Charity and Justice: Finding the Balance

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Charity and JusticeFinding the Balance

• Michael Clements, M.P.H., M.S.W.
• The Winston-Salem Foundation
• mclements_at_wsfoundation.org
• Doug Easterling, Ph.D.
• Wake Forest University School of Medicine
• dveaster_at_wfubmc.edu
• 2008 Forsyth County Health Summit
• January 15, 2008

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Motivation for the Session

• The Summit explores the balance between personal
  responsibility versus community responsibility in
  developing solutions to major public health
  problems.
• If we accept the premise that the community
  shares at least some responsibility, then how
  should the community respond?
• There are (at least) two distinct perspectives to
  guide the communitys response
• Charity (i.e., giving)
• Justice
• Charity and justice focus on different causes and
  remedies.
• How a community addresses issues such as HIV,
  childhood obesity, infant mortality, cancer, and
  heart disease will depend on which perspective is
  dominant.

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Key Questions to Explore

1. What assumptions and presumptions underlie each
   of the two perspectives (e.g., causes of disease,
   appropriate means for collective action)?
2. Who does what under each perspective?
3. What opportunities are offered by each
   perspective?
4. What are the limitations of each perspective?
5. Are the two perspectives compatible?

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Overview of Session

• Presentation (Doug and Michael)
• What constitutes Charity and Justice approaches
  to improving health?
• Comparison and Contrast
• Melding the two perspectives
• Discussion Applying the perspectives to promote
  creative problem-solving (HIV, childhood obesity)
  
• Review existing strategies
• What factors have been addressed?
• What other factors need to be addressed?
• What strategies (reflecting charity and/or
  justice) will have an impact on these factors?

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Charity Approach

• Examples
• Contributions to organizations that provide
  health and/or support services
• Volunteer services (e.g., Community Care Clinic,
  AIDS Care Services, etc.)
• Who in the community provides/promotes charity?
• Motivated individuals with time, talent, and or
  money to share
• Nonprofit organizations
• United Way
• Foundations
• What are the underlying principles?
• Voluntary
• Is driven by residents good will and commitment
  to the common good

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Charity Approach

• Strengths
• Charitable gifts (time, talent, dollars) provide
  important fuel for nonprofit organizations
  focused on health
• Giving and volunteering (especially doing with)
  promote social connectedness and a sense of
  shared responsibility (in contrast to taxation)
• Limitations
• Charitable gifts may be insufficient to fund
  critical programs (especially in poor
  communities)
• The community may not have nonprofit
  organizations that effectively address the most
  pressing health issues or the factors that
  underlie those issues
• Charity may displace government responsibility
• Giving money can relieve individuals from the
  need to promote more fundamental change to
  improve other peoples lives

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Justice Approach

• Examples
• Passage and enforcement of laws that protect
  against pollution
• Legal guarantees of access to health care
• Policies to ensure that government programs
  benefit all residents and address the communitys
  most pressing health issues
• Who in the community promotes justice?
• Policy makers
• Government agencies
• Courts
• Advocates and social justice organizations
• What are the underlying principles?
• Individuals have specific rights that promote
  their health and well-being
• Society (through government) has a responsibility
  to protect each persons rights
• Equality of opportunity
• Protect against the abuse of power and privilege

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Justice Approach

• Strengths
• Addresses core issues at root of many of our most
  important health problems
• Leads to macro-level solutions
• Limitations
• Slow, incremental process with the potential for
  slippage and backsliding
• Justice-oriented strategies do not necessarily
  translate directly and immediately into health
  benefits
• May compete with strategies that promote
  individual responsibility and self-sufficiency

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Contrasts Between Charity Justice

• Charity approaches rarely support procedural
  and/or distributive justice, especially justice
  that advances the rights and interests of those
  who have historically been disenfranchised
• Justice approaches rarely emphasize giving
• The two approaches are defined by different
  assumptions and a different sense of urgency re
  changing the status quo
• Often championed by two distinct segments of the
  community with different levels of privilege
• Some would argue that charity work is easier
  and safer than justice work.
• The charity perspective may divert resources and
  attention from more justice-oriented strategies.

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Bringing Charity and Justice Together

• At least in theory, the two perspectives can
  complement one another
• Look for problem-solving frameworks that
  encompass both giving and justice
• Social Capital
• ECHO (Everyone Can Help Out)
• Trust and respect across the community
• Giving
• Commitment to common good
• Civic engagement

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Discussion

• How might the charity and justice perspectives be
  applied to generate new community-level solutions
  to critical public health issues?
• HIV (session 1)
• Childhood obesity (session 2)

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DiscussionStrategies to Date

• What strategies have been most effective in
  addressing this issue?
• How does each of these strategies achieve its
  benefit?
• What factor(s) does the strategy act upon?

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DiscussionCauses

• Collectively, what factors have been addressed by
  current strategies?
• What other factors contribute to this health
  problem?

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DiscussionHow else might the community respond?

• How would you address these issues from a charity
  perspective?
• How would you address these issues from a justice
  perspective?
• Is there any way to incorporate both perspectives
  to generate a more comprehensive, effective
  solution?