tensions. This study provides those responsible for green hospital design with a better understanding of what tensions they are likely to encounter between health, social, and environmental goods and how to reduce those tensions’ occurrence. That understanding will help them to identify and avoid such tensions in their practice, but further work is needed to develop ethical guidance on how they should navigate the tensions when they occur.

Health research on climate change has increased substantially in recognition of the impact of climate change on human health. This research raises new ethical questions for health research priority-setting, including how to prioritize research on climate change and health versus other types of health research unrelated to climate change, and how to prioritize among different health research projects focused on climate change. In this paper, we focus on the latter. We consider whether the ethical criteria for health research priority-setting recently proposed by the World Health Organization (WHO) should be used by funders when allocating resources among health research projects focused on climate change. The WHO criteria were developed in response to imbalances around who controls and sets health research agendas and who benefits from them.The four criteria for ethical research priority-setting are optimizing social value, following fair procedures, respecting special obligations and assessing risks. We first show that these criteria are relevant to priority-setting for research on climate change and health because evidence suggests that the above-mentioned imbalances may exist when allocating resources to climate change and health research.We next assess whether the four criteria can help reduce imbalances in who controls and who benefits from resource allocation to such research. Our analyses indicate that the WHO criteria can help if further specifications are included for research on climate change and health. We provide recommendations for how to further specify the criteria.

We introduce five points for integrating environmental ethics into human genomic data governance: (i) recognizing the ethical imperative to consider environmental impacts of human genomic data; (ii) fostering collective responsibility for environmental harms; (iii) prospectively assessing benefits and harms; (iv) anticipating barriers to integration of environmental ethics into genomic data governance; and (v) meaningfully engaging all interest-holders. These points will be useful to all involved in the genomic data ecosystem.

We face an ever-worsening environmental crisis to which healthcare systems substantially contribute. This article clarifies what the duty to minimise healthcare's environmental impact entails as a matter of environmental and ecological justice. Yet upholding the duty raises further ethical questions around responsibilities and trade-offs: Should responsibility lie at the individual (micro), organisational (meso), or systemic (macro) level? How far should those responsible go to fulfil the duty when it conflicts with ethical duties to deliver health and social goods to patients? This article considers those questions using the case of carbon accounting in the ED. It presents a range of plausible answers, drawing on current debates in the green bioethics space.

Health systems contribute to the environmental crisis. Yet, addressing this problem seems to generate a resource allocation dilemma for hospitals: investing in healthcare delivery seems to mean sacrificing environmental goods, and vice versa. We question this zero-sum thinking. After presenting the benefits of investing in the two seemingly competing goods-environmental goods and health goods-we propose that the apparent dilemma arises due to a tendency to think in dualisms. Consequently, health and environmental goods seem, respectively, to correspond to opposing sides of four dualisms: human/nature, local/global, present/future and therapy/prevention. We argue, instead, that a relational frame that considers the human person in their relational context should be used to approach the problem. A relational understanding of the human person as a meaning-making subject in relationship to all that is shows us that choosing between either health goods or environmental goods is frequently a false dichotomy: both can serve the well-being of human beings adequately understood. Such an approach, then, widens our conception of health and healthcare to include environmental goods. This wider conception of health and healthcare means that hospitals should (1) look for co-benefits in the first instance when allocating resources, thereby often resolving zero-sum thinking that gives rise to the competing goods dilemma, and (2) in the remaining cases where co-benefits are not achievable, use classic resource allocation principles, such as proportionality of benefits and burdens, to reach allocation decisions about a now wider range of goods (i.e., health and environmental, rather than merely health goods).

Solidarity is one of the emerging values in global health ethics, and a few pieces of bioethics literature link it to decoloniality. However, conceptions of solidarity in global health ethics are influenced primarily by Western perspectives, thus suggesting the decolonial needs to include non-Western perspectives. This article explores a decolonial interpretation of solidarity to enrich our understanding of solidarity. It employs a palaver approach, typical of African (Yorùbá) relational culture, in developing a conception of solidarity grounded in a beehive metaphor. Through a decolonial methodological approach, this article posits that a beehive metaphor allegorically symbolises solidarity. In this decolonial interpretive account, solidarity embeds relational virtues and duties that foster harmony. Solidarity is a positively oriented affective disposition with people with whom one shares similar circumstances for harmonious well-being through concerted efforts. This article addresses five potential objections to this account of solidarity in global health ethics and consequently explores what an African account of solidarity means for global health research funding. This article concludes that the palaver decolonial approach from the Global South has implications for expanding conceptual perspectives on solidarity in global health ethics.

Climate change and worsening environmental degradation remain the greatest threat of our time. How to address the environmental crisis ethically and equitably is one of the most important questions facing the global community. Conceptions of environmental justice and ecological justice are key sources of guidance on this matter. Yet these conceptions are ill equipped to guide global action. They identify four core dimensions of environmental justice and ecological justice: distribution, recognition, inclusion, and well-being. In this paper, I argue that different ontological (e.g., holism) and experiential (e.g., colonization and coloniality) starting points in the Global South identify additional dimensions-harmony and power-and additional aspects of the recognition dimension that are largely missing from dominant multivalent concepts. I next offer three epistemic reasons why excluding the additional dimensions and aspects from our conception of environmental justice and ecological justice is problematic. I then apply relevant theory from the Global North and South to propose how the power, harmony, and recognition dimensions might be understood or reimagined. I demonstrate that a broadened environmental justice and ecological justice concept identifies certain issues voiced by people from the Global South as injustices, where current mainstream concepts do not. I conclude by considering important objections to the ideas proposed in the paper.

Growing recognition of intersections between our health and the environment, healthcare systems and the environment, and health research and the environment has led bioethics scholars to advocate that the field readopt a broader perspective that considers nature. As part of doing so, we urgently need to reimagine research ethics concepts and frameworks so that they account for the environment. This paper focuses on how we should reinterpret the ethical concept of social value in health research. The concept is understood in absolute and relative terms, and both must be revised. The absolute social value of health research is determined by judging its magnitude of benefits and likelihood of benefits. This paper aims to generate considerations for judging health research's magnitude of benefits that capture its environmental benefits. We start from the most comprehensive definition of absolute social value to-date and show how it falls short of adequately capturing the magnitude of potential benefits generated by health research that yields knowledge related to nature. Based on that analysis, we propose how to revise the definition of absolute social value to better account for the environment. To conclude, we highlight questions that our suggested revisions raise for making relative social value assessments that consider the environment.

Climate change, ecological degradation and global inequalities are symptoms of an eco-social polycrisis that threatens global health and health equity. This polycrisis is deeply rooted in Western value systems. These can be described as anthropocentric and individualistic and support the prevailing neoliberal economic model. Bioethics is now called to respond to the urgent health-related ethical challenges of the polycrisis and has recently begun to engage with Planetary Health and One Health in this regard. Both have mainly emerged in the Western scientific community and understand human health to be inextricably linked to the state of environmental and structural societal determinants. We argue that bioethics should indeed embrace holistic or integrated understandings of health but also carefully revisit the foundational Western value systems at the root of the polycrisis. If Planetary Health and One Health stay grounded in Western value systems, an extensive conceptual engagement might be problematic for bioethics. Instead of turning to Western concepts of health, bioethics should engage deeply with Indigenous and non-Western ways of knowing and critically reflect on its own role in inadvertently maintaining the status quo.

What does a commitment to social justice and equity mean for community engagement in public health? This chapter first discusses the moral aims that derive from the field's commitment to social justice and then argues that those aims are best advanced through a form of community engagement where decision-making power is shared with communities throughout public health research, practice, and policymaking. It then delves into how those working in public health can design engagement processes such that they share decision-making power with communities. The chapter concludes by considering what ethical dilemmas may arise amidst efforts to share decision-making power with communities in public health.

Six planetary boundaries have already been exceeded, including climate change, loss of biodiversity, chemical pollution, and land-system change. The health research sector contributes to the environmental crisis we are facing, though to a lesser extent than healthcare or agriculture sectors. It could take steps to reduce its environmental impact but generally has not done so, even as the planetary emergency worsens. So far, the normative case for why the health research sector should rectify that failure has not been made. This paper argues strong philosophical grounds, derived from theories of health and social justice, exist to support the claim that the sector has a duty to avoid or minimise causing or contributing to ecological harms that threaten human health or worsen health inequity. The paper next develops ideas about the duty's content, explaining why it should entail more than reducing carbon emissions, and considers what limits might be placed on the duty.