By Alexis Etow and Thalia González*
As an interdisciplinary legal scholar and public health attorney studying how education policies fit into the broader antiracist health equity agenda, health justice serves as both a conceptual framework for reform for legal academics and an accessible roadmap for change for policymakers and public health law professionals. Health justice functions to extend what has been previously accepted as within the health domain beyond traditional health care settings, systems, or laws. This broad applicability leaves ripe the opportunity to employ it to a broad range of health-impacting laws, policies, and systems that may not be designed or previously conceptualized as public health.
Consider, for example, school discipline and policing. Researchers and advocates have long-documented the disparate punishment and policing of Black, Indigenous, people of color (BIPOC) students compared to their white peers. For students with disabilities, especially those with intersectional identities, the risk factors and impacts of such policies are amplified. In the case of Black girls with disabilities, data shows that they experience the highest disparity for rates of referrals to law enforcement: six times more than white, non-disabled female students.
During COVID-19 and school closures, the disproportionality of these practices not only persist, but schools now employ new models of exclusion and police practices. This includes students remaining in Zoom waiting rooms during instructional time, resulting in unexcused absences, learning loss, and eventually truancy prosecution.
Despite evidence of the significant co-influential nature of health and education and specific health-harming effects of school discipline and policing — e.g., negative effect on students’ mental health, diminished health protective factors, disrupted educational attainment, threat to safety and wellbeing, and increased risk for justice system involvement — public health has been largely underemphasized in reform efforts and overlooked by the health law community. This is where a health justice approach is critical: it knits together and affirms that health and public health law professionals have key roles to play in education policy, law, and practice. It also places the health-harming effects of school discipline and policing squarely in the domain of public health law and prioritizes legal and policy responses with health equity at the forefront.
Health justice approaches seek to eliminate or reform health-harming laws and policies and advance health-promoting laws and policies, providing a multi-tiered approach to individual and community-wide health. In identifying structural reform pathways, three principles guide health justice responses. First, legal and policy responses must address structural discrimination and subordination — root causes of health inequities. In our work, a key, principal site for health justice-guided reforms is at the state level. For example, addressing state-level discipline laws and regulations that control the forms and uses of exclusionary, punitive, and zero tolerance discipline practices from pre-kindergarten to grade 12 as well as data collection and reporting mechanisms. Expanding the health justice framework to education laws and policies is also key for state and local governments, policymakers, and health organizations that have declared racism a public health crisis and now seek to advance concrete action plans. Under a health justice approach, a starting point is to actively and specifically expose, and then address, how structural discrimination has fueled disparities and deepened the persistence of health inequities. Specific action items and/or remedial steps can then be developed to meet the needs of impacted communities.
Second, health interventions should be holistic and supportive — offering legal protections, financial supports, and material and environmental contexts that facilitate compliance and minimize harms. In education, this translates into scaling up equity-centered and culturally competent practices — including school-based restorative justice practices, social and emotional learning, trauma-informed approaches, and mental health supports and services — that diminish the health risks for BIPOC students and students with disabilities.
And third, frontline communities should be prioritized and engaged as critical partners in the development and implementation of health interventions. This includes leveraging public health methodologies and health law responses to support students’, families’, and community partners’ heightened calls for school discipline and policing reform during periods of virtual learning and as students transition back to in-person learning. It will also require public health professionals to become more deeply integrated with community-driven movements, as collaborative partners that can help elevate the often-overlooked public health implications of discriminatory school policies and practices. Equally important, it will necessitate a shift in power to frontline communities within the growing multisectoral movement to uproot structural discrimination and address health disparities that existed before, during, and beyond COVID-19.
To achieve health justice, dismantle structural discrimination, and disrupt the pathways that lead to health inequities, ending discriminatory school discipline and policing policies is a concrete, and fundamental, next step. Coupled with direct systemic reforms, it is essential that a new generation of health justice advocates are trained to creatively and collaboratively address health disparities across the social determinants of health. As we discuss in our work, Medical Legal Partnerships, while growing across the country, are an underutilized opportunity to leverage legal and health resources to meet the needs of students.
*Authors are listed in alphabetical order to denote equal contributions to the essay. Alexis Etow is a managing director at ChangeLab Solutions. Thalia González is a senior scholar in the Center on Poverty and Inequity at Georgetown Law and professor at Occidental College.
More discussion about this topic can be found in the authors’ forthcoming articles, A Health Justice Response to School Discipline and Policing, 71 Am. U. L. Rev. (Forthcoming); An Antiracist Health Equity Agenda for Education, as part of the Journal of Law, Medicine, & Ethics’ Special Issue on Health Law and Anti-Racism (Spring 2022).