Gavel and stethoscope.

Symposium Conclusion: Health Justice: Engaging Critical Perspectives in Health Law & Policy

By Lindsay F. Wiley and Ruqaiijah Yearby

As our digital symposium on health justice comes to a close, we have much to be thankful for and inspired by. We are honored to provide a platform for contributions from scholars spanning multiple disciplines, perspectives, and aspects of health law and policy. Collectively with these contributors, we aim to define the contours of the health justice movement and debates within it, and to explore how scholars, activists, communities, and public health officials can work together to engage critical perspectives in health law and policy.

As we described in our symposium introduction, the questions we posed to contributors focused their work on four main themes: (1) subordination (including discrimination and poverty) is the root cause of health injustice, (2) subordination shapes health through multiple pathways, (3) health justice engages multiple kinds of experiences and expertise, and (4) health justice requires empowering communities, redressing harm, and reconstructing systems. Most of the contributions to this symposium cut across more than one of these themes, but we present them here in four broad categories.

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Lady Justice blindfolded with scales.

Health Justice Can’t Be Blind

By Daniel E. Dawes

“Justice is blind.” We have all heard this phrase before, and seen the iconic representation: the blindfolded Lady Justice.

That blindfold is supposed to symbolize impartiality. It represents our strict subscription to the notion that impartiality and objectivity are the principles upon which our system is built and by which it is protected. This notion that justice is blind is one rooted in equality.

But justice should not always be blind. Rather than prioritizing equal treatment, sometimes justice demands that we treat individuals differently to ensure equal outcomes. This notion of justice is rooted in the principle of equity.

Put simply, equity takes fairness as its aim. Where equality entails the equal (i.e., impartial) treatment of individuals, equity demands a nuanced approach to ensure equal outcomes.

To achieve justice in the realm of health, our focus must be on equity, and not on blind equality.

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BETHESDA, MD - JUNE 29, 2019: NIH NATIONAL INSTITUTES OF HEALTH sign emblem seal on gateway center entrance building at NIH campus. The NIH is the US's medical research agency.

The NIH Has the Opportunity to Address Research Funding Disparities

By Leah Pierson

The Biden administration plans to greatly increase funding for the National Institutes of Health (NIH) in 2022, presenting the agency with new opportunities to better align research funding with public health needs.

The NIH has long been criticized for disproportionately devoting its research dollars to the study of conditions that affect a small and advantaged portion of the global population.

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A volunteer loads food into the trunk of a vehicle during a drive thru food distribution by the Los Angeles Regional Food Bank at Exposition Park on Saturday, Jan. 23, 2021, in Los Angeles.

How Community Organizations and Health Departments Can Partner to Advance Health Justice

By Sarah de Guia, Rachel A. Davis, and Kiran Savage-Sangwan

Health justice is not just a cause or an idea, but the way forward for public health agencies and communities alike.

Beyond focusing attention on measurable disparities, the term health justice provides a vision for a fair future that minimizes inequities and sends a clear and urgent call to change discriminatory policies, practices, and systems. To achieve this vision, governments and other large institutions must share power with partners of all kinds to change the structural, systemic, and institutional causes of health and wealth disparities. Otherwise, these disparities will continue to keep our communities from achieving their greatest potential to live healthy, prosperous lives.

Our organizations — ChangeLab Solutions, Prevention Institute, and the California Pan-Ethnic Health Network, with support from The California Wellness Foundation and The Blue Shield of California Foundation — came together to help guide California policymakers in centering health justice in their approaches to COVID-19 response and recovery. Our work analyzing community health efforts in California during the COVID-19 pandemic underscores the necessity of collaborative partnerships in advancing health justice. Most importantly, our findings revealed the indispensable role that community-based organizations (CBOs) played in responding to community needs during this time of crisis.

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Washington, DC, USA - July 6, 2020: Protesters rally for housing as a human right at Black Homes Matter rally at Freedom Plaza, organized by Empower DC.

Building Power Across Movements for Health Justice 

By Solange Gould

At its core, public health is the radical concept that everyone has a fundamental right to the conditions required for health and well-being. To realize this vision of health justice, we must forge a strategy that moves beyond the pre-pandemic status quo and the broken systems that got us there.  

It’s time to re-envision and invest in a new public health infrastructure, one that is equipped and authorized to respond to the concurrent global crises we are facing: COVID-19; structural racism; White supremacy; climate change; and the failures of capitalism to provide for the basic human needs that are required for health. This infrastructure must center and build the power of those most impacted by structural inequity in order to truly advance justice. 

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Group of Diverse Kids Playing in a Field Together.

Health Justice is Within Our Reach

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.

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WASHINGTON, DC - OCT. 8, 2019: Rally for LGBTQ rights outside Supreme Court as Justices hear oral arguments in three cases dealing with discrimination in the workplace because of sexual orientation.

LGBTQ Health Equity and Health Justice

By Heather Walter-McCabe

LGBTQ communities experience health inequities compared to heterosexual and cisgender peers. The health justice framework allows advocates to move the work upstream to the root causes of the problems, rather than placing a band-aid on the resultant consequences once the harm is caused.

It is not enough to provide individual treatment for the harm caused by stigma and bias. Health justice is a crucial means of ensuring that health care is equitable and that impacted communities are involved in policy and system advocacy.

The health justice framework, with its emphasis on community involvement in structural and governmental responses to systems-level transformation, must guide work in the area of LGBTQ health equity.

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Empty Classroom In Elementary School With Whiteboard And Desks.

Addressing School Discipline Disparities Through the Health Justice Framework

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.

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U.S. Capitol Building.

Congress Should Act to Fund Medical-Legal Partnerships

By Emily Rock and James Bhandary-Alexander

On August 9, legislators introduced a new bill in Congress that allocates funding to the development of Medical-Legal Partnerships (MLPs), in recognition of the important role MLPs can play in the lives of older Americans.

As attorneys with the Medical-Legal Partnership program at the Solomon Center for Health Law and Policy at Yale Law School, we strongly encourage Congress to act quickly to pass this legislation.

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Brown Gavel With Medical Stethoscope Near Book At Wooden Desk In Courtroom.

Health Justice, Structural Change, and Medical-Legal Partnerships

By Liz Tobin-Tyler and Joel Teitelbaum

To us, health justice means change.

Changes to norms and attitudes, to systems and environments, to law and policy, to resource and opportunity distribution. Not cosmetic or peripheral change, but wide-scale, systemic change. For health justice to be realized — for all people to reach their full health potential — laws and policies must be geared toward restructuring the systems, practices, and norms that have heretofore advantaged some groups over others, and thus given them greater opportunity for good health, economic and social prosperity, and greater longevity.

We recognize that this kind of change is profoundly challenging, both biologically and structurally. Biologically, because humans are programmed to do what’s comfortable, and what’s comfortable is what’s already known. Structurally, because of the nation’s unique political, social, and cultural attributes. Some of these attributes include a strong sense of individualism, and thus an entrenched unwillingness to prioritize community benefit over individual choice; limited governmental power; capitalism; unprecedented wealth with massive inequality; resistance to growing racial and ethnic diversity; over-spending on the downstream consequences of the failure to invest in upstream wellness; and a willingness to enact and maintain policies and practices that privilege some lives over others.

For these reasons, we are not naïve about the prospects for major change in a relatively short period of time, but neither are we cowed by the challenge. We embrace the opportunity to get uncomfortable, to challenge the racist, gender-based, and ableist norms and attitudes in all forms that harm health and well-being, to raise awareness of the inert systems that perpetuate health injustice, and to promote innovative and progressive law and policy change.

One of the ways that we apply our approach to health justice is our work to develop and advance medical-legal partnerships (MLPs), as both an expert consultant (Liz) to and Co-Director (Joel) of the National Center for Medical-Legal Partnership.

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