Public health scholars, advocates, and officials have long recognized that factors outside an individual’s control act as barriers to individual and community health.
To strive for health equity, in which everyone “has the opportunity to attain . . . full health potential and no one is disadvantaged from achieving this potential because of social position or any other socially defined circumstance,” many have adopted the social determinants of health (SDOH) model, which identifies social and economic factors that shape health. Yet, health equity has remained elusive in the United States, in part because the frameworks that most prominently guide health reform do not adequately address subordination as the root cause of health inequity, focus too much on individuals, and fail to center community voices and perspectives.
The health justice movement seeks to fill these gaps. Based in part on principles from the reproductive justice, environmental justice, food justice, and civil rights movements, the health justice movement rejects the notion that health inequity is an individual phenomenon best explained and addressed by focusing on health-related behaviors and access to health care. Instead it focuses on health inequity as a social phenomenon demanding wide-ranging structural interventions.
This digital symposium, part of the Health Justice: Engaging Critical Perspectives in Health Law & Policy Initiative launched in 2020, seeks to further define the contours of and debates within the health justice movement and explore how scholars, activists, communities, and public health officials can use health justice frameworks to achieve health equity.
We posed four questions to inspire the contributions featured in this blog symposium:
- What does health justice mean to you?
- What role does it play in your work?
- How does health justice relate to other frameworks for advocacy, teaching, research, and scholarship?
- How should the community be involved in efforts to realize health justice?
The responses to these questions revealed four main themes that are key tenets for the movement.
First, though the contributors to this symposium each develop distinct meanings for health justice, a common thread emerged: how health justice primes us to interrogate laws, polices, and practices that reinforce subordination, including those rooted in blaming individuals for their own poor health.
Subordination is “a set of policies, practices, traditions, norms, definitions, cultural stories, and explanations that function to systematically hold down one social group to the benefit of another social group.” Examples of subordination are structural poverty and discrimination based on race, ethnicity, gender identity, sexual orientation, disability status, immigration status, and age.
Law is a tool of subordination. This is illustrated by laws enacted before and during COVID that explicitly or implicitly excluded undocumented immigrants, people who identify as LBGTQ, and disabled people. It is also evident in profit-motivated economic activity in the U.S. and globally that devalues the contributions, health, and well-being of many low-wage workers, who are disproportionately women and people of color — making it virtually impossible for them to escape poverty or protect their health and the health of their families and communities.
Second, the scope of this symposium — and the broader initiative of which it is a part — emphasizes that health justice is not limited to the law of health care financing and delivery. Our health and well-being is not determined exclusively or even primarily by access to health care services. Health inequity is tied to living and working conditions, the built environment, the food system, emergency preparedness and response, the educational system (including school discipline), medical technology, and the political system. The criminal justice system is a particularly significant factor in health inequities because it is not only the largest institutional provider of mental health services in the nation, but also it is a significant source of injury, trauma, and death for communities of color.
Third, this symposium highlights how research, training, and collaboration across multiple disciplines, sectors, and frameworks are critical to inform and realize health justice. To foster a more equitable future, we can train future lawyers to enforce existing laws and remove legal barriers that operate upstream of poor health outcomes and disparities, to identify opportunities to change law and policy to advance structural reform, and to work with community members so that they are armed with the knowledge and tools to assert and protect their rights.
Moreover, law can be used to create a responsive state that addresses health-harming social needs through civil law remedies. Yet, law is not the only tool. The tenets of health justice must also guide the design of research studies in the health and social sciences and the educational foundations and training for those who will be delivering health care services and serving as public health leaders.
Fourth, the emphasis on communities and their histories in this symposium highlights how health injustice harms us all and how healing requires truth and reconciliation.
Black feminists teach us that community rises and falls together, and so justice has to account for the whole. Health justice must include community engagement, empowerment, and respect for community meanings and values concerning health and well-being.
Further, health justice requires redressing harm not only through remuneration and forward-looking reforms, but also through healing and a truth and reconciliation process. To transform our systems in a way that goes beyond our current patchwork approach, we must collectively grapple with the historical injustices in which our current systems are rooted. Haphazard, incremental tinkering may be sufficient to quiet some critics, but inadequate to reckon with the historically and legally entrenched realties of subordination.
We must infuse health justice with love, freedom, grace, and power building. Health scholars, advocates, and officials must partner with communities and community organizations to achieve health equity in a way that disrupts subordination, equips the next generation of leaders to work across disciplines and sectors, builds community power, and fosters social healing and solidarity.
Ruqaiijah Yearby, J.D., M.P.H. is Co-Founder and Executive Director, Institute for Healing Justice and Equity, Saint Louis University and Professor of Law and Member of the Center for Health Law Studies, Saint Louis University, School of Law.
Lindsay F. Wiley is a Professor of Law and the Director of the Health Law and Policy Program at American University Washington College of Law.