Health Justice: A Framework (and Call to Action) for the Elimination of Health Inequity and Social Injustice

Abstract

Every aspect of society is dependent upon the health of its members. Health is essential to an individual’s well-being, quality of life, and ability to participate in society. Yet the healthcare industry, even at its optimal level of functioning, cannot improve the health of the population without addressing the underlying causes of poor health. The health of approximately 46.7 million individuals, most of whom are low-income and minority, is threatened by economic, societal, cultural, environmental, and social conditions. Poor health in any population group affects everyone, leading to higher crime rates, economic impacts, decreased residential home values, increased healthcare costs, and other devastating consequences. Despite this fact, efforts to improve health among low-income and minority communities are impeded by inequitable social structures, stereotypes, legal systems, and regulatory schemes that are not designed to take into account the social determinants of health in decision-making models and legal interpretation. As a result, a large segment of the population is continually denied the opportunity to live long, productive lives and to exercise their rights under democratic principles. Health, equity, and justice make up the keystone to a functional, thriving society. Yet these principles are unsatisfied when they do not apply equally to all members of society. In this article, I describe the social roots of poor health and how social injustice, health inequity, and poverty are inextricably linked. For example, I provide an in depth overview of the social determinants of health, including poverty, institutional discrimination and segregation, implicit bias, residential environmental hazards (leading to diseases like lead poisoning and asthma), adverse childhood experiences, and food insecurity. I discuss how the law is a determinant of health due to 1) court systems that do not evaluate individual circumstances, 2) the enactment of laws that perpetuate poor health and 3) the lack of primary prevention laws. Finally, I demonstrate how addressing these issues requires true adherence to principles of equality and making justice and freedom of opportunity accessible to everyone. I recommend the creation of “health justice,” a new jurisprudential and legislative framework for the achievement and delivery of health equity and social justice.

Keywords: health, justice, inequity, health disparity, equity, injustice, poverty, social justice, social determinants of health, discrimination, segregation, implicit bias, environmental, lead poisoning, asthma, adverse childhood experiences, food insecurity, eviction, abuse neglect