90. This is not to put all living beings on the same level nor to deprive human beings of their unique worth and the tremendous responsibility it entails. Nor does it imply a divinization of the earth which would prevent us from working on it and protecting it in its fragility. Such notions would end up creating new imbalances which would deflect us from the reality which challenges us.[68] At times we see an obsession with denying any pre-eminence to the human person; more zeal is shown in protecting other species than in defending the dignity which all human beings share in equal measure. Certainly, we should be concerned lest other living beings be treated irresponsibly. But we should be particularly indignant at the enormous inequalities in our midst, whereby we continue to tolerate some considering themselves more worthy than others. We fail to see that some are mired in desperate and degrading poverty, with no way out, while others have not the faintest idea of what to do with their possessions, vainly showing off their supposed superiority and leaving behind them so much waste which, if it were the case everywhere, would destroy the planet. In practice, we continue to tolerate that some consider themselves more human than others, as if they had been born with greater rights.
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232. Not everyone is called to engage directly in political life. Society is also enriched by a countless array of organizations which work to promote the common good and to defend the environment, whether natural or urban. Some, for example, show concern for a public place (a building, a fountain, an abandoned monument, a landscape, a square), and strive to protect, restore, improve or beautify it as something belonging to everyone. Around these community actions, relationships develop or are recovered and a new social fabric emerges. Thus, a community can break out of the indifference induced by consumerism. These actions cultivate a shared identity, with a story which can be remembered and handed on. In this way, the world, and the quality of life of the poorest, are cared for, with a sense of solidarity which is at the same time aware that we live in a common home which God has entrusted to us. These community actions, when they express self-giving love, can also become intense spiritual experiences.
A realist review methodology was used that is outlined in full in Appendix 1 (available at www.cmaj.ca/lookup/suppl/doi:10.1503/cmaj.160177/-/DC1). Broadly, multiple databases (e.g., Medline, Cumulative Index to Nursing and Allied Health Literature [CINAHL], Embase, ISI Web of Knowledge) were searched using the following search terms: Social near determinant* AND health OR Health near/2 *equit* OR disparit*, Health* worker* OR Health* professional* OR Health* provider* OR primary health care OR community health worker* and training* or education* or capacity strengthening OR capacity building. Additional searches of selected relevant websites were conducted, including those of the Canadian Task Force on Preventive Health Care, US Preventive Services Task Force, UK National Institute for Health and Care Excellence, National Guideline Clearinghouse and the Guide to Community Preventive Services. Grey literature was identified by Google searches, scanning reference lists, key informant discussions and postings on Internet listserves relating to health equity. This search identified almost 500 documents that were scanned for relevance, and a total of 71 documents were retained. Because this is a relatively new area of scientific inquiry that examines a variety of complex interventions impacting multiple health and social outcomes, a qualitative synthesis of the findings is presented that can be used as a framework for action on social determinants in clinical practice. With the exception of some clinical practice guidelines, most of the evidence on the effectiveness of physician intervention in social determinants is from smaller-scale observational studies and a few randomized controlled studies, as well as a growing number of qualitative and mixed-methods studies that are able to better assess the complexity involved and the role of context in influencing outcomes. Most publications pertain to low-resource settings within high-income country contexts, such as inner city neighbourhoods with high rates of poverty. 2ff7e9595c
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