Expanded Conceptual Framework for Ethical Action by Nurses on the "Further Upstream and Farther Downstream" Determinants of Health Equity.

ABSTRACT: Determinants of health (DOH) are key predictors of health, wellness, morbidity, and mortality. The more familiar social DOH are not the only DOH. By themselves, the social DOH do not adequately explain how individuals and populations achieve and maintain health equity or inequity. Other DOH also exert political, economic, and institutional forces at all levels of the socioecological systems in which humans interact with their environment.According to the American Nurses Association, the Nursing Code of Ethics is a "non-negotiable moral standard for the profession" (Fowler, 2015a, p. viii). Provision 9 of the Code of Ethics states that social justice is of primary concern for social ethics (p. 159) and that professional nurses are obligated to advocate for and integrate principles of social justice into nursing practice and health policy (p. 151).In search of conceptual explanations for these phenomena, and to locate health equity/inequity within a wide array of upstream DOH, a comprehensive review of the interdisciplinary professional literature and conceptual analysis were conducted. A new conceptual framework that acknowledges nursing's collective responsibility for ethical action for transformative change was developed. The framework addresses both "further upstream" antioppression efforts and "farther downstream" efforts to remediate the impacts of health inequity.The purpose of this Policy Watch column was to introduce a new "Expanded Conceptual Framework for Ethical Action by Nurses on the 'Further Upstream and Farther Downstream' Determinants of Health Equity" (Fornili, 2022).

International Control Efforts to Curb the Global Production and Trafficking of Fentanyl and Other Synthetic Opioids.

The purpose of this Policy Watch column is to provide a brief overview of the global problems associated with the illicit production and trafficking of synthetic opioids as well as international efforts and policy approaches designed to curb them. An in-depth evaluation of drug control efforts of many different nations is important for a comprehensive analysis. However, because of the vast amount of information available, this column is limited to cooperative global control efforts, not efforts specific to any one nation. A great deal of information about production methods, clandestine laboratories, international trafficking methods, and online sales over the dark Web has been omitted. It is important to understand key issues regarding the illicit cultivation and distribution of plant-based opioids derived from natural compounds found in opium poppies (heroin, opium, morphine, codeine) or other drugs (cocaine, methamphetamines, etc.), but the scope of this column is limited to discussion about synthetic opioids including fentanyl, fentanyl analogues, and fentanyl precursor chemicals. Issues about human rights and ethical considerations for nurses and other addictions professionals are also discussed.

Racialized Mass Incarceration and the War on Drugs: A Critical Race Theory Appraisal.

The purpose of this column is to summarize important aspects of the racialized War on Drugs, including (a) the school-to-prison pipeline, (b) the for-profit prison system ("prison industrial complex"), (c) racialized mass incarceration, and (d) the disproportionately negative impact of the War on Drugs on families and communities of color. Analysis of critical race theory (CRT), the study of the relationships between race, racism, and power, will provide a cohesive framework for examining these four aspects. CRT maintains that American laws, including antidiscrimination laws, are structured to maintain White privilege (Alexander, 2010; Capers, 2014; Delgado & Stefancic, 2017; Nyika & Murray-Orr, 2017). Proponents of CRT are committed to progressive race consciousness and view CRT as a mechanism for analyzing and addressing racial inequity (Capers, 2014). We cannot incarcerate our way out of the drug epidemic. The War on Drugs is a war on individuals who experience a treatable medical condition and on the communities in which they reside. It should more properly be called "The War on Our Own People." The failed War on Drugs and the current administration's efforts to revive and strengthen it provide examples of how the dominant society allows, and perhaps even actively promotes, the destruction of minority communities. Addictions nurses object to the conditions that perpetuate the War on Drugs and racialized mass incarceration. We view it our ethical responsibility to advocate for social justice and healthy sociopolitical environments for all members of society, regardless of race, class, or creed.