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The introduction to Understanding Health Inequalities and Justice: New Conversations Across the Disciplines describes the terrain of health justice and inequalities and the multiple disciplinary perspectives that explore it. In the introduction, the editors advance the view that how we approach health inequalities and justice is a matter of great import, and argue for the positive impact multiple disciplinary perspectives may have when engaged in conversations together on these matters. The introduction offers a substantive discussion of normative paradigms informing health justice including egalitarian, libertarian, utilitiarian, rights-based, and principles-based bioethics approaches. In addition to examining each of the three sub-headings of the volume: 1. Interrogating Normative Perspectives on Health Inequality and Justice, 2. Disrupting Assumptions and Expanding Perspectives through Cases, and 3. Rethinking Evidence and the Making of Policy, each chapter is given a detailed introduction and described in relationship to other relevant chapters in the volume.

Changes in health system financing and delivery have the potential to save thousands of lives and billions of dollars. The overarching value system embedded in these new models for payment is a rough utilitarianism with origins in economic analysis. These models use financial incentives to change the behavior of physicians, hospitals, and patients. In addition, many of these policy approaches are also based in other normative approaches to medical care with links to liberal economic theory. While these utilitarian-based innovations in insurance and payment policy have often proven to improve access and quality of care in the aggregate, they have frequently been shown to have less benefit or even cause harm to vulnerable populations. This chapter demonstrates how improvements in quality of care frequently have the unintended consequence of widening disparities, either because the populations who had the worst outcomes to start with are more difficult to reach with improved-care models, or because the mechanisms designed to increase access and quality actually destabilize institutions that have long served the poor. As health reforms are implemented, attention to their impact on poor patients and the institutions that serve them will be essential.

The first chapter introduces the Superfund process, and describes how concepts and theories around environmental justice and political ecology need to be framed with an understanding of settler colonialism to be applied to Native American communities. This introduction also describes the community based methods from which this project was born, and lays out the three bodies (individual, social and political) through which Akwesasro:non responses to topics throughout the book are framed

Drawing from interviews, archival materials, public meeting minutes, and newspaper clippings, the second chapter documents the history of the discovery of, and efforts to remediate environmental contamination, as well as the work that went into establishing community based environmental health research at Akwesasne

Rooted in interview material with scientists, field workers and study participants, as well as the literatures of citizen science, CBPR, and study report-back, the third chapter discusses the benefits and challenges for both scientists and community members of this large-scale CBPR project.

The fifth chapter explores the ways in which Akwesasne community members conceptualize the environmental, social, and physiological origins of diabetes, placing the blame not just on individual non-compliant bodies, but rather weaving a more complex etiology that indicates connections between PCBs and diabetes

The book’s conclusion highlights how Akwesasro:non suggestions for ways to improve environmental health research and health care can be framed through a model of three bodies: the individual, social, and political bodies. This final chapter also explores how Mohawks have created a third space of sovereignty that addresses their health, cultural and research needs in the face of environmental contamination, through grassroots and tribal programs

Chapter 1 lays out the history of this community in the context of a driving tour, using landmarks along the main thoroughfare to discuss relevant points in Akwesasne’s history to illustrate the historico-political setting for community responses to the environmental contamination

Prior to the discovery of contamination in the river, Akwesasne relied on fishing and farming to sustain food needs and the local economy. The fourth chapter focuses on changes in food culture in Akwesasne and the direct and collateral ways that people connect this, and the ensuing health complications, to the environmental contamination and other factors