Center for Social Justice and Health Equity

Overview

The Center for Social Justice and Health Equity at Massachusetts General Hospital is dedicated to the advancement of unbiased health care among underserved patient populations. We hope to achieve our mission of fostering more inclusive health care, social policy and practice through leadership in key areas such as:

• Advocacy of health care, social policies and practices that are inclusive of all patient populations, with particular attention to the health-related social needs (HRSN) of underserved communities
• Educating all health care leaders interested in working with community members to integrate effective solutions into everyday practice
• Public health and health services research that minimize vulnerabilities and produce innovative solutions for the stigmatizing social conditions that impact underserved patient populations
• Quality improvement initiatives, such as the Mass General Freedom Clinic and Human Trafficking Initiative, that employ evidence-based programs to address the HRSNs of underserved patient populations and narrow the gap in health outcomes

Our vision is to promote a health care system that responds to the wide-ranging needs of the diverse communities that we serve.

Focus Areas

The primary areas of ongoing effort for members of the center include:

• HRSNs such as health literacy, health outcome disparities, housing instability and substance use disorders
• Injury prevention with particular attention paid to incidents related to firearms and suicide
• Interpersonal violence, which covers all aspects from domestic to community violence as well as human trafficking and sexual abuse
• Professional diversity and inclusion such as workforce development, retention and recruitment and initiatives related to women in the workplace
• Underserved populations including LGBTQ, hostage recovery care (Mass General Freedom Clinic), immigrant health and homeless groups
• Increasing civic engagement among marginalized groups
• Transforming emergency departments nationwide into the front door for evidence-based treatment of opioid addiction

Climate Change, Health & Equity

Through work based at Harvard University, Renee N. Salas, MD, MPH, MS leads two national efforts on climate change and health: The Lancet Countdown on Health and Climate Change Brief for the United States and Working Group and the Climate Crisis and Clinical Practice Initiative with The New England Journal of Medicine (NEJM). Climate change disproportionately harms the health of vulnerable communities, and thus health equity is woven into the very fabric of these two endeavors. In addition, clinical work in the emergency department increasingly illustrates how climate change is harming the health of patients today—reinforcing the need for urgent upstream climate action and the rapid implementation of health protections.

The Global Lancet Countdown was created in 2016 to produce an annual report that tracks the health implications of a changing climate and the world’s response—or lack thereof. This international, multi-disciplinary collaboration publishes an annual Global Report in The Lancet that tracks a suite of indicators across five domains and prioritizes the dissemination of its research findings to policymakers through collaborations with key partners to produce national briefs. The briefs outline the state of climate change and health at a country-level, highlighting select indicators for which national-level data exists, and provide national policymakers with recommendations. The annual U.S. Policy Brief process, co-branded with the American Public Health Association, is supported by a Working Group of over 70 member institutions, organizations, and centers from universities, public health and medical organizations, federal agencies, and environmental and health non-governmental organizations. Dr. Salas has served as the lead author since 2018 and founded and leads its Working Group.

The Climate Crisis and Clinical Practice Initiative, which Dr. Salas spearheads, was launched in Boston in February, 2020 with the first Climate Crisis and Clinical Practice Symposium, in collaboration with the NEJM, and a companion NEJM Perspective article.  In collaboration the Harvard Global Health Institute (HGHI), the Center for Climate, Health, and the Global Environment (Harvard C-CHANGE) at the Harvard T.H. Chan School of Public Health, and Harvard Medical School, this Symposium brought together every major hospital system in Greater Boston to discuss the local implications of the climate crisis on clinical practice and health care delivery. Flagship sites within the U.S. and abroad committed to bringing their healthcare systems together in a similar forum, with additional partner events ongoing.

Evidence-Based Opioid Addiction Recovery Treatment in The Emergency Department

Opioid Use Disorder (OUD) has reached crisis levels across the United States in recent years and the impact is felt in no place more than our nation’s Emergency Departments. The Get Waivered Campaign launched at Massachusetts General Hospital Emergency Department, in collaboration with behavioral economics firm ideas42 and the Mass General Program in Substance Use & Addiction Services, has explored insights and approaches from behavioral science to optimize our emergency department OUD treatment protocols to 1) get physicians waivered and 2) enable physicians to help more patients get into effective, evidence-based treatment. Key components of our approach include an on-demand, transitional outpatient ‘Bridge’ clinic and immediate access to buprenorphine in the emergency department (dual pathway model) which was the first hospital to offer this in Massachusetts in 2017 and among the first hospitals nationwide. Our hospital-behavioral economics firm collaboration has developed a set of behavioral interventions (or nudges) that were launched and tested in Mass General's Emergency Department that increased the rates of ED clinician initiated treatment for OUD. Read more about our national program Get Waivered National or visit our state partner sites in Texas through Get Waivered Texas, and Nebraska through Get Waivered Nebraska to learn more.

Voter Registration

Through a collaboration with Turbovote, a nonprofit that works to simplify the voting process, the Mass General Emergency Department has launched an ED based online voter registration platform called VotER. The VotER platform is a seamless, online, iPad-based portal for low acuity patients to use to become registered to vote while they wait in the ED. The platform uses the online voter registration portals of Secretary of State websites across the country to get patients registered virtually. Mass General is now working with hospitals in a multi-state pilot to establish VotER registration platforms that give patients convenient access to voter registration while they wait all across the country.

Human Trafficking

The Mass General Human Trafficking Initiative (HTI) was launched in 2008 to raise awareness of human trafficking as a public health issue and advance anti-trafficking efforts in research, education, policy and clinical care within the health sector. From 2008-2010, HTI completed nine social-science research case studies on human trafficking in the United States, United Kingdom, Brazil and the Philippines. Our research examined local public health responses to sex trafficking of women and girls in order to understand the health sector’s role in mitigating the health effects of trafficking.

HTI has built on its research by developing an evidence-based training on human trafficking for multidisciplinary health care audiences with the goal of heightening awareness, improving victim identification and developing trauma-informed responses that address the complex health and social needs of trafficked persons. In addition to this work, HTI has engaged in advocacy for the development and implementation of evidence-based policies to safely and effectively assist survivors of trafficking. The initiative's newest efforts have focused on providing comprehensive, trauma-informed and survivor-centered care for victims and survivors of human trafficking referred to the Mass General Freedom Clinic.

Human Trafficking in Health Care

Human trafficking is a global issue of grave public health concern. According to a 2012 report from the International Labour Organization (ILO), an estimated 20.9 million persons worldwide are trapped in forced labor and sexual exploitation.

In the U.S., cases of human trafficking have been reported in all 50 states and make reference to both citizens and foreign nationals. Trafficked persons experience numerous negative health outcomes including, but not limited to:

• Malnutrition
• Neglect of chronic medical conditions
• Occupational injuries
• Psychological trauma
• Sexually transmitted infections and diseases (including HIV)
• Substance use disorders
• Unplanned pregnancy
• Violence-related injuries

In a 2014 study conducted by Laura Lederer, founder and president of the non-profit Global Centurion, up to 87.8% of human trafficking survivors report undergoing an evaluation in a health care facility at least once while trafficked. Health care providers are uniquely positioned to prevent trafficking as well as identify and respond to trafficked persons in the health care setting.

Our Focus Areas

Research

• Identify opportunities for more effective approaches in the health care setting that assist trafficked persons
• Elucidate the epidemiology and pathology of human trafficking in the U.S.
• Examine the health sector response to the needs of trafficked persons
• Understand the health sector’s role in mitigating human trafficking

Policy Advocacy

• Build a network of health care providers to serve as advocates for trafficked persons
• Inform policy through research
• Represent the health sector in agencies and policy groups at the federal and state levels

Education and Training

• Develop evidence-based resources on human trafficking for health care providers
• Provide in-person trainings, live and recorded webinars and online courses for health care professionals
• Train health care providers in trauma-informed, survivor-centered approaches to care

Clinical Care

• Assess and address medical, mental health and social needs via case management
• Include survivors on the clinic's advisory board
• Promote the Mass General Freedom Clinic, which provides free comprehensive primary and preventive care for victims and survivors of human trafficking in the Greater Boston area and beyond
• Refer as needed to medical subspecialty care and community-based legal/social services

Acknowledgements

We would like to acknowledge our funder, Give Way to Freedom, for helping us make all of this possible!