Los Angeles, California / USA - May 28, 2020: People in Downtown Los Angeles protest the brutal Police killing of George Floyd.

Health Justice: Love, Freedom Dreaming, and Power Building

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.

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Four individuals embracing each other at the waist.

The Communities of Health Justice

By Charlene Galarneau

To the extent that communities are the principal contexts for the social relations and institutions most central to health and health care, then communities should be critical moral actors in determining what constitutes health justice.

I propose that the health justice framework may be fruitfully developed in conversation with community justice, a social justice framework for health and health care that centers communities and their notions of health justice within national standards of justice. As Michael Walzer has observed, “Justice is a human construction, and it is doubtful that it can be made in only one way.”

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Scales of justice and gavel on table.

Symposium Introduction: Health Justice: Engaging Critical Perspectives in Health Law and Policy

By Ruqaiijah Yearby and Lindsay F. Wiley

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.

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Toward an Epidemiological Definition of Community

By Nathaniel Counts

With the coordination and additional funding afforded by the National Prevention, Health Promotion, and Public Health Council and the Prevention and Public Health Fund under the Affordable Care Act, scholars may have a unique opportunity to work toward an epidemiological definition of community.  The evaluation and record-keeping components of the different interventions will inevitably lead to a great deal of additional information about individuals, including their beliefs, behaviors, and health, over time.  If one’s behaviors, and in particular the Leading Health Indicators (ten factors chosen by Health and Human Services that contribute to health, including substance abuse, exercise levels, condom use, etc.) and health status are determined in part by social signaling, it may be possible to use this data to determine which individuals seem to be part of a community.  Various environmental, and possibly even genetic, factors could be controlled for to find groups of individuals whose Leading Health Indicators affect one another’s, and whose health statuses are linked.  This grouping would be a functional “community,” a group of people who influence one another, whether they realize it or not. Currently, the notion of community is usually defined geographically – your community are those that are close to you, unless it is a city, in which case your community are those who are nearby of similar socioeconomic class.  This method would allow for greater precision in determining groups that influence another.

A more precise understanding of community would be useful for assessing the impact of interventions, public health or otherwise.  If you can see the initial community structures at the beginning of an intervention, you could target the individual communities for change and see how their Leading Health Indicators and health statuses evolve.  You could also, and more importantly, see how an intervention changes the make-up of a community.  A new basketball program in a local gymnasium will bring together different arrangements of individuals, who may in turn influence one another, joining them into a community and linking their health statuses.  This could determine choices of programs – a youth basketball league will shape communities differently than a family program or an adult program, and conscious choices could be made about how to bin people based on their current risk behaviors.  This type of information could also provide caution to those planning any sort of intervention – any interaction could reshape communities, subtly changing individual’s values and even their health in ways unbeknownst to them and unintended by the intervener.