The discourse surrounding health has shifted focus from individual lifestyle choices to the broader societal conditions that determine well-being. Modern public health recognizes that a person’s health is often dictated by factors far beyond personal control, moving toward an analysis of systemic issues. This perspective places social justice at the center of efforts to understand and improve population health. Examining health through this lens requires looking past immediate disease symptoms to the structural arrangements that produce patterns of illness and wellness across communities.
Defining Social Justice in Public Health
Social justice in public health is a framework concerned with the ethical distribution of resources, opportunities, and burdens within a society, ensuring every individual has access to the conditions necessary for optimal health. It operates on the premise that health is a fundamental human right, not a commodity. This viewpoint considers health disparities—differences in health outcomes between population groups—to be the result of unjust societal structures, not personal failings.
Applying social justice principles demands shifting focus from treating disease clinically to addressing the root causes of unequal disease distribution. When one group consistently experiences worse health outcomes, the social justice lens identifies this as a moral failure reflecting an unequal distribution of money, power, and resources. This compels public health efforts to dismantle systemic barriers that prevent people from reaching their full health potential.
The core commitment is the fair disbursement of advantages and the sharing of burdens, paying particular attention to the most disadvantaged populations. This involves actively working against policies that maintain an unequal playing field based on factors like race, class, or geography. By framing health as an issue of justice, public health advocates for foundational societal change, ensuring well-being is accessible to all people.
The Role of Social Determinants of Health
The structural mechanisms through which social injustice manifests in health outcomes are collectively known as the Social Determinants of Health (SDOH). These are the non-medical factors in the environments where people are born, live, learn, work, and age that profoundly influence their health and longevity. Factors outside of clinical care, such as socioeconomic status and environment, may account for up to 50 percent of the variation in health outcomes between different counties.
SDOH are grouped into five domains:
- Economic stability
- Neighborhood and built environment
- Education access and quality
- Health care access and quality
- Social and community context
Economic stability, for example, directly impacts a person’s ability to afford nutritious food, safe housing, and reliable transportation, all prerequisites for good health. Poverty is a fundamental driver that influences nearly every other determinant, creating stress and limiting access to resources.
Unequal access to these determinants leads to predictable health disparities. Living in a neighborhood with poor housing quality, often due to historical disinvestment, increases exposure to environmental toxins like lead paint or mold, resulting in chronic respiratory illnesses. Lower educational attainment is linked to fewer job opportunities, less income, and a higher risk for chronic conditions such as heart disease and diabetes. Addressing SDOH is the practical target of social justice efforts, as improving these conditions directly mitigates the structural causes of poor health.
Distinguishing Social Justice from Health Equity
While closely related, social justice and health equity represent distinct concepts in public health, with one serving as the means and the other as the end. Health equity is the desired goal: a state where everyone has a fair and just opportunity to attain their highest level of health. Achieving health equity means eliminating systematic disparities that are avoidable, unnecessary, and unfair, particularly those affecting socially disadvantaged groups.
Social justice, by contrast, is the analytical framework and moral imperative used to achieve that goal. It provides the rationale for identifying and dismantling the structural barriers that create health inequities. Health equity focuses on the outcome—the absence of disparities—while social justice focuses on the root causes and the ethical obligation to correct them.
The pursuit of health equity is embedded within the broader pursuit of social justice. Without social justice principles, efforts might only focus on mitigating the effects of unfair systems without changing the systems themselves. For example, providing free flu shots addresses an inequity, but a social justice approach also advocates for better public transportation and paid time off policies to ensure access without financial hardship. Social justice provides the structural analysis needed to remove the barriers that caused the gaps.
Applying Social Justice Principles to Public Health Policy
Translating social justice principles into public health policy requires moving beyond traditional health programs to target structural change across multiple sectors. This often involves adopting a “health-in-all-policies” strategy, ensuring that decisions made in non-health sectors (such as housing, transportation, and education) are evaluated for their impact on population health and equity. This recognizes that public health outcomes are determined by a wide range of governmental and economic decisions.
Specific policy interventions focus on shifting power and resources to marginalized populations to address the SDOH directly. Advocating for living wage campaigns and labor protections tackles the economic stability domain by ensuring workers earn an income sufficient to support a healthy life. Reforms to exclusionary zoning laws can increase access to affordable housing and create neighborhoods with better infrastructure, improving the built environment and community safety.
Public health agencies also engage in targeted advocacy to eliminate systemic discrimination, supporting policies that address the impact of structural racism on health outcomes. This includes promoting community-led initiatives and participatory research, ensuring the voices of those most affected by inequities are central to policy development. Interventions like expanding health insurance coverage (such as the Affordable Care Act) reflect social justice by removing financial barriers to care and addressing unequal access to services.