The concept of public health has long centered on preventing disease and extending life, yet persistent health disparities continue to divide populations based on factors like race, income, and geography. Modern discussions recognize that merely treating illness or focusing on individual behavior is insufficient to close these gaps. Health justice emerges as a transformative framework, shifting the focus from individual health outcomes to the societal conditions that create sickness and prevent well-being. This approach necessitates a deep examination of the political, economic, and social systems that unfairly distribute the opportunity for health, ensuring good health is a universal right, not a privilege.
Defining Health Justice and Its Scope
Health justice is a socio-political goal focused on ensuring that all people have the right to achieve their highest possible level of health. It is fundamentally concerned with fairness and the intentional dismantling of systemic obstacles that prevent equitable health outcomes. The scope extends far beyond the medical system, encompassing all resources and structures that determine a person’s well-being. This includes access to healthy food, safe housing, quality education, and reliable transportation, all of which are prerequisites for health.
Achieving health justice requires systemic change rather than merely modifying individual behavior or increasing access to clinical care. It demands that societal resources and structures operate fairly and without discrimination for all populations. For example, a health justice lens views disproportionately high rates of asthma in a neighborhood not as a failure of individual residents, but as a failure of zoning policies that allowed a polluting factory to be placed there.
Health Justice vs. Health Equity: Understanding the Distinction
The terms health equity and health justice are often used interchangeably, but they represent two distinct levels of intervention. Health equity is the aim of achieving fairness in health outcomes by providing resources based on need to address existing disparities. This approach recognizes that people start from different positions and therefore require tailored support, such as providing a ramp for wheelchair access where stairs exist for others. Health equity works to close the gaps in health that currently exist.
Health justice, however, is a broader, more fundamental concept that focuses on the root causes of those disparities. It is the active process of identifying and removing the structural barriers that created the gaps. If health equity is about ensuring everyone can climb the wall, health justice is about tearing down the wall so no one has to climb it. It addresses the power structures, rights, and legal and political frameworks that created the unequal system, focusing on rebuilding the system entirely.
Structural Barriers and Social Determinants of Health
Health justice centers on dismantling the structural barriers that create unequal distributions of health-promoting resources. These barriers manifest through the Social Determinants of Health (SDOH), which are the non-medical factors that profoundly influence health outcomes, often accounting for as much as 50 percent of a person’s health status. These factors include economic stability, neighborhood environment quality, educational opportunities, food security, and the broader community context. These SDOH are not random but are often the direct result of systemic policies.
The lasting impact of historical policies, such as the practice of redlining in the mid-20th century, illustrates how structural barriers operate. Redlining systematically denied services, including access to credit and home loans, to residents of specific neighborhoods, primarily based on race. This action triggered a cycle of disinvestment that endures today, resulting in formerly redlined areas having lower life expectancy, higher rates of chronic diseases like diabetes and hypertension, and increased exposure to environmental hazards. For instance, a study found that the color-coding of historical maps corresponded almost exactly to patients’ risk of complications and mortality after common surgeries, even when controlling for modern measures of neighborhood disadvantage.
These structural determinants are the “upstream” root causes that shape the “downstream” SDOH. They encompass the governing processes and economic policies that determine whether resources are distributed equally or unjustly based on characteristics like race, gender, or geography. The pursuit of health justice requires addressing these deeply embedded, systematic policies, as the unequal distribution of resources is the mechanism by which health inequities are created and maintained.
Pathways to Achieving Health Justice
Moving from a focus on health equity to health justice requires concrete action aimed at systemic transformation. A primary pathway involves robust legal and policy reform that targets the structural causes of poor health. This includes advocating for changes to zoning laws that permit polluting industries in residential areas or demanding fair housing policies that counteract the effects of historical discrimination. Professionals from various fields, including lawyers, policymakers, and community organizers, must collaborate closely with health experts to achieve these goals.
Community organizing is a fundamental component of this work, empowering marginalized groups to influence the decisions that affect their health. This involves “codesign,” where communities collaborate with institutions to identify issues and develop solutions that are locally appropriate and effective. Advocacy efforts focus on building political will to secure more equitable access to health insurance and reform reimbursement policies that perpetuate disparities in the healthcare delivery system. Ultimately, advancing health justice requires interdisciplinary efforts to shift power and resources, ensuring systems are structured to support the health of all people.