Personal Reflection 

1. Engaging Change
2. Gaps of Culture
3. Gaps of Geo-Political-Socio-Economics (GPSE)     
4. Gaps of Systems
5. Gaps of Power Perspective
6. Mind the Gaps: Applied to Individual
7. Mind the Gaps: Applied to Institutional/Systems Issue
8. Mind the Gaps: Conclusion

Mind the Gaps [whole document ]
Mind the Gaps Applied: Institutional/Systems [7 of 8]

Conclusion


In discussing this poster and working with people of diverse and vulnerable populations, I discovered that creating an inclusive space remains elusive, even for people who are committed to doing important work for social good. I offer a backbone for building capacity so that those who are committed to cultivating inclusive spaces might be able to realize their aspirations. 

Until we can fully embrace the truth of our wholeness, we may have difficulty gaining the trust of those who have been oppressed.  For if we hasten to challenge injustice, we bring our blindness, (we do not see ourselves in wholeness), deafness (we do not hear because we do not ask/listen) and arrogance (we ignore guidance from those we claim to help because we know better).  Masked by our good intentions, we may recommit the problems of the past as our actions contradict our stated intentions. Our actions, motivated by an unhealed state, are like shooting arrows at those we claims to defend.  

As a previously oppressed person, I may develop the capacity to deflect this arrow and realize that I am an unintended target. When no longer in fear and having healed any prior injury, I may ask the person who shot the arrow, “why have you shot this arrow?”  And the person, whose identity as ‘fighter against injustice’ is so strong that s/he cannot see that s/he could possibly shoot an arrow responds earnestly, “I did not shoot an arrow.”  The powerful force of cognitive dissonance blocks him/her from seeing an arrow, and s/he becomes indignant hearing the statement of an alternative perspective as an accusation, “I would never shoot an arrow.  I am not an archer, I am a pacifist.” … 

Mind the Gaps [whole document ]
Mind the Gaps Conclusion [8 of 8]
Mind the Gaps Applied: Individuals [6 of 8]

III. Mind the Gaps: Applied

The following two scenarios reflect the application of how one might apply Mind the Gaps to promote inclusive action.  The first scenario shows an administrator using the Mind the Gaps framework to consider how to address a conflict at the school.  The second scenario demonstrates how a proposed government action was evaluated under the Mind the Gaps framework and illustrates the responsive action that sought to promote conscious, inclusive action for social change.


B. Institutional:  Emergency Preparedness

In December 2005, the Center for Disease Control (CDC) hosted a teleconference proposing that local governments throughout the United States adopt “Community Legal Preparedness for Public Health Emergency” and expand the public health authority for an infectious disease outbreak, like avian flu.  During the Questions & Answers, I inquired how this proposed scheme to broaden authority would address the needs and protect the rights of people from diverse communities, such as those who didn’t speak English; there was a long pause, and someone attempted to respond but didn’t actually address the question. I wondered what an inclusive preparedness plan would look like?

Public Health Authority is the power that government has over the people to protect the public’s health.  The public entrusts discretionary power to the public health authority, and the proposal sought to broaden discretionary authority even further eliminating restrictions placed after historical episodes of misuse of authority over marginalized communities. I reflected on the response to my question about non-native English speakers and wondered who else might not be adequately included in a plan developed by people who aren’t thinking consciously about inclusion. Below are outlined some of the questions that I considered when thinking through how to make the CDC’s proposed course of action truly inclusive.

1. Gaps of Culture: Public Health

- What if the public health authority’s good intentions to protect the public good gets overrun by the politics of fear and discrimination in a time of panic and uncertainty?

- How does the public health authority intend to use their discretionary power?

- Is there concrete guidance on how to use discretionary power in difficult situations?

- What protections exist for the public, if we fail to meet our ethical aspiration to use our power well?

- What if the public does not trust the public health authority or it’s good intention? 

– what if the public health authority is not as good as it presumes to be and what has been done to ensure that the good intentions are realized?

Having done a critical legal history of public health’s treatment of vulnerable populations[1] during infectious disease outbreaks, I wondered whether the public health authority would be able to carry out its noble intention amidst the heavy political pressures that dominate, particularly in the initial stages of a public health disaster, when fear looms and science lags. I also wondered how those who do not trust the public health authority, or government in general, would be affected during a public health emergency and what the implications would be for the public’s overall health if some sub-groups did not follow the public health directives.  I also considered that getting funding and support for preventative efforts and for marginalized communities is nearly impossible, and I considered that if there were a collective interest, it might facilitate funding for inclusive policies.


2. Gaps of GPSE: Public Health

- How might people from different GPSE be affected during the critical stages? (awareness/prevention, screening, treatment, vaccination, quarantine)

- How will geography play a part in an epidemic? With regard to limiting access to treatment and spreading disease?

- How will political status influence the public health authority efforts?  What happens to non-English speakers, what happens to recent immigrants who are often scared to access public services in the US?  What happens to prisoners?  What happens to people who are not legal citizens?

- What social factors will influence the epidemic?  What happens to the elderly?  the elderly who are institutionalized in nursing homes?  What happens to a child whose only parent may become ill? 

- How might different economic status impact the public health authority plans?  How will the homeless be contacted?  How will the poor be impacted?  Will the need to eat and fear of job loss lead people who work rather than stay under quarantine?

Relying on my historical identification of marginalized communities and scenarios from the SARS outbreak in Toronto, I developed 5 scenarios and used them to identify who might be impacted but might not be considered in the planning events.

I identified the following groups seemed the most likely to be omitted from the traditional planning strategies: homeless, poor, persons with disabilities, persons who are institutionalized (prisons, nursing homes), children, elderly, illegal immigrants/immigrants (incl. language access).  These groups all have little political power and thus have minimal access to ensure that their interests are included in emergency preparedness endeavors and protected during times of crisis.[2]

In an infectious disease outbreak, the personnel of transportation become key players in a variety of circumstances so paying attention to the geography of a situation remains important. 
 

3. Gaps of Systems: Public Health

- Who is not adequately served by the current health care system?

- Will people who are illegal and fear deportation be afraid to come to the hospital during a pandemic?

- If the strategy is to use media to promote awareness and prevention, who will that miss?  How will people who don’t speak English learn of this?  people who cannot read?  people who cannot afford a tv/radio? people who are homeless?

- How do public systems, such as public transit, affect who may come into contact with an infectious disease and how does it inform the way that disease may spread?

I considered that the public health system relies on three critical systems – the public health authority/government, the health care system, and the media.  For people who have historically poor relationships with government, it is important to consider how they might respond/ignore the admonitions of government. 

The government and health care system systemically alienate certain members of our community, particularly illegal immigrants.  The fear that illegal immigrants have of government might prompt them to respond/ignore public health advisories in a way that would have significant implications to the overall health of the public.  Considering the manner and degree to which this community is alienated from the health care system, I wondered what would be necessary to promote compliance and trust in the public health directives. 

Most public health announcements are made through media channels, and I wondered what would happen to people who are not part of regular media.  Homeless people who don’t have a radio/TV, deaf people who don’t listen to the radio, illiterate people who can’t read a flyer, and announcements made in English would miss a number of community members who don’t speak English.


4. Gaps of Power Perspective: Public Health

- How does this proposed action reflect assumptions of my power and privilege?

- Where and how can I use my power most effectively?

I saw the greatest contribution I could make to support the “vulnerable populations” I identified was to speak to the group that I was a “part” of and to use the tool of my training, law and ethics, to suggest ways to guide this very broad discretionary power.  I developed an ethical argument to justify preventative policies that address the unique needs of vulnerable populations during a public health emergency.   To see what an effort for inclusion on this issue looks like, I made that paper into a poster, Vulnerable Populations During a Public Health Emergency[3], that was presented at the CDC’s Public Health Law Conference in June 2005.  When Hurricane Katrina hit three months later, the groups identified and the issues anticipated in the poster became a part of tragic history.  It is my hope that if we endeavor to use these steps rigorously and consistently, we can promote inclusion action for social change.

The opportunity here that I did not undertake due to my position (a student writing a paper rather than a policy maker) would be to invite the now identified constituents into the problem solving process to ensure that any subsequent actions, such as the proposed preventative policies, were not based upon the power perspective of the problem solver. 

In discussing this poster and working with people of diverse and vulnerable populations, I discovered that creating an inclusive space remains elusive, even for people who are committed to doing important work for social good. I offer a backbone for building capacity so that those who are committed to cultivating inclusive spaces might be able to realize their aspirations. 



[1] Ettinger,K. A Critical Legal History of Public Health’s Treatment of Vulnerable Populations during a Public Health Emergency.  (available from the author)
[2] This is not intended to indicate that this is the state of affairs at present.  Though reports indicate, overall emergency preparedness planning is not well developed.  As such, one wonders how much attention will be paid to the interests of marginalized communities in the time of a crisis and that was the purpose of this endeavor taking the focus that it did.
[3] Ettinger, KM. Vulnerable Populations During a Public Health Emergency, available at: www2a.cdc.gov/phlp/conferencecd2005/docs/kettinger.pdf

Mind the Gaps [whole document ]
Mind the Gaps Applied: Institution/Systems  [7 of 8]
Gaps of Power Perspective  [5 of 8]

III. Mind the Gaps: Applied

The following two scenarios reflect the application of how one might apply Mind the Gaps to promote inclusive action.  The first scenario shows an administrator using the Mind the Gaps framework to consider how to address a conflict at the school.  The second scenario demonstrates how a proposed government action was evaluated under the Mind the Gaps framework and illustrates the responsive action that sought to promote conscious, inclusive action for social change.


A.  Individual
As the principal of the private school where a bullying incident occurred, Mrs. M considers how a response to the situation might be most inclusive. 


1. Gaps of Culture


Mrs. M questions how the approach to handling the situation would appear to someone who felt uncertain about the school’s commitment to the girls’ education.  She wonders whether the private school status might make a student or parent uncertain about whether the discipline was based on wealth or on culpability.

She decides to call all the families into meet with each other and the administrators. She considers that this approach fosters the kind of open communication that the school advocates.  She wonders whether the parents may feel a perception of partiality since she has a conflict in complete neutrality for economic reasons, and she decides to hire a neutral mediator who can facilitate the conversation.  She considers that a mediator has the ability to foster dialogue and understanding and the practice of mediation/facilitation is generally accepted across communities.  To be certain, she asks all sets of parents whether they are comfortable with having a mediator present to facilitate the dialogue. 

She doesn’t consider that the remaining parents may have concerns about the situation, nor does she consider that the other students not directly affected may have residual concerns arising from this event. 


2. Gaps of GPSE

Mrs. M does not recognize any geographic considerations in this case, but there are political concerns.  Mrs. M recognizes that the two sets of parents involved between the instigator and the victim have vastly different political outlooks, social status, and wealth.  The instigator’s parents are wealthy, prominent business people with a lengthy lineage of family who have graduated from the school; the victim’s parents work in the public health and government, and both parents are second generation immigrants of comfortable means but limited wealth.  She wonders how to create a more level playing field for the conversation, and decides that it will be the work of the mediator to balance these disparities.

She does not consider that the two sets of parents come from vastly different backgrounds may have different experiences of justice in their personal history, nor that they might have different understandings of the cause of the situation and diverse needs to have a sense of justice achieved.  She does not consider that other students may identify with qualities of the victim and in turn from empathic identification they may experience a sense of ongoing fear from this event.


3. Gaps of Systems

Mrs. M was aware that her approach to this situation was dependent upon trust in the school’s handling of difficult situations as well as in trust in the mediation process.  She recognized the potential mistrust of the school’s commitment to discipline arising from the need for funding as well as the mission to educate its students.  To promote a sense of confidence in the school’s commitment to neutrality, Mrs. M chose to use a mediator. 

To inspire confidence for the handling of this situation, Mrs. M decided to work with a coalition of teachers, parents, and students to identify and develop a way to handle a future incident with consistency and transparent, while retaining flexibility. 

Mrs. M did not consider whether the victim’s parents who have a health background are familiar with mediation and whether they would be comfortable with mediation.  Mrs. M does not check to see whether the mediator has experience with multi-cultural conflicts and does not consider what qualifications the mediator might need to have to establish legitimacy with the parents.


4. Gaps of Power Perspective

Mrs. M reflects on her power in this situation and sees that while she has authority at school, she does not have authority over the parents and in many ways, she is accountable to the parents.  She considers that by inviting a mediator to facilitate the conversation she will enable the removal of any power conflicts that she might hold in this situation.

Mrs. M did not consider that her position could be perceived differently between the two parents.  While the instigator’s parents who are wealthy patrons of the school feel comfortable expressing their perspective and needs, the victim’s parents who do not have a strong economic relationship with the school do not feel equally entitled to ensure that their perspective is understood and their concerns are met.  She also does not consider that the victim’s parents are concerned about their relationship with the school and ensuring that their daughter will not have a difficult time, whereas the instigator’s parents do not even consider that stating their thoughts would have any implication on their daughter’s educational experience at the school.   These are difference arising out of the parents different power positions and the perspective of their privileges.  Mrs. M is not aware of her own privileged perspective and thus, is not able to be sensitive to the ways that privilege informs actions.

Mind the Gaps [whole document ]
Mind the Gaps Applied: Individual [6 of 8]
 Gaps of Systems  [4 of 8]

D. Gaps of Power Perspective

Assessing Gaps of Perspective, we consider how our power perspective informs the proposed action.  We often develop strategies for social change unconsciously informed by our power perspective, and we may not realize that others do not enjoy the same power, privilege, and position.  For example, if we choose to use a peaceful protest, we assume that others, whose rights may be the subject of the protest, will be comfortable demonstrating and exercising the right to peaceful protest in this manner.  But for some whose experience with the law reflects inconsistent or unequal justice, there may be less security in exercising one’s rights.   The exclusion of segments of interested parties reduces the inclusiveness of the action and may undermine the entire effort.  So, we must endeavor to consider how our experience of power, privilege, and position shape what we do, and we must reflect upon how we can use our power, privilege and position most effectively to share our power.

Mind the Gaps [whole document ]
Gaps of Power Perspective  [5 of 8]
     Gaps of GPSE  [3 of 8] 

C. Gaps of Systems

Assessing Gaps of Systems asks that we consider the inclusiveness of the systems upon which our proposed action depends and that we reflect critically upon the limitations of those systems.  For example, if we propose to communicate a message – upon what systems does our message depend?  We must consider how we will reach people who do not speak our language, who cannot hear/read, and to what extent there may be communities who lack access media.  Alternatively, if we locate a free mediation service at the court-house, we must consider whom our legal system serves and fails to serve and whether our efforts to provide alternative methods for conflict resolution might be limited due to the legal system’s limitations.  Ultimately, this aspect of Gap review asks whether we aware of the limitations of our existing systems and how we may create more inclusive systems.

Mind the Gaps [whole document ]
 Gaps of Systems  [4 of 8]
     Gaps of Culture  [2 of 8]

B. Gaps of Geo-Political-Socio-Economics (GPSE)

To assess the Gaps of GPSE, we consider how these contextual layers – geography, politics, and socio-economics that impact communities differently, might limit a proposed action.  The Gaps of GPSE are already well recognized as critical components of ongoing disparities.  For example, the GPSE factors constitute ‘social determinants of health;’ they reflect recognized barriers to accessing legal services and equitable remedies; and they associate with exposure to environmental hazards.  Thus, when we aspire to take conscious, inclusive action, we want to make sure that we reflect critically upon these components and assess whether our proposed action may unintentionally exclude groups based on GPSE attributes?

Mind the Gaps [whole document ]
     Gaps of GPSE  [3 of 8]
Mind the Gaps: Engaging Change [1 of 8]

A. Gaps of Culture

To assess Gaps of Culture asks that we cultivate the awareness that we are a fish swimming in water.  We look to see the layers of assumptions that underpin the actions that we choose, the language that we use, the approach to problem solving we select, and the values that we promote.  We do not need to, per se, challenge these assumptions rather that we must be sufficiently aware of the assumptions so that we may begin to consider where and how diverging perspective may exist that may shift the way we understand the situation. 

While this inquiry may include the traditional concepts of ‘culture’ related to one’s customs, values, and beliefs in this context Gaps of Cultures demands that we examine the assumptions implicit within our professional disciplines, selected strategies, preferred methodologies, and presumed doctrines.  We are looking for barriers we don’t see based on our disciplinary assumptions and we seek to find different approaches to how we might address the situation.

Mind the Gaps [whole document ]
     Gaps of Culture  [2 of 8]

I. Engaging Change

“ ‘Mind the Gap’ a voice overhead calls out as the doors open for the Tube in London, that is precisely the same thing we aspire to in meditation, to mind the gap between where we are in this moment before we act to get where we are going.  If we can recognize that space, hold it open, then we have a chance to transform our actions from blind habit to conscious action.”[1] 

Identify gaps in our society and responding wisely to these situations is a critical component of creating a just, democratic, and civil society.  Meditation and mindfulness facilitate developing the capacity to recognize gaps within our daily life, to be present with gaps in order to gain clarity and understanding, and to respond to gaps with insight and wisdom for the betterment of ourselves, for our communities and for the world.

The paper explains a framework to promote conscious, inclusive social action, and demonstrates how this framework could be used at the individual and institutional level.  It culminates in describing the capacity we need to build to support inclusive problem solving, a necessary step to promoting inclusive, conscious social change.

II. Mind the Gaps: Conscious, Inclusive Action for Social Change

The “Mind the Gaps” framework is broadly applicable to a variety of issues.  This 4-step Gap Analysis enables one to “check” the inclusiveness of actions by individuals or organizations. When we encounter a gap in our action plan, the capacity for inclusive problem solving will allow participation of voices not historically engaged in the problem solving process.  To be inclusive we need to create a space that allows for diverse constituents to input understanding the problem and for diverse perspectives on the appropriateness of proposed strategies.  After we take a proposed action through the 4 steps, we may, ultimately, determine that our initial action is optimal, even if not fully inclusive, but we make that choice consciously, more aware of future opportunities for more inclusive solutions.

Mind the Gaps

1. Gaps of Culture
2. Gaps of GPSE (geo-political socio-economics)
3. Gaps of Systems
4. Gaps of Power Perspective

          
While the 4-steps of Mind the Gaps may seem familiar or intuitive, we have the opportunity to adopt using the 4-step framework consistently in our personal and professional activities to raise our awareness and Mind the Gaps in our daily life.



[1] Ingen Breen, a soto zen priest, who shared meditation practice guidance and this brilliant analogy.