By Jamila Michener
“Justice is what love looks like in public.”
— Cornel West
Simple yet resonant, Cornel West’s rendering of justice draws on an emotion that most people understand on a deep personal level: love. Viewing health justice through the lens of love concretizes it when I am otherwise tempted to treat it as an abstract notion. Love is familiar, intuitive, and tangible. Conceptualizing health justice as a public enactment of love directs my thoughts to the people I cherish most dearly, bringing the reality of the concept into sharp relief.
What do I want for the people I love? Of course, I want them to have access to high-quality health care: primary care doctors, acute care physicians, specialists, nurses, therapists, local hospitals where they will be treated with dignity and much more.
Over and above these features of health care systems, I want the people I love to have the building blocks necessary for healthy living: safe and comfortable housing, nutritious food, supportive social relationships, jobs that offer a living wage, education, freedom from poverty, violence, and exploitation.
Going even further, I want the people I love to have the agency to shape their own lives and the capacity to chart paths in the communities they inhabit. In short, I want them to have power. Power facilitates all the things listed above (i.e., the social determinants of health) on a durable, equitable, and sustainable basis.
When infused with an ethic of love, health justice is both destination and pathway, end and means, outcome and process. As a destination, health justice reflects a vision for what every person should have, irrespective of their economic or social status: every person should be treated as someone who is deeply loved, whose life is valued, and whose maximally healthy presence in the world is invaluable.
This may sound like a highfalutin, pollyannish dream. But, as Robin D.G. Kelley has noted, “the map to a new world is in the imagination, in what we see in our third eyes rather than in the desolation that surrounds us.” Kelley calls this freedom dreaming. Freedom dreams look beyond what is present in the world or what seems feasible. They turn us towards a new world that is “free of toxins and environmental hazards, free of poverty, racism, and sexism…just free.” Envisioning health justice is freedom dreaming: it is embracing the radical dream of a future where everyone is free to be healthy. This means freedom from all forms of oppression and domination, most notably those related to categories of difference like race, class, and gender.
Moving from dream to reality means approaching health justice not only as an outcome we would like to achieve, but as a process we must advance. A process-oriented view of health justice sensitizes us to power. How can we attain the radical ends implied by the goal of health justice? Only by altering the power dynamics that undergird the current system.
The path towards a world where everyone can have the resources, support, and access needed for the healthiest life possible is not inevitable. We are not naturally or progressively headed there. Health justice as envisioned here threatens the profits, position, and power of those who benefit from the status quo — so it cannot be realized without struggle. Achieving health justice will require hard-fought political change on the local, state, national, and global levels. The most viable (even if most difficult) way forward demands building power: cultivating the political capacity of people within the racially- and economically-marginalized communities most harmed by prevailing conditions. Power building — through community organizing, forming multi-racial and cross-class coalitions, mobilizing grassroots social movements, and more, positions otherwise vulnerable and excluded communities to substantively influence the policies, practices, and institutions that shape their lives.
To understand the dynamics of cultivating power from the margins, my own scholarly work examines the relationships between poverty, race/ism, and public policy. This includes research examining how Medicaid affects democratic participation, the political implications of the Affordable Care Act, the political consequences of Medicaid program cuts, inequalities in access to the ballot, the politics of equitable legal representation in housing courts, and more. The common thread connecting all this work is an attentiveness to people living at various intersections of systemic disadvantage (race, class, gender) and the ways policies either amplify or stultify their political voice, thereby constraining or enabling their power.
If “justice is what love looks like in public,” then public policy is one conduit through which justice should advance. Pursuing the politics and policies necessary to build power among marginalized groups will move us towards the radical dream of health justice. My main purpose here is to emphasize the imperative role of power in that pursuit. Not power for its own sake, but power mobilized to enact the vision of health justice laid out here: a future where everyone has the freedom to be healthy. Freedom from the many structural harms that threaten health, and freedom to access the resources and opportunities that promote it. These are the freedoms that we want for the people we love most deeply. Justice demands that everyone have them.
Jamila Michener is an associate professor in the department of government at Cornell University and co-director of the Cornell Center for Health Equity.