U.S. Supreme Court

There’s No Justice Without Health Justice

By Yolonda Wilson

Last month the U.S. Supreme Court struck down the eviction moratorium issued by the Centers for Disease Control (CDC). The Court reasoned that, among other things, the eviction moratorium was an overreach by the CDC. That is, even in light of a global pandemic where being unhoused increases one’s risk of acute COVID-19 infection and subsequent serious illness, the Court rejected the CDC’s argument for the connection between housing justice and health justice. The Court raised several telling rhetorical questions in their decision that were intended to show the potentially troubling slippery slope that would commence if the moratorium were allowed to stand:

Could the CDC, for example, mandate free grocery delivery to the homes of the sick or vulnerable? Require manufacturers to provide free computers to enable people to work from home? Order telecommunications companies to provide free high-speed Internet service to facilitate remote work?

Whereas the Court viewed the eviction moratorium as an overreach that would lead to unthinkably absurd consequences for other sectors of social and economic life, a Black feminist conception of justice, as expressed, for example, in the historic statement of the Combahee River Collective, is necessarily grounded in a sense of the importance of community, rather than as a mere collection of individuals who may have little to no connection with or obligations to one another. Though the Court prioritized the interests of landlords and real estate agents, a Black feminist conception of justice foregrounds the needs of the overall community, such that if the well-being of the community depended on free grocery delivery to the sick and vulnerable, then so be it. The community rises and falls together, and so justice must account for the whole, not merely the well-heeled. Implicit in this conception of justice is an understanding that the community can only thrive, can only aspire to a Black feminist conception of justice, to the degree that the community is well or ill.

Well-being and ill-being can be measured in many ways, but health is a fundamental part of the picture and is inextricably intertwined with justice. As a philosopher whose area of specialization is political philosophy, I think about the nature and limits of the state. The endeavor of justice, broadly construed, and health justice in particular, is normative. It lays out obligations to the state and those who comprise it.

Indeed, arguably the single most influential work of political philosophy in the past fifty years (in the Anglophone philosophical tradition, at least) is John Rawls’s A Theory of Justice. So, the idea of justice and what it requires undergirds the contemporary canon in Western political philosophy. At the same time, questions about political obligation, rights and duties of citizens and denizens, and political legitimacy have historically taken as their theoretical starting point an abstract, unencumbered being whose only ties to others are freely chosen — and just as freely severed. This unencumbered being is responsible to and for no one else. Nor does the unencumbered being have obligations to and for others that cannot easily be shed.

However, the Black feminist intellectual tradition that also informs my work and my understanding of theories of justice and the state makes it clear that the experience of Black womanhood in the U.S. has never been one of unencumbrance. Indeed, the questions of justice that have guided and continue to guide Black feminist political thought are certainly questions of rights and duties. For instance, to return to the Combahee River Collective, the authors argue for an explicit “liberation of all oppressed people.” As such, there can be no presumption of an abstract being whose only connections to others are freely chosen and easily severed. Viewing health justice through a Black feminist lens expands the domain of health justice to concerns about the environment, workers’ rights, and support for care work (for both children and adults), and also combatting structural racism, sexism, and ableism.

The current pandemic has shown the disproportionate impact of COVID-19’s devastation on communities of color in the U.S. and globally. As I have written elsewhere, this revelation was not a surprising one to those who understand the structural reality of race and gender injustice. The realities of a greater likelihood of living in close quarters, of having jobs in service industries that do not allow for remote work and places workers in contact with many people (including people who feel entitled to only think of their own individual comfort and convenience), and limited access to health care when ill, created conditions where communities of color fell ill and died at disproportionate rates. This was no accident. Rather, these disproportionate effects were a reflection of centuries of housing, employment, and health injustice through willful public policy and intransigent social custom. Further, the notion of what constitutes the denizens’ obligations to the state and to one another to mitigate the pandemic’s harm relies on the idea of an abstract being who is only “personally responsible” — with obligations only to himself (yes, “him-”) and the bonds with others that he has explicitly chosen.

The oft-expressed attitude early in the current pandemic that “only” the aged or “only” those with preexisting health conditions were dying from COVID-19 reflects the primacy of this abstract individual with no ties or obligations to others. In other words, not only is it the case that those who do not fit into either (or both) of these categories have nothing (or at least very little) to worry about when it comes to risk of disease, but also the implicit assumption is that those who are neither aged nor ill have no obligations to restrict their own behavior in order to keep others safe.  A necessary feature of a Black feminist health justice — one that begins with community — would have prioritized the most vulnerable among us, rather than taking the position that “only” the aged or “only” those with preexisting conditions were getting sick, as though some populations of human beings are disposable. A pandemic response guided by a Black feminist bioethic would have understood that the very idea of “personal responsibility” is inextricably bound up in racism, sexism, classism, and ableism, and is therefore an improper guide for community well-being, for health justice. The idea of easing restrictions on gatherings, travel, or wearing masks would be unthinkable under such conditions.

This is why there can be no justice without health justice. Access to care, quality of care, being taken seriously when one seeks care, how accessible the broader world is that one moves through, valuing care work — these are all elements that comprise health justice. And these are all matters of Black feminist concern. Additionally, Black feminists have intimately understood that safe, stable housing, environmental justice and disaster planning, and fair employment opportunities are also matters of health and health justice. The Black feminist lens has shown the interconnectedness of all of these issues on the well- or ill-being of community. This Black feminist framework undergirds my own work. My understanding of health justice takes seriously as a starting point the reality that humans are not unencumbered selves. Rather, we exist in complex social arrangements that are sometimes hierarchical, sometimes overlapping and intersecting, and yes, even sometimes freely chosen and severable. This starting point allows for different possibilities for health justice, possibilities that reflect human interconnectedness. More importantly, my own understanding of health justice is also both backward-looking and forward-looking. It is backward-looking because my work relies on the importance of rectifying historical injustice as part and parcel of any conception of justice, and it is forward-looking because I emphasize the importance of addressing continuing injustice in order to envision the world as it could and should be. This is health justice.

Yolonda Wilson is an associate professor in the departments of Health Care Ethics, Philosophy, and African American Studies at St. Louis University in Missouri.

The Petrie-Flom Center Staff

The Petrie-Flom Center staff often posts updates, announcements, and guests posts on behalf of others.

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