Injustice is an Underlying Condition
University of Pennsylvania Journal of Law & Public Affairs, Vol. 6, Issue 2, Pp. 201-266.
67 Pages Posted: 1 Feb 2021
Date Written: December 1, 2020
Race, poverty, and zip code serve as critical determinants of a person's health. Research showed the links between these factors and poor health and mortality before COVID-19, and they have only been amplified during this pandemic.
People of color experience higher rates of asthma, heart disease, diabetes, and other chronic conditions. People of color who live in poverty are even more likely to suffer from poor health; they face a “double burden” of health disparities associated with both racial and socioeconomic marginalization. Neighborhoods with concentrated poverty and with residents who are primarily people of color have even faced a life expectancy decades shorter than higher income, predominantly white neighborhoods. Now, a virus that does not itself discriminate is disproportionately infecting and killing people of color across the nation. Biology cannot explain either the longstanding disparities that COVID has spotlighted or the new disparities that have been framed as the “color of COVID.” The common underlying condition? Injustice.
The U.S. Centers for Disease Control and Prevention (“CDC”) and other health experts across the world recognize the powerful role that social determinants play in health. Social and economic conditions such as unemployment, housing instability, food insecurity, and unequal access to quality education, drive as much as 80% of a person's health. These social determinants, and the racist legal structures that have furthered them, are at the root of the health disparities illuminated by COVID.
A growing body of “health justice” scholarship explores the role of law and policy in eliminating unjust disparities. A health justice approach requires as a fundamental first step a structural understanding of health disparities and the ways that social determinants of health drive those inequities. This article examines two major social determinants of health that drove disparities pre-COVID and are exacerbating them now: food insecurity and housing instability. With the pandemic and resulting recession, hunger is growing rapidly in the U.S., with dangerous impacts on health, especially for children. As unemployment escalates, millions of Americans find themselves unable to pay rent and on the brink of eviction and homelessness, both of which are associated with poor health outcomes. Low-income Americans are confined to homes with substandard conditions like mold and rodents that drive asthma and other respiratory diseases, at a time when those illnesses can make people more susceptible to complications from COVID.
Health justice scholars have called for major law and policy reforms to address disparities in these areas. However, existing legal rights in the areas of public benefits and housing law are under-enforced, with deleterious health effects. While we work towards a health justice revolution, this article argues for the full enforcement of laws already on the books to attack injustice and advance health. During the COVID recovery and beyond, justice is a requisite for a healthier nation.
Keywords: health law and policy, health justice, health and econony, poverty
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