Envelope from U.S. Citizenship and Immigration Services with the American flag on top/U.S. immigration concept.

Health Justice for Immigrants, Revisited

By Medha D. Makhlouf

A major contribution of health justice is that it provides a framework for understanding how universal access to health care protects collective, as well as individual, interests. The pandemic has underscored the collective nature of the health and wellbeing of every person living in the United States, regardless of immigration status.

In a 2019 article, Health Justice for Immigrants, I adopted and adapted the health justice framework to the problem of disparities in immigrant access to subsidized health coverage. I argued that, in future health care reforms, health justice requires that immigrants be included in the “universe” of universal access to health care. In this blog post, I revisit this argument in light of the COVID-19 pandemic.

This blog post applies the health justice lens to inequities in immigrant health and access to health care, drawing out lessons for the pandemic and post-pandemic eras. It describes three examples illustrating the utility of health justice for catalyzing cross-sector initiatives to improve health, reducing the role of bias in the design of interventions to address health disparities, and ensuring that such efforts are serving the needs of historically subordinated communities.

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elderly person's hand clasped in young person's hands

Vulnerability Theory and Health Justice

By Matthew B. Lawrence

If we want to understand how changes to the law might affect health outcomes, we must remain mindful that the law not only regulates how we behave in the world as it is, but also shapes the institutions and structures that make the world the way it is.

The dominant theoretical frameworks of classical liberalism and behavioral economics obscure this critical relationship.

In this blog post, I suggest that health justice and vulnerability theory fill this theoretical gap, and serve as invaluable, and largely complementary, frameworks for understanding health law and policy.

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Bracket fungi, or shelf fungi produce shelf- or bracket-shaped or occasionally circular fruiting bodies called conks. They are mainly found on trees.

Whack-a-Mole, Fungi, and Intersectionality, or What I’ve Learned from Health Justice

By Mary Crossley

Nearly three decades ago, I published my first law review article considering the law’s ability to address unequal treatment in a health care setting. The newly minted Americans with Disabilities Act was the law, and physicians’ reluctance to provide treatment to infants believed to be infected with HIV was the inequality. Eventually I expanded my horizon beyond disability law to consider potential legal remedies for physician bias across a range of patient traits. As I did so, I described the thread tying together my scholarly projects as “how the law responds (or fails to respond) to instances of health care inequality.”

The key word in that description was “instances.” It suggested that health inequality presents discrete problems for the law to address. Given those problems’ ubiquity, however, policy makers, regulators, and advocates deploying law against health inequities found themselves in a game of Whack-a-Mole. Whack one mole, and another one pops its head up. Address one instance of health injustice, and another pops up. The problem is that, no matter how quick our reaction times are, health inequality surrounds us, firmly embedded in American society. We need to look deeper to find its roots.

Over the last decade, the development of health justice frameworks, along with increasing public and legal attention to social determinants of health, have changed how I frame my scholarship, in several ways.

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A range of contraceptive methods: DMPA, vaginal ring, IUD, emergency contraceptive, contraceptive pills.

Connecting the Dots: Reproductive Justice + Research Justice = Health Justice

By Monica R. McLemore

I believe that together, reproductive justice and research justice should result in health justice.

I am choosing to focus on research because it is the evidence base that is foundational to clinical care provision and because teaching is generated by research.

Thus, research serves as one root cause of harm associated with clinical care and teaching, and a potential barrier to realizing health justice, which has been outlined as a comprehensive approach to resolve the social determinants of health and develop jurisprudence toward health equity. Research justice is critical to the conceptualization, development and implementation of these measures.

However, the law cannot establish health justice without reproductive justice, at least not for pregnant-capable people. Reproductive health, rights, and justice have been the proverbial canaries in the coal mine when considering the loss of bodily autonomy and human rights.

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police cars lined up.

Health Justice and the Criminal Legal System: From Reform to Transformation

By Aysha Pamukcu and Angela P. Harris

Using health justice to reframe and reshape the criminal legal system

The demand to “defund the police,” circulated by the Movement for Black Lives and allies after the brutal 2020 murder of George Floyd, was a departure from the usual discourse of police reform. The demand garnered backlash as being both politically unrealistic and potentially dangerous. But in our view, it demonstrates the transformative potential of social movements focused on justice for marginalized communities. As these justice movements build and strengthen partnerships with public health and civil rights advocates, we see the potential of using the health justice framework to reimagine the future of the criminal legal system.

Calls to deploy the American criminal legal system to enforce national health anxieties are not new, but they too often have produced unjust outcomes, such as adopting criminal punishments for people who are HIV-positive or who are dependent on drugs and pregnant.

In contrast, the health justice framework centers the leadership of social movements for justice and inclusion. Such movements have the capacity to rapidly shift the terms of public debate, making previously unimaginable policy initiatives first discussable, and then doable. And centered in values of anti-subordination, justice movements can challenge biases within elite, highly professionalized disciplines like law and public health.

Policy innovations that emerge from this triple alliance of law, public health, and social movements stand a better chance of improving the lives of marginalized communities than those that treat these communities as targets of discipline or charity. The call to defund the police demonstrates some of these possibilities.

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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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Close-up Of Stethoscope On Us Currency And American Flag.

America’s Underinsurance Crisis in the Age of COVID-19

By Dessie Otachliska

The COVID-19 pandemic has shone a light on the underinsurance crisis that has long kept millions of Americans on the precipice of financial disaster — just one unexpected illness or injury away from bankruptcy.

A 2019 Gallup poll showed that 25% of Americans reported delaying treatment for serious medical conditions due to cost concerns — the highest proportion since Gallup first began asking the question in 1991. Even during the pandemic, when medical treatment could mean the difference between life and death, studies show that nearly 1 in 7 Americans would avoid seeking medical care if they experienced key COVID-19 symptoms because of fears associated with the cost of treatment.

These statistics are unsurprising, and the concerns they underscore well-founded: the average treatment costs for COVID patients with symptoms serious enough to require inpatient hospital stays range from $42,486 for relatively mild cases to $74,310 for patients with major complications or comorbidities.

In the pandemic context, hesitance to seek medical treatment due to fear of the associated cost has proved tragically fatal. Darius Settles died after being dissuaded from seeking further COVID-19 treatment due to his uninsured status. The Nashville, TN hospital where Settles originally received care had failed to disclose the possibility that his medical costs would be covered by the federal government. And, despite the availability of reimbursement funds, the hospital nonetheless sent his widow a bill for a portion of his treatment costs.

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New Market, Esplanade, Kolkata, 05-23-2021: Due to lockdown, closed market and roadside hawker stalls at S. S. Hogg Market, which usually is heavily crowded as a popular shopping arena.

A Critical Analysis of the Eurocentric Response to COVID-19: Global Classism

By Hayley Evans

The international response to COVID-19 has paid insufficient attention to the realities in the Global South, making the response Eurocentric in several ways.

The first post in this series scrutinized the technification of the international response to COVID-19. The second post looked at how the international pandemic response reflects primarily Western ideas of health, which in turn exacerbates negative health outcomes in the Global South.

This third and final installment analyzes the classist approach to the pandemic response. The international response has paid insufficient attention to the existence of the informal economy and of the needs of those who must work to eat — both of which are found more commonly in the Global South.

This series draws on primary research conducted remotely with diverse actors on the ground in Colombia, Nigeria, and the United Kingdom, as well as secondary research gathered through periodicals, webinars, an online course in contact tracing, and membership in the Ecological Rights Working Group of the Global Pandemic Network. I have written about previous findings from this work here.

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