Health is often viewed as a personal matter, a result of individual choices and access to medical care. However, a person’s well-being is overwhelmingly shaped by the conditions of their daily life, such as their neighborhood, income, and environment. These non-medical factors are powerful drivers of health outcomes, creating wide and persistent disparities across populations. Health justice is a framework for understanding how these disparities are manufactured by society and for developing strategies to dismantle them. This approach shifts the focus from treating illness to addressing the structural forces that create sickness in the first place.
Defining Health Justice
Health justice is a rights-based framework asserting that all people have a fundamental right to the social, economic, and environmental conditions required for optimal health. Recognizing that clinical care accounts for only a fraction of health status, this concept moves beyond medical services to center on eliminating the unfair distribution of power and resources that leads to poor health outcomes for marginalized groups.
The health justice approach demands examination of how laws, policies, and institutions actively create and perpetuate health inequities. It focuses on structural accountability rather than individual behavior or lifestyle choices as the primary cause of disparities. By naming subordination—such as racism, classism, and sexism—as the root cause, health justice seeks to transform the systems themselves, not just mitigate their effects.
Distinguishing Health Justice from Related Concepts
Understanding health justice requires separating it from two related concepts: health equality and health equity. Health equality means giving everyone the exact same resources or opportunities, regardless of their starting point or specific needs. This would mean providing the same resources, such as the same level of funding, to every neighborhood clinic.
Health equity recognizes that people begin from different positions and therefore require tailored resources to reach the same outcome. It aims to level the playing field by providing resources proportionate to need, such as offering an interpreter or placing more resources in an underserved community.
Health justice represents the next step, moving beyond the remediation efforts of equity to address the underlying cause of the disparity itself. If equality is giving everyone the same box to see over a fence, and equity is giving people boxes of different heights so they can all see, justice is the act of tearing down the fence completely. Justice requires dismantling the structural and historical forces that built the barrier, ensuring that a fence is not reconstructed elsewhere.
Systemic Determinants of Health Injustice
Health injustice is not a random occurrence but is systematically produced by deeply embedded structural and institutional factors. One powerful determinant is institutionalized racism, which operates through discriminatory policies that shape where people live and what resources they access. Historic practices like redlining—which denied mortgages and investment based on race—continue to impact health today, creating areas with fewer grocery stores, lower quality schools, and less access to preventative care.
Economic inequality is another major driver, as poverty limits access to the foundational elements of well-being. Lack of a living wage or employment benefits often forces individuals into unstable housing or high-stress environments, directly contributing to chronic diseases and lower life expectancies.
Environmental factors also disproportionately harm marginalized communities through policy failures and industry practices. Historically, zoning laws and regulatory gaps have led to the placement of polluting industrial facilities, waste dumps, and major highways in low-income areas and communities of color. This results in higher exposure to air and water pollution, translating into elevated rates of asthma, lead poisoning, and certain cancers in these communities.
Policy failures in areas seemingly unrelated to health, such as inadequate public education or transportation infrastructure, perpetuate health injustice. When a community lacks reliable public transit, residents may struggle to reach medical appointments, pharmacies, or employment centers that offer better wages and health benefits. These systemic barriers are the result of policies that create unequal conditions in housing, employment, and education, making them structural determinants of poor health.
Pathways to Achieving Health Justice
Achieving health justice requires a fundamental shift in how society approaches health problems, moving from individual fixes to collective, structural transformation. One key pathway is through legal and policy advocacy, which involves using the force of law to dismantle discriminatory structures. This includes efforts to challenge policies that uphold residential segregation, block environmental protections, or fail to secure minimum living wages.
Community organizing and empowerment form the backbone of this movement, ensuring that those most affected by injustice have decision-making power in the solutions. By building power at the grassroots level, communities can demand reforms tailored to their needs and hold institutions accountable.
A commitment to accountability is woven throughout the health justice framework, holding government agencies, corporations, and institutions responsible for the systemic harms they inflict. This involves implementing mechanisms to measure the impact of policies on health equity and to enforce compliance with human rights standards. Ultimately, realizing health justice means prioritizing material resources and legal protections over interventions that focus solely on changing individual behavior.