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Learn more: PMC Disclaimer | PMC Copyright Notice J Natl Cancer Inst Monogr . 2025 Aug 11;2025(70):287–300. doi: 10.1093/jncimonographs/lgaf022 Search in PMC Search in PubMed View in NLM Catalog Add to search Developing social justice competencies: preparing the next generation of health disparities researchers and practitioners D’Andra B Odom D’Andra B Odom , MPA 1 Forge AHEAD, Pennington Biomedical Research Center, Baton Rouge, LA 70808, United States Conceptualization, Data curation, Writing - original draft, Writing - review & editing Find articles by D’Andra B Odom 1 , Christie R Edwards Christie R Edwards , MPH 2 Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL 60612, United States Conceptualization, Data curation, Writing - original draft, Writing - review & editing Find articles by Christie R Edwards 2 , Judelysse Gomez Judelysse Gomez , PhD 3 Institute of Health Systems Science, Feinstein Institutes for Medical Research, New Hyde Park, NY, United States Conceptualization, Data curation, Methodology, Writing - original draft, Writing - review & editing Find articles by Judelysse Gomez 3 , Mona AuYoung Mona AuYoung , PhD, MS, MPH 4 David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, United States Conceptualization, Data curation, Writing - original draft, Writing - review & editing Find articles by Mona AuYoung 4 , Pebbles Fagan Pebbles Fagan , PhD, MPH 5 Center for the Study of Tobacco, Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States Conceptualization, Data curation, Methodology, Supervision, Writing - original draft, Writing - review & editing Find articles by Pebbles Fagan 5, ✉ ; Social Justice Competencies Subcommittee of the Community Engagement Working Group, Health Equity Action Network 6 Author information Article notes Copyright and License information 1 Forge AHEAD, Pennington Biomedical Research Center, Baton Rouge, LA 70808, United States 2 Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL 60612, United States 3 Institute of Health Systems Science, Feinstein Institutes for Medical Research, New Hyde Park, NY, United States 4 David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, United States 5 Center for the Study of Tobacco, Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States 6 The Social Justice Competencies Subcommittee, Community Engagement Working Group, Health Equity Action Network, School of Medicine, University of California San Francisco, San Francisco, CA, United States ✉ Corresponding author: Pebbles Fagan, PhD, MPH, Center for the Study of Tobacco, Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham, Little Rock, AR 72205, United States ( [email protected] ). Roles D’Andra B Odom : MPA , Conceptualization, Data curation, Writing - original draft, Writing - review & editing Christie R Edwards : MPH , Conceptualization, Data curation, Writing - original draft, Writing - review & editing Judelysse Gomez : PhD , Conceptualization, Data curation, Methodology, Writing - original draft, Writing - review & editing Mona AuYoung : PhD, MS, MPH , Conceptualization, Data curation, Writing - original draft, Writing - review & editing Pebbles Fagan : PhD, MPH , Conceptualization, Data curation, Methodology, Supervision, Writing - original draft, Writing - review & editing Received 2024 Dec 8; Revised 2025 Feb 19; Accepted 2025 Mar 24; Collection date 2025 Aug. © The Author(s) 2025. Published by Oxford University Press. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected]. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model ( https://academic.oup.com/pages/standard-publication-reuse-rights ) PMC Copyright notice PMCID: PMC12342936 NIHMSID: NIHMS2164276 PMID: 40795914 Abstract This paper describes the process used by the Social Justice Competencies Subcommittee to identify social justice competency domains and related constructs that inform social justice approaches to research, practice, policies, and government infrastructures. The Subcommittee held monthly virtual meetings from November 2023 to September 2024. A literature review was conducted to identify existing competency measures. Voting and consensus processes were used to determine the content validity of the domains and constructs. The Subcommittee identified 5 domains and 59 constructs that describe (1) internal awareness; (2) attitudes, values, and beliefs; (3) knowledge that influences a social justice orientation or action; (4) skills in practice that incite others into action; and (5) skills in practice that build strong research and practice teams to engage in social justice approaches. Endgame strategies to eliminate chronic disease and risk factor disparities require that the workforce has the competencies to execute impactful research, practice, and policies. Introduction The 2024 Surgeon General’s report, Eliminating Tobacco-Related Disease and Death: Addressing Disparities , concluded that “tobacco-related health disparities are a social injustice.” 1 Social injustices encompass unfair policies, practices, and conditions that lead to disparities in health and well-being. The concept of social justice, or la giustizia sociale , has existed for centuries and can dictate how governments are structured, distribute resources, and administer power to protect citizens from injustices, 2 , 3 including tobacco-related health disparities and overall health disparities. The Constitution for Social Justice (1848), written nearly 2 centuries ago, asserts that governments are accountable for creating systems that protect citizens from injustices, are just, and have utility for all citizens including those who are in the minority. 4 In the absence of a social justice approach in the fabric of government, in public health, and in other systems that influence social, structural, and political determinants of health, new injustices emerge that reverse progress made to eliminate global health disparities. The core aim of social justice is to dismantle injustices 5 that cause health disparities. The field of public health, for instance, links social justice to health equity, which aims to ensure that everyone in society has a fair and just opportunity to attain their highest level of health 6 as suggested in the 2024 Surgeon General’s report. 1 Health equity requires that everyone is valued equally, with focused and ongoing societal efforts to address cultural responsiveness, avoidable inequalities, historical and contemporary injustices, and the elimination of health and health-care disparities. 7 Social justice offers a pathway to achieve health equity and reduce overall health disparities and tobacco-related inequities. 1 Consequently, the application of social justice to public health requires that people and institutions have the competencies and skills to conduct this work. However, there is a lack of consensus on measurable social justice competencies across disciplines that can guide socially just public health research, practice, and policy aiming to end health disparities. Social justice competencies have been defined “as both a process and a goal which includes the knowledge, skills, and dispositions needed to create learning environments that foster equitable participation of all groups while seeking to address and acknowledge issues of oppression, privilege, and power.” 8 Several disciplines have used social justice competences to guide their professional workforces. For example, the Multicultural and Social Justice Counseling Competencies provide counselors with a framework by which to integrate social justice competencies into counseling theories, practices, and research. 9 The model describes the knowledge, attitudes, beliefs, skills, and actions within 4 domains (counselor self-awareness, client worldview, counseling relationships, and counseling and advocacy interventions) that can guide counseling practices. 9 , 10 Measures to support this model are limited. 11 Goodman et al. 12 propose a set of competencies for social work education that includes a focus on critical consciousness, empowerment, and advocacy. Hardiman et al. 13 identify key competencies for educators, emphasizing cultural humility, allyship, and the ability to facilitate difficult conversations about race, privilege, and inequity. Ford and Airhihenbuwa 14 provide a social justice framework in the field of public health centered on community engagement; capacity building; and policy advocacy to dismantle social and political determinants of health, such as poverty, racism, and inequitable resource distribution. None of these models include a set of defined measures that assess social justice skills and competencies needed to eliminate tobacco-related health and overall disparities and inequities. Although progress has been made to conceptualize social justice competencies, there is a lack of consensus on the specific competencies needed to address chronic disease health disparities and inequities within the public health context that include individual and organizational competencies. To fill this critical gap, the Social Justice Competencies Subcommittee developed a set of competencies to guide the work of people engaged in health equity research and practices to reduce chronic disease health disparities. This paper describes the engagement process used to identify and define social justice competency domains and related constructs. Additionally, we propose a model by which specific competency domains can influence a social justice approach to research and practice that aims to reduce health disparities. Methods Setting In 2021, a total of 11 institutions and a research coordinating center were established with competitive funding to support regional comprehensive research centers on the prevention, treatment, and management of comorbid chronic diseases that disproportionately affect populations experiencing health disparities. In addition to conducting research within each center, cross-center collaborative work is facilitated to advance health disparities research and practice. In 2023, the cross-center Community Engagement Working Group met at an annual meeting of grantees to discuss potential collaborative projects. The working group prioritized 2 projects that would advance the working group’s mission and included the development of (1) social justice competency domains to inform individual and organizational practices and (2) a special issue on meaningful community engagement. The Social Justice Competencies Subcommittee was established to engage diverse experts in the identification and development of measures and scales to assess social justice competencies. This paper reports phase 1, which included the identification of social justice competency domains and related constructs. Phase 2 is ongoing and includes the identification and development of measures that correspond with the constructs that the Subcommittee will recommend to the field. Procedures The Subcommittee held monthly virtual meetings and engaged in a participatory process to develop the social justice competency domains and constructs from November 2023 to September 2024. The participatory process was guided by the core principles of meaningful community engagement as well as 2 domains that reflect meaningful community engagement: (1) strengthening partnerships and alliances and (2) expanding knowledge. 15 We expected that the adoption of engagement principles would result in trust and that participants felt that their contributions were equally heard, valued, and reflected in products no matter the occupational rank or institution. The 3 Subcommittee co-chairs conducted the initial literature review in PubMed, Google Scholar, and Google to identify existing social justice competency scales and measures. The co-chairs, with support from the research coordinating center, created a spreadsheet that could be used for Subcommittee members to review. To promote an inclusive process, Subcommittee members were asked to brainstorm potential domains, conduct literature searches, determine the constructs that exist within the domains, and bring existing scales and measures to the virtual monthly Subcommittee meetings for discussion. Two meetings (January and February 2023) were used to discuss the domains and to assess the initial content validity of the constructs within each of 5 domains. To support a co-created process, we asked Subcommittee members whether the domains represented social competencies and if the constructs within the domains were adequately representative. 16 A Google form was used to vote on the constructs the committee would retain (must retain, consider retaining, do not retain) within 5 domains and to establish the content validity of the domains that we believed represented social justice competencies. For this specific exercise, it was not our intent to assess the content validity of specific scale items 16 but rather the domains and overall constructs. The Subcommittee engaged in an iterative discussion, voting, and consensus process to inform the final 5 domains. For each domain, we determined whether relevant measures, scales, or instruments existed. For each measure, we documented the domain, construct, subconstruct, definition, response categories, validity of the scale, associated outcomes, and references of measures. For subsequent virtual meetings, we reexamined the agreed on constructs to determine their fit for each domain. This paper only reports on the domains and constructs that represent those domains. The writers of the paper developed a conceptual model to highlight the interactions among all the domains (see Figure 1 ). The writers discussed various components of the model and then obtained feedback during 2 Subcommittee meeting. The writing subgroup conducted multiple iterations of the model to reflect the opinions of the Subcommittee members. Figure 1. Open in a new tab Conceptual model on building social justice competencies to engage in health disparities research and practice. Abbreviation: D = domain. Positionality statement The authors hold the position that through meaningful engagement, we, together, can improve the workforce that aims to reduce chronic disease health disparities by developing social justice competencies. The competencies and constructs that represent them were shaped by the diversity of the Subcommittee members who serve different populations in different geographic locations. The authors acknowledge that both writers and verbal contributors facilitate processes of change. The writers critically reflect on the idea that developing social justice competencies is an academic process, dependent on writing, which can be a barrier to persons for whom writing is not a reward, symbolic for action, or time bound. Results Sociodemographics of Subcommittee participants Participants represented 8 of 11 funded centers and representatives from the research coordinating center (see Table 1 ). Of the 26 people who participated in at least 1 Subcommittee meeting, 21 responded to our demographic questionnaire. Of these, 90% (n = 19) identified as women and 10% (n = 2) as men; 65% (n = 14) self-identified as Black or African American, 25% (n = 5) as White, 5% (n = 1) as Asian American, and 5% (n = 1) as multiracial. Of the 21, 15% (n = 3) indicated that they were Latino, Hispanic, or Latinx. On average, respondents reported having 20 years (SD = 10 years) of experience in community engagement. On average, 6.25 centers have participated in the Subcommittee monthly meetings, with 18.4 participants per meeting. Table 1. Description of participants on the social justice competencies subcommittee (n = 21) (deidentified) a , b Centers No. on subcommittee Participant occupations US region and communities served to improve the health of all people in America c C1 3 Faculty Pacific region Hispanics, Latinos, and Latinx people; caregivers; children; multigenerational households C2 1 Research staff Northeast region Black and African American people; Hispanics, Latinos, and Latinx people; community health workers C3 1 Faculty Northeast region Chinese people, Korean people, other Asian American people, caregivers C4 1 Faculty and researcher Southern region Black and African American people, Black and African American men, people who live in rural communities, schools in low-income and rural communities C5 5 Faculty Research staff Southern region Black and African American people, people who live in low-income and low-resource communities, people who live in rural communities C6 2 Researchers Research staff Pacific region Black and African American people; Hispanic, Latinos, and Latinx people; Vietnamese people; other Asian American people; Native Hawaiian and Pacific Islander people; families; people who live in low-income and low-resource communities C7 4 Physician Consultant Program manager Midwest region Black and African American people; Hispanic, Latinos, and Latinx people; older adult people; patients with low income C8 3 Faculty and physician Researchers Research staff Deputy operations director Midwest region Veteran people, Black and African American people, African immigrant people, older adult people RC 1 Faculty No population foci Open in a new tab Abbreviation: RC= research coordinating center. a Of the 11 centers, 8 participated in the Social Justice Competencies Subcommittee. Of the 26 participants, 21 (80%) members reported demographic information. b All people connected to the national consortium, including community partners, were provided the opportunity to join this working group and the manuscript development subgroup. Population served: collectively, the centers reach all of America’s people. c All people connected to the national consortium, including community partners, were provided the opportunity to join this working group and the manuscript development subgroup. Engagement process to establish content validity of domains The 5 domains included (1) internal awareness, (2) attitudes and beliefs, (3) knowledge that influences a social justice orientation or action, (4) skills in practice that incite others into action, and (5) skills in practice that build strong teams and communities toward social justice. The domains focused on awareness, knowledge, and skills that the Subcommittee decided would be important for people to have when undertaking interventions related to chronic disease disparities. Table 2 shows the 61 constructs within each domain that were identified by members of the Subcommittee and how the Subcommittee members voted. Votes for “must retain” ranged from 60% to 100%, indicating a high level of agreement on constructs representing the domains. The Subcommittee established a cut point of less than 70% to determine whether items would be retained. There were few “do not retain” votes for any constructs. Only 3 constructs—allyship, egalitarian values, and expressed empathy—received less than 70% vote for “retain” but greater than 90% votes when combining “retain” or “consider retaining.” Thus, the committee did not delete any of the constructs. Table 2. Establishing content validity for the 5 social justice competency domains and related constructs (n = 61 constructs) a Domain Construct Must retain b n (%) Consider retaining n (%) Do not retain n (%) D1. Internal awareness (n = 8 constructs) Ongoing self-awareness (self-reflection) 14 (93.3) 1 (6.7) 0 (0.0) Critical consciousness c 12 (80.0) 2 (13.3) 1 (6.7) Awareness of one’s own privilege, power, and oppression in society and within organizations 13 (86.7) 2 (13.3) 0 (0.0) Awareness of how one’s space or environment and positionality influence perceptions of privilege and power 14 (93.3) 1 (6.7) 0 (0.0) Awareness and critical reflection of one’s own contributions to social injustices and unfair treatment 14 (93.3) 0 (0.0) 1 (6.7) Critical reflection of organizational factors that perpetuate social injustices and unjust treatment 15 (100.0) 0 (0.0) 0 (0.0) Allyship 10 (66.7) 5 (33.3) 0 (0.0) Awareness of inclusive language and its impact on people 13 (86.7) 2 (13.3) 0 (0.0) D2. Attitudes, values, and beliefs that influence social justice (n = 8 constructs) Value for others, including people and communities 15 (100.0) 0 (0.0) 0 (0.0) Value for diversity 12 (80.0) 3 (20.0) 0 (0.0) Openness to changes 15 (100.0) 0 (0.0) 0 (0.0) Willingness to learn 13 (86.7) 2 (13.3) 0 (0.0) Value for social justice 13 (86.7) 2 (13.3) 0 (0.0) Respect for different worldviews 13 (86.7) 2 (13.3) 0 (0.0) Belief in collective action (collective efficacy) 12 (80.0) 3 (20.0) 0 (0.0) Social justice efficacy 12 (80.0) 2 (13.3) 1 (6.7) D3. Knowledge and awareness that influence social justice orientation and actions (n = 10 constructs) Consciousness raising 14 (93.3) 0 (0.0) 1 (6.7) Knowledge of different ways of connecting through communication and communication styles 11 (73.3) 4 (26.7) 0 (0.0) Knowledge of languages and use of words 11 (73.3) 4 (26.7) 0 (0.0) Decolonization of knowledge 12 (80.0) 3 (20.0) 0 (0.0) Knowledge of group members’ biases 13 (86.7) 2 (13.3) 0 (0.0) Knowledge and awareness of history, cultural heritage, and sociopolitical backgrounds that contribute to disparities 13 (86.7) 2 (13.3) 0 (0.0) Knowledge of societal inequities 15 (100.0) 0 (0.0) 0 (0.0) Knowledge of structural inequities 11 (73.3) 4 (26.7) 0 (0.0) Knowledge of health and social disparities in communities 12 (80.0) 3 (20.0) 0 (0.0) Egalitarian values 10 (66.7) 4 (26.7) 1 (6.7) D4. Skills in practice of social justice that incite others to act (n = 10 constructs) Giving voice 10 (100) 0 (0%) 0 (0) Increasing access to the tool of self-determination at the individual and community levels 7 (70) 3 (30) 0 (0) Self-determinism realization 9 (90) 1 (10) 0 (0) Building imagination of what can be 6 (60) 3 (30) 1 (10) Sharing power 10 (100) 0 (0) 0 (0) Strength building 9 (90) 1 (10) 0 (0) Conflict resolution 8 (80) 1(10) 1 (10) Creating safe space for interactions 9 (90) 1 (10) 0 (0) Encouraging civic participation 10 (100) 0 (0) 0 (0) Facilitating connectivity and attachment 7 (70) 3 (30) 0 (0) D5. Skills in practice of social justice that build stronger teams and communities toward social justice (n = 25 constructs) Critical consciousness c 10 (10) 0 (0) 0 (0) Skills to build equity and inclusivity 8 (80) 2 (20) 0 (0) Skills to interact with diverse groups in a variety of contexts 9 (90) 1 (10) 0 (0) Social justice interest 7 (70) 3 (30) 0 (0) Social justice commitment 9 (90) 1 (10) 0 (0) Skills to organize people 8 (80) 2 (20) 0 (0) Engaging people in participatory processes toward solutions 9 (90) 1 (10) 0 (0) Expressed empathy 6 (60) 4 (40) 0 (0) Sharing full histories of people’s lived experiences 7 (70) 3 (30) 0 (0) Social justice advocacy 9 (90) 1 (10) 0 (0) Addressing differences in communication styles across groups 8 (80) 2 (20) 0 (0) Negotiating cultural conflicts 7 (70) 3 (30) 0 (0) Establishing group norms that reflect cultural differences 9 (90) 1 (10) 0 (0) Cultural humility 10 (100) 0 (0) 0 (0) Responsiveness to language needs 8 (80) 2 (20) 0 (0) Demonstration of just and fair leadership 9 (90) 1 (10) 0 (0) Skills to create societal change including in policies 10 (100) 0 (0) 0 (0) Listening 7 (70) 3 (30) 0 (0) Acknowledgment of oppression in communities 8 (80) 2 (20) 0 (0) Righting historical wrongs 9 (90) 1 (10) 0 (0) Skills to transform institutions 8 (80) 2 (20) 0 (0) Justice sensitivity 9 (90) 1 (10) 0 (0) Victim sensitivity 7 (70) 3 (30) 0 (0) Treating people with dignity and love 9 (90) 1 (10) 0 (0) Providing equitable solutions 9 (90) 1 (10) 0 (0) Open in a new tab Abbreviation: D = domain. a Content validity was based on asking participants if the specific domain represented a social justice competency and if the specific construct represented that domain. b The “n” represents the number of people who voted. The percent is calculated for each row based on the number of people who voted for the specific construct. c Because critical consciousness includes critical reflection, critical motivation, and critical action, it was listed under D1 and D5 as part of the voting process. Definitions of social justice competencies domains and constructs Table 3 shows the definitions of the domains and constructs. After reviewing the constructs through an iterative process, we deleted 3 constructs (acknowledgement of oppression in communities, skills to create change, engage in participatory process toward solutions) that were similar to other constructs. One construct, transformative consciousness, was added under domain 1. Table 3 shows the 5 domains and 59 related constructs. Table 3. Definition of the 5 domains of social justice competencies and constructs within each domain a Domain 1. Internal awareness (n = 8 constructs) Internal awareness is a metacognitive factor that is central to the process of individuals and institutions engaging in social justice action to improve health. Internal awareness requires the examination of patterns of thinking that create space for new knowledge related to inequities. At the organizational level, internal awareness requires that key leaders, who make decisions about policies, procedures, and strategic planning, come together to discuss how they think about how institutions operate to facilitate health disparities and inequities. Internal awareness includes self-reflection, critical consciousness, transformative consciousness, awareness of privilege and oppression in society, awareness of one’s space and positionality in the environment, awareness of individual and organizational contribution to social injustices and unfair treatment, and allyship. Constructs Definitions Ongoing self-reflection or awareness Self-reflection or awareness includes the capacity to reflect on oneself and to inspect and evaluate one’s thoughts, experiences, feelings, behaviors, and insights. 17-22 The process of self-reflection includes constructive examination. Individuals and institutions may spend considerable time in self-reflection without gaining insight. Critical consciousness Critical consciousness represents oppressed or marginalized people’s critical analysis of their social conditions and individual or collective action taken to change perceived inequities. 23 , 24 It is characterized as “reflection and action upon the world in order to transform it.” 25 Critical consciousness includes levels of consciousness and action that produce potential for change at 1 or more socioecosystemic (eg, individual, institutional) levels. 26 Critical consciousness can include the components of critical reflection, critical motivation, and critical action. 27 Transformative consciousness (connected to critical consciousness) b Transformative consciousness includes the components of awareness, behavioral responses, and consequences. It is a person’s level of socioecosystemic reflection on inequitable factors and causes that perpetuate a problem; the potential behavioral responses to inequities; and the consequences of inequities for the development and implementation of potential solutions. 28 , 29 Transformative consciousness also includes an organization’s reflection on inequitable elements that perpetuate a particular problem and how institutions respond to the problem and their ability to develop solutions that address the inequities. Awareness of one’s own privilege and power and oppression in society and within organizations Awareness of privilege and oppression is an individuals’ recognition of social privilege and oppression. 30 The construct differs from self-reflection, which examines the ways in which individuals begin to question social structures that create oppression 31 that then impact health. Ideally, individuals and institutions must be aware of privilege and oppression before they question injustices and hierarchy within systems 32 including health, academic, government, political, and social systems that influence health. Awareness of how one’s space and environment and positionality influence perception of privilege and power Awareness of one’s own space includes a recognition of how where one sits or is positioned in society influences how one thinks about health disparities. The space can include a title or position that one owns and physical space and assets and deficits in that space, as well as resource encompassed in the space of individuals and institutions. Awareness and critical reflection of one’s own contributions to social injustices and unfair treatment Critical reflection of one’s own contributions includes the critical analysis of perceived social inequalities 25 and how individuals perceive their contributions to injustices in health. This process differs from self-reflection as it requires that a person sees himself, herself, they as a contributor to the health problem. Critical reflection of organizational factors that perpetuate social injustices and unjust treatment Critical reflection of organizational factors refers to the awareness of the role that companies or systems play in contributing to social problems. 33 Specifically, this process focuses on how institutions collectively reflect on factors within their boundaries and in other systems to which they are connected perpetuate injustices related to health. Allyship Allyship is the act acts of compassion performed by members of a dominant social group not directly experiencing oppression, injustice, or suffering. 34 Allyship is a title that is assigned to individuals or groups based on how others feel that the allies act toward them. 35 Allyship requires an awareness of others’ suffering and inequities that then results in feelings of compassion and empathy. Allyship is a cognitive process as much as it is an action. Allyship as an action cannot be performed without having compassion and empathy driven by awareness of others’ suffering. Domain 2. Attitudes, values, and beliefs that influence social justice (n = 9 constructs) Attitudes, values, and beliefs that influence social justice encompass how we think about social justice, the judgment we place on the level of importance of issues related to social justice, and what we think is true or exists about social justice–related health disparities and inequities. The attitudes, values, and beliefs are often precursors to motivation to conduct social justice actions or inaction. Positive attitudes and beliefs toward social justice can influence action that helps eliminate disparities, whereas negative attitudes and beliefs toward social justice can influence actions to facilitate health disparities. This domain includes attitudes toward change and learning; respect for worldviews; values for people, diversity, social justice and egalitarianism; and collective beliefs and individual beliefs about one’s ability to achieve the goal of social justice. This domain represents constructs that are influenced by one’s internal awareness and vice versa and precedes intentions to conduct social justice actions. Openness to change Openness to change is the idea that individuals and institutions are receptive to new ideas and ways of conducting research and practice that impact health disparities and health equity. Willingness to learn Willingness to learn refers to an individual’s openness and readiness to acquire new knowledge, skills, or competencies. It involves a proactive attitude toward self-improvement, adaptability to change, and the continuous pursuit of personal and professional cognitive growth. Those who demonstrate a willingness to learn are eager to embrace challenges, take constructive feedback, and invest time in lifelong learning. 38 Value for diversity Value for diversity is the empowerment of people by respecting and appreciating what makes them different, in terms of age, gender, religion, sexual orientation, disability, education, experiences, religion, worldviews, and their cognition. 39 Respect for different worldviews Respect for different worldviews is one component of value for diversity. Respect includes showing people with different world views that their ideas are important and are valued as part of research or practice dialogue of engagement. 40 Value for people and communities Value for people and communities means that we hold a person and communities as worthy of appreciation, worthy of time, and worthy of attention to address the disparities that they experience. 41 Value for social justice Value for social justice means that social justice is prioritized as an important approach to health disparities and equity research and practice by individuals and institutions. 42 Egalitarian values c Egalitarian values means that equality is an important goal that is applied to how we approach health, health care, and the policies that impact health and health disparities. 43 Collective efficacy Collective efficacy is the shared belief and confidence that people have about their collective power to execute actions related to a common goal. 44 Social justice efficacy Social justice efficacy is an individual’s perceived beliefs about one’s ability to perform specific social justice tasks across multiple domains. 45 Domain 3. Knowledge and awareness that influence social justice orientation and actions (n = 10 constructs) Knowledge and awareness that influence social justice orientation and actions focused on what people understand and the information they have to equip them to take actions to eliminate health disparities. Knowledge as power helps people obtain information to solve health disparities and inequities, facilitates critical thinking about the underlying causes of health disparities, facilitates critical reflection, and informs decision making about health equity solutions. Knowledge can influence internal awareness, and internal awareness can influence knowledge seeking that helps prepare people to act. This domain includes consciousness raising; knowledge of communication styles, language, decolonization, and biases; knowledge of history, cultural heritage, and sociopolitical backgrounds that contribute to disparities; knowledge of societal and structural inequities; and knowledge of health and social disparities in communities. Consciousness raising, conscientizacao Consciousness raising includes the ways in which individuals and communities develop an accurate critical understanding of their social reality through reflection and action 23 , 25 and how these realities can reinforce and maintain systemic inequities at multiple levels. 12 , 46 Freire says it includes examining and acting on the root causes of oppression. As an action, consciousness raising can include building connections with others’ experiences to de-isolate people. 47 Awareness of different ways of connecting via communication styles e Awareness of different ways of connecting includes the ability to recognize and understand that there are culturally specific ways of communicating within and between groups and that these different forms of communication are legitimate. Knowledge of languages and use of words Knowledge of languages and use of words is understanding that people may use the same overarching language (eg, English or Spanish) but may use different words, dialects, phrases, and styles (eg, storytelling) to communicate. Awareness of how inclusive language impacts people Awareness of inclusive language means that people are aware of how people choose to self-identify. It requires that people have knowledge on how people choose to self-identify as social groups and understand the heterogeneity within and between racial, ethnic, gender, and cultural groups regarding self-identification, which can change over time and within specific contexts. Decolonization of knowledge Decolonization of knowledge seeks to deconstruct existing ways of knowing and construct and legitimize other ways of knowing than those imposed by dominant narratives associated with colonization. 48 , 49 Knowledge of group members’ biases Knowledge of group members’ biases includes understanding their prejudices, stereotypes, internalized notions of superiority or inferiority, their own social identity, cultural influences, and an intersection of these. Other experts have identified these factors as important competences. 46 , 50 Knowledge and awareness of history, cultural heritage, and sociopolitical backgrounds that contribute to disparities Knowledge of history and cultural heritage includes having an in-depth awareness and understanding of historical, cultural, and sociopolitical factors that shape and influence health disparities and inequities. Knowledge of societal inequities Knowledge of societal inequities includes identifying and making correct attributions about the sources of historical societal factors as root causes of health disparities. 51 Knowledge of structural inequities Knowledge of structural inequities includes identifying and making correct attributions about the sources of historical structural factors as root causes of health disparities. 52 , 53 Knowledge of health and social disparities in communities Knowledge of health and social disparities includes identifying social factors, risk factors, and health consequences that result from structural and systemic inequalities within communities. Domain 4. Skills in the practice of social justice that incite others to act (n = 11 constructs) Skills in the practice of social justice that incite others to act include the steps that people take to encourage others to act. Deliberate steps must be taken to build the capacity of people to engage in social justice actions to eliminate health disparities and inequities. The actors can include anyone, but this step requires that people see themselves as part of the solution to help others act. Thus, internal awareness must precede this phase as this awareness builds skills. The constructs include giving voice; expressed empathy; increasing access to self-determination and realization; building the imagination; sharing power; building strengths; conflict resolution; creating a safe space; encouraging civic participation; and facilitating attachments. Individuals and institutions can facilitate these acts that help others conduct socially just research and practice. Giving voice Giving voices provides opportunities and supports others to share lived experiences, questions, and goals. Giving voice advocates for people and institutions to share their thoughts and opinions. This includes speaking up to those who have positions of hierarchal power and overcoming reluctance to express concerns over conditions. 54 , 55 Expressed empathy f Expressed empathy is the action one takes to show understanding and feel the emotional states of others. 56 Empathy requires cognitive, emotional, behavioral, and moral capacities to understand and respond to the suffering of others who experience inequities. It is related to compassion because empathy cannot exist without compassion. 56 Expressed empathy gives people the space to respond to inequities. Increasing access to self-determination Increasing access to self-determination helps people and communities understand what their support systems are and tools for sustainability that then can be used to take actions. 57 Self-determinism realization Self-determinism realization provides people with tools to shape their own lives and believe that they have autonomy and control over their lives. 58 , 59 Building imagination of what can be Building imagination helps people and institutions envision a better future for self and community. Building imagination fosters individual and collective vision that liberates people from existing health disparities and social and structural inequities and supports their cognitive ability to create solutions. Imagination itself is built on daily life experiences, which mediates one’s cognitive and emotional processes for creativity. 60-62 Sharing power Sharing power fosters interactions, emergence of voices, and emancipation at the individual and community level. The ability to share power supports a true democracy. 63 Strength building Strength building helps people and institutions identify their strengths, skills, and talents and recognize their competency as powerful individuals and institutions. 64 Conflict resolution Conflict resolution is the act of helping people navigate conflict and harm. It facilitates dialogue to acknowledge, address, and generate collectively agreed on accountability measures that are restorative for the perpetrators and recipients of harmful practices and behaviors. Conflict resolution is the ability to restore “hope for building community in the midst of conflict.” 65 Creating safe space for interactions Creating a safe space for interactions is the act of facilitating dialogue that is inclusive and growth focused, where all are heard and valued without the threat of retaliation or attacks. 66 , 67 Encouraging civic participation Encouraging civic participation entails the act of inspiring others to participate in a wide range of formal and informal activities, such as voting, volunteering, political activism, participating in group activities, and community gardening. 68 Civic participation provides opportunities to increase social cohesion and well-being and the ability to influence the social and structural factors that influence health disparities. Facilitating connectivity and attachment Facilitating connectivity and attachments helps others network and build personal relationships with others as part of well-being. Attachments are a critical domain of social justice well-being. 59 Domain 5. Skills in practice of social justice that build stronger teams and communities toward social justice (n = 21) Skills in practice of social justice that build stronger teams and communities toward social justice includes the steps that facilitate the actions of research teams and communities to advance social justice in research, practice, and policies. The skills include critical collective action; building equity and inclusivity; interacting with diverse groups; social justice interest and commitment; skills to organize people; sharing full histories; social justice advocacy; negotiating cultural conflicts; establishing group norms; cultural humility; responsiveness to language needs and communications styles; listening; fair and just leadership; righting historical wrongs; skills to transform institutions; justice and victim sensitivity; treat people with dignity; and equitable solutions. While these skills also apply to D4, for this domain, D5 represents how these skills apply to teams and communities to engage in collective action. Critical collective action (engage people in participatory process toward solutions) d Critical collective action stems from critical action, a component of critical consciousness and collective efficacy. Critical action is the participation of individuals or groups in actions that aims to produce change, challenge inequities, and address the sociopolitical and oppressive factors that impact inequalities. There is a reciprocal relationship between critical action and critical reflection that is transformative for human agency. 17-22 , 24 , 25 Collective critical action requires collective efficacy because collective confidence to achieve particular goals must precede the actions. Critical collective action is one component of civic engagement but focuses on changing the oppressive components of society 27 such as changing health policies to reduce health disparities. Critical collective action is the deliberate engagement of teams and communities in actions that aim to change and challenge inequities. Critical collective action can have a greater impact on reducing health disparities. Skills to build equity and inclusivity Skills to build equity and inclusivity is the act of helping others build structures and spaces where those who are most affected by health injustices can participate and are included regardless of their life conditions and embodied identities. 69 Skills to interact with diverse groups in a variety of contexts Skills to interact with diverse groups in a variety of contexts is the act of helping others interact effectively across people with diverse backgrounds and connect social justice principles in different settings and geographical locations. 70 Social justice interest Social justice interests operate at the individual and organization levels. At the individual level, it is expressed as activities that people engage in or facilitate that allow people to address and talk about social justice issues such as selecting a job or career, reading about social justice issues, and talking about social justice issues. 45 At the organizational level, it is engaging research organizations and communities in social justice issues through lectures, hosting cultural events, offering specific jobs in this area, and providing resources internal to the organizations and externally to community partners that advance interest in social justice. Social justice commitment Social justice commitment refers to the specific goals or intentions that teams and communities have established to pursue related to social justice. 45 Skills to organize people Skills to organize people refers to teaching people the art of community organizing, 71 research team organizing, and organizing institutions to effect changes that influence health disparities and health equity research and practice. Sharing full histories of people’s lived experiences Sharing full histories of people’s lived experiences is the action of sharing the experiences in the context of research and practice teams and communicating accurate information to reflect those experiences. Social justice advocacy Social justice advocacy is the action of convening groups to promote the improvement of conditions for vulnerable and marginalized individuals and communities. 72 , 73 Negotiating cultural conflicts Negotiating cultural conflicts includes working within teams to effectively navigate disagreements that stem from cultural differences and reconnecting individuals in teams to common goals. 74 Establishing group norms that reflect cultural differences Establishing group norms means that teams discuss what respect means related to cultural differences and creating agreements on how teams will function based on those expectations. 75 Cultural humility Cultural humility is the action of teams to self-explore and self-critique while having the willingness to learn from others. 76 Responsiveness to language needs of populations Responsiveness to language needs of populations is ensuring that team practices are grounded in language justice by making meetings, spaces, interactions, and relevant materials accessible to different age groups, people with disabilities or limited capacity, and people who may speak a different language than that of the dominant group. Addressing differences in communication styles across groups Addressing differences in communication styles is an extension of being aware of these styles. It requires teams to create a space to accommodate these differences. This may include the provision of interpretation services, using words that everyone understands, and translation of technical concepts into lay terms and include groups that are part of the populations of interest on teams to facilitate effective communication. Listening Listening is the ability of teams to pay thoughtful attention to each other and to audiences of interest and to hear and understand what people mean in the use of verbal, written, or body language without judgment. It includes centering the voices of those most affected by injustice, including their input and expertise in establishing goals, norms, and strategies for social change. 77 Demonstration of just and fair leadership Demonstration of just and fair leadership is the act of critically evaluating leadership styles and practices on an ongoing basis to determine impartiality; validation of team members concerns irrespective of position and rank; and use of processes, procedures, policies, and accountability measures that are applied in a fair way and that facilitate the conduct of health disparities and equity research and practice. 78 Righting historical wrongs Righting historical wrongs includes efforts by teams and communities to identify historical injustices and advance solutions to address historical injustices that have had generational impact on different communities. Skills to transform institutions Skills to transform communities includes the efforts by teams and communities to teach people how to engage in structural changes that transform institutions in service of benefiting those who are most affected by health-related injustices. 29 Justice sensitivity Justice sensitivity helps teams practice how to perceive and respond to injustices experienced by communities. 79 Victim sensitivity Victim sensitivity helps teams practice openness to understand injustice from the victim’s perspective without the threat of reverse victimization or blaming victims for their life circumstances. This action requires an awareness of social and structural factors that impact a victim’s life circumstance. 79 Treating people with dignity and love Treating people with dignity and love helps teams practice the provision of respect and compassion for people regardless of circumstances and who they are. This requires that people engage in collective care for individuals and communities. 59 Providing equitable solutions Providing equitable solutions helps diverse teams with the skills to identify solutions to provide equitable resources that increase the ability to change conditions across diverse communities. Open in a new tab Abbreviation: D = domain. a Following the voting process ( Table 2 ), some constructs were moved to domains where they fit best. Others were deleted if they were represented within other constructs. Skills to create change is listed in Table 2 D5 and was deleted in Table 3 . It is related to critical action and skills to organize also listed in D5. Acknowledgment of oppression in communities is listed in Table 2 under D5 and was deleted from D5 as it is represented under multiple constructs in D1 in Table 3 . Engage in participatory process toward solutions was listed in Table 2 D5 and was deleted in Table 3 . b One new construct, transformational consciousness, connected to critical consciousness was added to D1. c The egalitarian values construct is listed in Table 2 under D3 and was moved to D2 in Table 3 . d The construct critical consciousness is listed in Table 2 D1 and D5. In Table 3 , we list critical action under D3, which is the component of critical consciousness relevant to D5. e The awareness of how inclusive language impacts people is listed in Table 2 under D1 and was moved to D3 in Table 3 . f Expressed empathy is listed in Table 2 under D5 and was moved to D4 in Table 3 . Domain 1 (D1) . Internal awareness includes 8 constructs. Internal awareness is a metacognitive factor that is central to the process of individuals and organizations engaging in social justice action to improve health. Internal awareness requires the examination of patterns of thinking that create space for new knowledge related to inequities. At the organizational level, internal awareness requires that key leaders, who make decisions about policies, procedures, and strategic planning, come together to discuss how they think about how organizations operate to facilitate health disparities and inequities. Internal awareness includes ongoing self-reflection; critical consciousness; transformative consciousness; awareness of one’s own privilege and power, and oppression in society and within organizations; awareness of one’s space or environment and positionality influence perception of privilege and power; awareness and critical reflection of one’s own contributions to social injustices and unfair treatment; critical reflection of organizational factors that perpetuate social injustices and unjust treatment; and allyship. The internal awareness competency is inextricably connected to social justice action as actions cannot occur at the individual or organizational levels if internal awareness is not ongoing. Domain 2 (D2) . Attitudes, values, and beliefs that influence social justice includes 9 constructs. Domain 2 encompasses how we think about social justice, the judgment we place on the level of importance of issues related to social justice, and what we think is true or exists about social justice-related health disparities and inequities. The attitudes, values, and beliefs (whether positive or negative) are often precursors to motivation to conduct social justice actions or inaction. Domain 2 includes attitudes toward openness to change; willingness to learn; valuing diversity; respect for worldviews; values for people and communities; value for social justice; egalitarian values; collective efficacy; and social justice efficacy. Domain 3 (D3) . Knowledge and awareness that influences social justice orientation and actions includes 10 constructs. D3 focuses on what people understand and the information they have to equip them to take actions to eliminate health disparities. Knowledge as power helps people obtain information to solve health disparities and inequities, facilitates critical thinking about underlying causes of health disparities, facilitates critical reflection, and informs decision making about health equity solutions. This domain includes consciousness raising ( conscientizacao ); 23 knowledge of communication styles; knowledge of language and use of words; awareness of how inclusive language impacts people; decolonization of knowledge; knowledge of group member biases; knowledge of history, cultural heritage, and sociopolitical backgrounds that contribute to disparities; knowledge of social inequities; knowledge of structural inequities; and knowledge of health and social disparities in communities. Domain 4 (D4) . Skills in practice of social justice that incite others to act includes 11 constructs. D4 includes the deliberate steps that individuals and institutions take to encourage others to act. The actors can include anyone, but this step requires that people see themselves as part of the solution to help others act. Internal awareness must precede D4 to effectively build these skills. The constructs in D4 include giving voice; expressed empathy; increasing access to self-determination; self-determination realization; building the imagination of what can be; sharing power; building strengths; conflict resolution; creating a safe space for interactions; encouraging civic participation; and facilitating connectivity or attachments. Domain 5 (D5) . Skills in practice of social justice that build stronger teams and communities toward social justice includes 21 constructs. Domain 5 includes the steps that facilitate the actions of research teams and communities to advance social justice in research, practice, and policies. The skills include critical collective action; skills to build equity and inclusivity; skills to interact with diverse groups in a variety of contexts; social justice interest; social justice commitment; skills to organize people; sharing full histories of peoples’ lived experiences; social justice advocacy; negotiating cultural conflicts; establishing group norms that reflect cultural differences; cultural humility; responsiveness to language needs of populations; addressing differences in communication styles across groups; listening; demonstrating fair and just leadership; righting historical wrongs; skills to transform institutions; justice sensitivity; victim sensitivity; treating people with dignity and love; and providing equitable solutions. Although these skills also apply to D4, D5 represents how leaders apply these skills to build strong teams and communities to engage in collective action. Conceptual model of the 5 domains of social justice competencies Figure 1 suggests that reflection at the individual or institutional level is ongoing throughout all stages of engaging in social justice competencies. The model indicates that the internal awareness domain must occur at the individual and institutional levels. Awareness then influences knowledge, which is shaped by individuals’ and institutions’ beliefs, values, and attitudes. Individuals’ and institutions’ beliefs, values, and attitudes can also influence knowledge related to social justice orientation or actions. Finally, in alignment with behavioral theories, 36 , 37 knowledge, attitudes, and beliefs influence the intention to conduct or support research and practice using a social justice lens. Discussion The Social Justice Competencies Subcommittee, which represented a cross-center collaboration, established content validity for 5 social justice competency domains and 61 related constructs. All constructs received at least 90% of votes to be retained or consider retaining by the committee. After having iterative discussions, 59 constructs were included in the final summary of the 5 domains (see Table 3 ). These domains included internal awareness (D1); attitudes, values, and beliefs that influence social justice (D2); knowledge and awareness that influence social justice orientation and actions (D3); skills in practice of social justice that incite others to act (D4); and skills in practice of social justice that build stronger teams and communities toward social justice (D5). The social justice competencies provide an operational framework by which institutions and communities can engage to develop a competent and resilient workforce that is prepared to develop, conduct, and evaluate research and practice that seeks to eliminate chronic disease disparities and achieve health equity. Further, use of these competencies can hold systems accountable for protecting citizens from injustices, including those who are in the minority. 4 The absence of social justice competencies perpetuates and maintains health disparities, reversing the progress made in global health to date. Although the Subcommittee is still identifying measures that align with each construct, emerging political determinants that systematical and abruptly restructure public health infrastructure and distribution of resources have global implications and have prompted the need for immediate critical collective action. The Subcommittee agreed that internal awareness, a metacognitive process, must precede any actions that individuals and institutions will take to advance social justice in research and practice. This means that individuals and institutions must reflect on how they think about the world, academic processes, people who experience disparities, and how they themselves contribute to oppression and practices that contribute to poor health outcomes among different groups. For many of the constructs in D1, we were able to draw on existing definitions as much of this work has grown out of Paulo Freire’s framework 25 on processes of liberation for the oppressed. Research that aims to eliminate health disparities and inequities must include strategies for internal awareness of individuals, institutions, and systems. This step is often not integrated into research planning. However, the conduct of research processes is as much of an intervention as the intervention conducted with populations for whom change is intended. We caution that internal awareness does not assume that people care that oppression is harmful to people. People may reflect on how they contribute to oppression with the goal of advancing oppression and indoctrinating people with the idea that oppression, a harmful act, is acceptable, just, and right. As such, other processes such as those in Figure 1 are necessary parts of social justice competency development. The Subcommittee’s conceptual model suggests that individual and organizational self-reflection is a necessary and ongoing process to inform changes in knowledge, attitudes, values, and beliefs that then influence skills and competencies resulting in socially just approaches to the development, conduct, and evaluation of research. For example, a social justice approach can include how a research team develops research questions or designs interventions that aim to reduce tobacco-related health disparities. It can also include how research centers engage with each other to form a committee to develop social justice competencies and what their investment is in the process and how they engage with community partners and members. Many members of the Subcommittee had not participated in measurement development studies. Thus, the process facilitated multidirectional learning and skills building. Subcommittee members discussed the cultural relevance of measures and how to integrate culturally centered measures in their work. A multidirectional process, where each person’s opinions were discussed and shared, resulted in cocreated competencies that were inclusive of diverse perspectives. Inclusivity meant that we considered the different ways in how people contribute verbally and in writing and how we translated research to practice language and vice versa. Most people on the Subcommittee were affiliated with an academic institution, but not all were traditional researchers or had participated in measurement development or scientific writing. This process aimed to ensure that all voices and ways of knowing are valued and alternative processes are valued and that there is flexibility to support the time it takes to achieve Subcommittee goals. The Constitution for Social Justice that was written nearly 2 centuries ago stated that governments are accountable for creating systems that support citizens’ freedoms and protection from injustices including those who are in the minority. 4 The cross-center engagement process has created a structured framework of competencies that can guide the public health workforce even if public health is deprioritized. In the past, people have come together to advance health disparities and health equity research, practice, and policy under a variety of political circumstances. The investment and commitment to eliminating health disparities and promoting health equity has gained momentum over the past 30 years. The Subcommittee was limited to people who were affiliated with 1 of 11 funded research centers and the research coordinating center. Not all funded centers had representatives who participated on the Subcommittee. We recognize that some people are interested in the outcome and not the process that helps achieve the outcome—a factor that also impacted participation on the Subcommittee. Overall, we had a diverse group of participants with different skills and talents that resulted in the identification of the social justice competencies. Subcommittee meetings are ongoing and are used to identify and develop specific measures for each construct that can be recommended for use in the field. By integrating existing talents with personal reflections from diverse participants, the Subcommittee developed competencies that can guide future processes that aim to reduce chronic disease health disparities and inequities. We developed these competencies because there is an urgent need for a socially just competent workforce and government, academic, business, and community structures to expedite progress in eliminating health disparities and inequities. The completion of the process to develop social justice competencies and release of the 35th report of the Surgeon General, Eliminating Tobacco-Related Disease and Death: Addressing Disparities 1 is quite timely. The 35th Surgeon’s report concluded that social, structural, and commercial factors such as persistent poverty and inequitable economic and social conditions lead to inequitable opportunities for living a life free from tobacco-related death and disease. 1 These same conditions lead to inequitable opportunities to live free from any chronic disease or condition. Public health researchers, practitioners, and advocates must remain anchored to “radical hope,” which can be a powerful motivator and reminder that socially just approaches are critical safeguards to the health and well-being of all communities. Social justice remains an enduring fight, and even in moments of disillusionment, we find strength in the pursuit of equity—collectively and through meaningful engagement of all partners. The process used to develop social justice competencies and the competencies themselves can inform funding structures, infrastructure development, training programs, and community actions. The competencies can inform how all funding agencies shape funding initiatives that focus on 2 stages of intervention research: (1) interventions to change and prepare institutions and partners to conduct health and equity disparities research and (2) interventions to eliminate chronic disease disparities. Acknowledgments The writers of this paper would like to thank the Social Justice Competencies Subcommittee for their hard work and dedication to the engaged process of developing the social justice competencies for the field. We thank the research coordinating center for their help in supporting the process. We acknowledge the following people who agreed to have their name listed as a contributor to the process: Vivian Carter, PhD; Sheila A. Dugan, MD; Bernice L. Frazier; Barbara Green-Ajufo; Darryl T. Jenkins; KiTani P. Lemieux, PhD, MS; Julia S. Mangione, MSc; Doriane C. Miller, MD; Pastor Gregory C. Nettles, BA, MDiv; Ijeoma Nnodim Opara, MD; Greg Rebchook, PhD; Kim F. Rhoads, MD, MS, MPH, FACS; and Toria Turner. We also acknowledge that social injustices are underlying causes of chronic disease health disparities and that the social and structural injustices must change to eliminate health disparities and inequities. We thank the people and organizations who are committed to the elimination of health disparities through social justice approaches. This work would not have been possible without the funding from the National Institute on Minority Health and Health Disparities who supported the 11 Multiple Chronic Disease Centers and the coordinating center at the University of California, San Francisco. Contributor Information D’Andra B Odom, Forge AHEAD, Pennington Biomedical Research Center, Baton Rouge, LA 70808, United States. Christie R Edwards, Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL 60612, United States. Judelysse Gomez, Institute of Health Systems Science, Feinstein Institutes for Medical Research, New Hyde Park, NY, United States. Mona AuYoung, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, United States. Pebbles Fagan, Center for the Study of Tobacco, Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States. Social Justice Competencies Subcommittee of the Community Engagement Working Group, Health Equity Action Network, The Social Justice Competencies Subcommittee, Community Engagement Working Group, Health Equity Action Network, School of Medicine, University of California San Francisco, San Francisco, CA, United States. Social Justice Competencies Subcommittee of the Community Engagement Working Group, Health Equity Action Network: Vivian Carter , Sheila A Dugan , Bernice L Frazier , Barbara Green-Ajufo , Darryl T Jenkins , KiTani P Lemieux , Julia S Mangione , Doriane C Miller , Pastor Gregory C Nettles , Ijeoma Nnodim Opara , Greg Rebchook , Kim F Rhoads , and Toria Turner Author contributions D’Andra B. Odom (Conceptualization; Data curation; Writing—original draft; Writing—review & editing), Christie R. Edwards (Conceptualization; Data curation; Writing—original draft; Writing—review & editing), Judelysse Gomez (Conceptualization; Data curation; Methodology; Writing—original draft; Writing—review & editing), Mona AuYoung (Conceptualization; Data curation; Writing—original draft; Writing—review & editing), and Pebbles Fagan, (Conceptualization; Data curation; Methodology; Supervision; Writing—original draft; Writing—review & editing). Funding This work was supported by the National Institute on Minority Health and Health Disparities as part of the Multiple Chronic Disease Centers (grant #: 1P50MD017344; 1P50MD017341; 1P50MD017348; 1P50MD017356; 1P50MD017319; 1P50MD017338; 1P50MD017366; 1P50MD017349; 1P50MD017342; 1P50MD017347; 1P50MD017351; 1U24MD017250). This content is solely the responsibility of the authors and the Social Justice Competencies Subcommittee and does not necessarily represent the official views of the National Institute on Minority Health and Health Disparities or the National Institutes of Health. Some of the authors were paid contributors to a Surgeon General’s Report and the corresponding author received an honorarium for their contribution to this special issue. Monograph sponsorship This article appears as part of the monograph, “Continued Impact of the Use of Commercial Tobacco Products on Health Disparities in the U.S.,” sponsored by the Robert Wood Johnson Foundation. The views expressed here do not necessarily reflect the views of the Foundation. Conflicts of interest None declared. Data availability Not applicable. References 1. U.S. Department of Health and Human Services. Eliminating Tobacco-Related Disease and Death: Addressing Disparities—A Report of the Surgeon General: Executive Summary. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2024. [ Google Scholar ] 2. Taparelli L. Saggio Teoretico di Dritto Naturale Appoggiato sul Fatto . Vol 5. La Civiltà Cattolica; 1855. 3. Kraynack RP. The origins of “social justice” in the natural law philosophy of Antonio Rosmini. Rev Polit. 2018;80:3-29. [ Google Scholar ] 4. Rosmini A. The Constitution under Social Justice. Lexington Books, Rowman and Littlefield Publishers; 2007. [ Google Scholar ] 5. Garland R, Batty ML. Moving beyond the rhetoric of social justice in nursing education. Can J Crit Nurs Discourse. 2021;3:17-30. [ Google Scholar ] 6. Centers for Disease Control and Prevention. What is health equity? Accessed October 4, 2024. https://www.cdc.gov/health-equity/what-is/index.html 7. Braveman P. Health disparities and health equity: concepts and measurement. Annu Rev Public Health. 2006;27:167-194. [ DOI ] [ PubMed ] [ Google Scholar ] 8. Loffredo V. The social justice and inclusion competency. 2016. https://www.naspa.org/blog/the-social-justice-and-inclusion-competency . Accessed October 4, 2024. 9. Ratts MJ, Singh AA, Nassar‐McMillan S, Butler SK, McCullough JR. Multicultural and social justice counseling competencies: guidelines for the counseling profession. J Multicult Couns Dev. 2016;44:28-48. [ Google Scholar ] 10. Singh AA, Appling B, Trepal H. Using the multicultural and social justice counseling competencies to decolonize counseling practice: the important roles of theory, power, and action. J Counsel Dev. 2020;98:261-271. [ Google Scholar ] 11. Killian T, Peters HC, Floren M. Development and validation of the multicultural and social justice counseling competencies-inventory. Meas Eval Counsel Dev. 2023;56:329-346., [ Google Scholar ] 12. Goodman LA, Liang B, Helms JE, Latta RE, Sparks E, Weintraub SR. Training counseling psychologists as social justice agents: feminist and multicultural principles in action. Counsel Psychol. 2004;32:793-836. [ Google Scholar ] 13. Hardiman R, Jackson BW, Griffin P. Conceptual foundations for social justice education. In: Adams M, Bell LA, Griffin P, eds. Teaching for Diversity and Social Justice, 3rd ed. Routledge; 2017. [ Google Scholar ] 14. Ford CL, Airhihenbuwa CO. Critical race theory, race equity, and public health: Toward antiracism praxis. Am J Public Health. 2010;100(suppl 1):S30-S35. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 15. Aguilar-Gaxiola S, Ahmed SM, Anise A, et al. Assessing meaningful community engagement: A conceptual model to advance health equity through transformed systems for health: Organizing committee for assessing meaningful community engagement in health & health care programs & policies. NAM Perspect. 2022;2022:17. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 16. Freire P. Pedagogy of the Oppressed. Seabury Press; 1970. [ Google Scholar ] 17. Grant A, Franklin J, Langford P. The self-reflection and insight scale: a new measure of private self-consciousness. Soc Behav Pers. 2002;30:821-835. [ Google Scholar ] 18. Carver CS, Scheier MF. On the Self-Regulation of Behavior. Cambridge University Press; 1998 [ Google Scholar ] 19. Carver CS. Self-awareness. In: Leary MR, Tangney JP, eds. Handbook of Self and Identity. Guilford; 2003:179-196. [ Google Scholar ] 20. Carver CS, Scheier MF. Principles of self-regulation: action and emotion. In: Sorrentino R, Higgins ET, eds. Handbook of Motivation and Cognition. Vol. 2. Guilford; 1990:3-52. [ Google Scholar ] 21. Duval TS, Silvia PJ. Self-Awareness and Causal Attribution: A Dual Systems Theory. Kluwer Academic Publishers; 2001. [ Google Scholar ] 22. Duval TS, Silvia PJ. Self-awareness, probability of improvement, and the self-serving bias. J Soc Psychol. 2002;82:49-61. [ DOI ] [ PubMed ] [ Google Scholar ] 23. Konicki Di Lorio C. Measurement in Health Behavior Methods for Research and Evaluation. Jossey-Bass; 2005: 215. [ Google Scholar ] 24. Watts RJ, Diemer MA, Voight AM. Critical consciousness: current status and future directions. In: Flanagan CA, Christens BD, eds. Youth Civic Development: Work at the Cutting Edge. Vol. 134. New Directions for Child and Adolescent Development; 2011:43-57. [ DOI ] [ PubMed ] [ Google Scholar ] 25. Freire P. Education for Critical Consciousness. Continuum; 1973. [ Google Scholar ] 26. Jemal AD. Transformative Consciousness: Conceptualization, Scale Development and Testing (Unpublished Doctoral Dissertation). Rutgers University; 2016. 27. Diemer MA, Rapa LJ, Voight AM, McWhirter EH. Critical consciousness: a developmental approach to addressing marginalization and oppression. Child Dev Perspect. 2016;10:216-221. [ Google Scholar ] 28. Jemal A, Bussey SR, Davis K. Transformative consciousness. csw. 2020;21:30-53. [ Google Scholar ] 29. Jemal A. Transformative consciousness of health inequities: oppression is a virus and critical consciousness is the antidote. J Hum Rights Soc Work. 2018;3:202-215. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 30. Montross LP. Awareness of privilege and oppression scale: construction and initial validation (Doctoral dissertation). Available from ProQuest. (Document No. 765146431); 2003. Accessed February 1, 2024. 31. Diemer MA, Hsieh C. Sociopolitical development and vocational expectations among lower socioeconomic status adolescents of color. Career Dev Q. 2008;56:257-267. [ Google Scholar ] 32. McClellan MJ, Montross-Thomas LP, Remer P, Nakai Y, Monroe AD. Development and validation of the awareness of privilege and oppression scale–2. SAGE Open. 2019;9:1-15.34290901 [ Google Scholar ] 33. Brooks A. Critical reflection as a response to organizational disruption. Adv Dev Hum Resourc. 1999;1:66-79. [ Google Scholar ] 34. LeBlanc L, Gingles D, Byers E. The role of compassion in social justice efforts. In: Sadavoy J, Zube M, eds. A Scientific Framework for Compassion and Social Justice: Lessons in Applied Behavior Analysis. Routledge; 2022:60-65. [ Google Scholar ] 35. Smith J, Puckett C, Simon W. Indigenous Allyship: An Overview. Office of Aboriginal Initiatives, Wilfrid Laurier University; 2016. [ Google Scholar ] 36. Becker MH. The health belief model and personal health behavior. Health Educ Monogr. 1974;2:324-473. [ Google Scholar ] 37. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50:179-211. [ Google Scholar ] 38. Cunningham JB, Hillier EA. Informal learning in the workplace: key activities and processes. Int J Train Dev. 2013;17:1-14. [ Google Scholar ] 39. Miville ML, Gelso CJ, Pannu R, et al. Appreciating similarities and valuing differences: the Miville-Guzman universality-diversity scale. J Counsel Psychol. 1999;46:291-307. [ Google Scholar ] 40. Brown KM. Assessing pre-serice leaders’ beliefs, attitudes, and values regarding issues of diversity, social justice, and equity: a review of existing measures. Equity Excell Educ. 2004;37:332-342. [ Google Scholar ] 41. Luengo Kanacri BP, Eisenberg N, Tramontano C, et al. Measuring prosocial behaviors: Psychometric properties and cross-national validation of the prosociality scale in Five Countries. Front Psychol. 2021;12:693174. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 42. Liebig A, Sebastian H, Meike M. Principles of the just distribution of benefits and burdens: The “basic social justice orientations” scale for measuring order-related social justice attitudes, SOEPpapers on Multidisciplinary Panel Data Research; 2016, No. 831, Deutsches Institut für Wirtschaftsforschung (DIW), Berlin. 43. Sen AK. Equality of what? In: McMurrin S, ed. Tanner Lectures on Human Values. Vol 1. Cambridge University Press; 1980:1-26. [ Google Scholar ] 44. Delea MG, Sclar GD, Woreta M, et al. Collective efficacy: development and validation of a measurement scale for use in public health and development programmes. Int J Environ Res Public Health. 2018;15:2139. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 45. Miller MJ, Sendrowitz K, Connacher C, et al. College students’ social justice interest and commitment: a social cognitive approach. J Counsel Psychol. 2009;56:495-507. [ Google Scholar ] 46. Flores MP, De La Rue L, Neville HA, et al. Developing social justice competencies: a consultation training approach. The Counseling Psychologist. 2014;42:998-1020. [ Google Scholar ] 47. Gornick V. ‘Consciousness’. In Crow BA, ed. Radical Feminism: A Documentary Reader. New York University Press; 2000:287-300. [ Google Scholar ] 48. Mitova V. Decolonising knowledge here and now. Philos Pap. 2020;49:191-212. [ Google Scholar ] 49. Wiredu K. Conceptual decolonization as an imperative in contemporary African philosophy: Some personal reflections. Rue Descartes. 2002;36:53-64. [ Google Scholar ] 50. Singh AA, Merchant N, Skudrzyk B, Ingene D, Hutchins AM, Rubel D. Association for specialist in group work: multicultural and social justice competency principles for group workers; 2012. Accessed October 6, 2024. https://www.stcloudstate.edu/graduate/clinical-mental- health/_files/documents/asgw-mc-sj-priniciples.pdf 51. Elenbaas L, Rizzo MT, Killen M. A developmental science perspective on social inequality. Curr Direct Psychol Sci. 2020;29:610-616. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 52. Hays DG, Chang CY, Decker SL. Initial development and psychometric data for the privilege and oppression inventory. Meas Eval Counsel Dev. 2007;40:66-79. [ Google Scholar ] 53. Torres-Harding SR, Siers B, Olson BD. Development and psychometric evaluation of the Social Justice Scale (SJS). Am J Community Psychol. 2012;50:77-88. [ DOI ] [ PubMed ] [ Google Scholar ] 54. Gentile MC. Giving voice to values: how to speak your mind when you know what’s right. Vill L Rev. 2022;66:915-923. [ Google Scholar ] 55. Detert JR, Edmondson AC. Implicit voice theories: taken-for-granted rules of self-censorship at work. AMJ. 2011;54:461-488. [ Google Scholar ] 56. Riess H. The science of empathy. J Patient Exp. 2017;4:74-77. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 57. Wehmeyer ML. The Arc’s self-determination assessment procedural guidelines. 1995. Accessed October 4, 2024. https://www.thearc.org/wpcontent/uploads/forchapters/SD%20Scale%20Procedural%20Guid elines.pdf 58. Deci EL, Ryan RM. The “what” and “why” of goal pursuits: Human needs and the self- determination of behavior. Psychol Inq. 2000;11:227-268. [ Google Scholar ] 59. Powers M, Faden R. Social Justice: The Moral Foundations of Public Health and Health Policy. Oxford University Press; 2006. [ DOI ] [ PubMed ] [ Google Scholar ] 60. Jung RE, Flores RA, Hunter D. A new measure of imagination ability: anatomical brain correlates. Front Psychol. 2016;7:496. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 61. Karwowski M, Soszynski M. How to develop creative imagination?: assumptions, aims and effectiveness of Role Play Training in Creativity (RPTC). Think Skills Creat. 2008;3:163-171. [ Google Scholar ] 62. Wang CC, Ho HC, Cheng YY. Building a learning progression for scientific imagination: a measurement approach. Think Skills Creat. 2015;17:1-14. [ Google Scholar ] 63. Bochsler D, Juon A. Power-sharing and the quality of democracy. Eur Polit Acad Manage J. 1990;33:692-724. [ Google Scholar ] 64. Mathie A, Cameron J, Gibson K. Asset-based and citizen-led development: Using a diffracted power lens to analyze the possibilities and challenges. Prog Dev Stud. 2017;17:54-66. [ Google Scholar ] 65. Vogel HJ. The restorative justice wager: the promise and hope of a value-based, dialogue- driven approach to conflict resolution for social healing. Cardozo J Conflict Resol. 2006;8:565. [ Google Scholar ] 66. Edmondson A. Psychological safety and learning behavior in work teams. Adm Sci Q. 1999;44:350-383. [ Google Scholar ] 67. Kahn WA. Psychological conditions of personal engagement and disengagement at work. Acad Manage J. 1990;33:692-724. [ Google Scholar ] 68. Abbott S. Social capital and health: the role of participation. Soc Theory Health. 2010;8:51-65. [ Google Scholar ] 69. Carmeli A, Reiter-Palmon R, Ziv E. Inclusive leadership and employee involvement in creative tasks in the workplace: the mediating role of psychological safety. Creat Res J. 2010;22:250-260. [ Google Scholar ] 70. Argyriadis A, Paoullis P, Samsari E, Argyriadi A. Self-Assessment Inclusion Scale (SAIS): a tool for measuring inclusive competence and sensitivity. Perspect Educ. 2023;41:34-49. [ Google Scholar ] 71. Alinsky SD, 1909-1972. Rules for Radicals: A Practical Primer for Realistic Radicals. Random House; 1971. [ Google Scholar ] 72. Marszalek JM, Barber C, Nilsson JE. Development of the Social Issues Advocacy Scale-2 (SIAS-2). Soc Just Res. 2017;30:117-144. [ Google Scholar ] 73. McCarther SM, Davis DM, Nilsson J, Marszalek J, Barbe C. Social justice advocacy competency: a step on the journey to develop an analytic instrument to pinpoint development and build capacity in 21st century school leaders. Natl FORUM Appl Educ Res J. 2013;26:94-103. [ Google Scholar ] 74. Broom A, Kirby E, Kokanović R, et al. Individualising difference, negotiating culture: Intersections of culture and care. Health. 2020;24:552-571. [ DOI ] [ PubMed ] [ Google Scholar ] 75. Neville FG, Templeton A, Smith JR, Louis WR. Social norms, social identities and the COVID‐19 pandemic: theory and recommendations. Soc Personal Psychol. Compass. 2021;15:e12596. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 76. Hook JN, Davis DE, Owen J, Worthington EL Jr, Utsey SO. Cultural humility: Measuring openness to culturally diverse clients. J Couns Psychol 2013;60:353-366. [ DOI ] [ PubMed ] [ Google Scholar ] 77. Bodie GD. The Active-Empathic Listening Scale (AELS): conceptualization and evidence of validity with the interpersonal domain. Commun Q. 2011;59:277-295. [ Google Scholar ] 78. Frankel AS, Leonard MW, Denham CR. Fair and just culture, team behavior, and leadership engagement: the tools to achieve high reliability. Health Serv Res. 2006;41:1690-1709. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 79. Schmitt M, Baumert A, Gollwitzer M, Maes J. The justice sensitivity inventory: factorial validity, location in the personality facet space, demographic pattern, and normative data. Soc Just Res . 2010;23:211-238. Associated Data This section collects any data citations, data availability statements, or supplementary materials included in this article. Data Availability Statement Not applicable. Articles from Journal of the National Cancer Institute. 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