By Dayna Bowen Matthew
Health justice is the outcome when law protects against the unequal distribution of the basic needs that all humanity requires to be healthy. Angela Harris and Aysha Pamukcu define health justice in terms of ending the subordination and discrimination that produce health disparities.
I first saw and experienced the need for the work to achieve health justice as a child. I grew up in the South Bronx, insulated from the absence of health justice until the fourth grade, when I began attending private school. Before then, I had no idea that the racially, ethnically, and economically segregated society in which I lived, played, and attended school and church was any different than the society that existed unbeknownst to me outside of my zip code.
I crossed interstate highway exchanges daily as I walked to P.S. 93, oblivious to the fact that other kids did not breathe the exhaust fumes and toxins from nearby waste transfer stations that tainted the air where my mostly Black, Dominican, and Puerto Rican neighbors lived. I had no idea that clean, breathable air was inequitably distributed in this country by race.
It was not until I left the South Bronx to attend school in Riverdale that I realized other families had an array of housing options to choose from that were different than mine. In fourth grade, when my family began voluntarily bussing me to private school, I learned that the housing available to families extended beyond the racially segregated shotgun row house I lived in, the stinky, dimly lit apartment buildings on my corner or “the projects” where my grandparents lived in Harlem. Who knew there were sprawling homes atop manicured lawns and opulent apartments overlooking Central Park available throughout other parts of the city? Who knew that even modestly priced apartments could be located near green spaces, well-stocked grocery markets, and schools that prepared kids well for college? Not me. I had no idea until I began to see that decent, clean, affordable housing, and resource-rich neighborhoods are inequitably distributed by race and ethnicity in America.
Perhaps most shocking, I had no idea that all fathers who sent their children to summer camp did not have to work three or four jobs to afford to do so. And I did not know that all mothers who aspired to an education beyond high school did not have to go at night after working a full day. I did not know that education — and thus employment, income, and wealth — were distributed in this country by race and ethnicity. I experienced the association between injustice and health firsthand, however, when my father died at age 49 and my mother passed at age 61. Both died from preventable, stress-related diseases. As a result, I have turned my longing to visit or vacation with my parents into the energy with which I work to increase health justice in the United States of America and in the world.
I define justice as fairness administered by law. I define health justice as the result of fair laws that protect all humans’ opportunity to receive what they deserve, by virtue of their humanity. In America, this must mean that we live up to our declaration that all are created equal by their Creator, and entitled to enjoy equal opportunity for healthy housing, food security, clean environments, good education, and safe neighborhoods by law.
To be clear, I ascribe to the Rawlsian ideal of justice — the notion that all members of the human race deserve and are entitled to an equal opportunity to live healthy lives, and that our society is just to the extent that we minimize the differences among those who are most and least advantaged among us. In my view, all humans, because they are human, deserve a chance to live healthy lives. All humans are equally human, and therefore deserve this chance equally. This egalitarian view of justice is within our reach.
To achieve health justice, America must enforce its self-proclaimed commitment to equality. Health justice requires laws that both equally distribute the resources humanity needs to be healthy, and protect against inequities that unfairly disadvantage some humans while advantaging others.
We must enact food recovery legislation to close the gap between the 10.9% of Americans who are food insecure and the 22 to 33 billion pounds of food waste that restaurants generate each year. We must enforce the Clean Water and Safe Drinking Water Acts to equalize access to clean drinking water and sanitation. We must restore private citizens’ power to sue under Title VI of the Civil Rights Act of 1964 to equalize access to clean breathable air. We must prohibit discrimination in housing using the Fair Housing Act, zoning, and Tenant Opportunity to Purchase laws to combat resegregation. We must aggressively reverse gentrification by freezing property taxes and mandating affordable rents for long-term residents. We must build affordable housing. We must compel state lawmakers to equalize funding for education so that majority white school districts no longer receive $23 billion more than majority Black and Latinx school districts. And localities must enact legislation such as the “Reverse Mass Incarceration Act” to reform sentencing, policing, and bail practices that disproportionately disrupt the social fabric of Black and Latinx communities in America.
My point is that laws are an effective tool to guarantee that the kids in my South Bronx neighborhood have an equal opportunity to grow up as healthy as the kids in Riverdale, where I attended private school. All we now need is the courage to do so.
Dayna Bowen Matthew is the Dean and Harold H. Green Professor of Law at the George Washington University Law School.