Social justice & health

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Why should I care?

Social justice is the view that everyone deserves equal rights and opportunities —this includes the right to good health. Yet today, there are inequities in health that are avoidable, unnecessary and unjust.1 2 These inequities are the result of policies and practices that create an unequal distribution of money, power and resources among communities based on race, class, gender, place and other factors. To assure that everyone has the opportunity to attain their highest level of health, we must address the social determinants of health AND equity.

Racism and other forms of structured inequity sap our potential to become the healthiest nation.  Racism is a system of structuring opportunity and assigning value to individuals and communities based on race that unfairly disadvantages some individuals and unfairly advantages others.3 4   Racism and other “isms” are forces that determine the distribution of the social determinants of health, including:  

Health care: More than 30 percent of direct medical costs faced by blacks, Hispanics and Asian-Americans can be tied to health inequities. Because of inequitable access to care and other health-promoting resources, these populations are often sicker when they do find a source of care and incur higher medical costs. That 30 percent translates to more than $230 billion over a four-year period.5 In addition, studies have shown that clinicians tend to have more negative attitudes toward people of color,6 and unconscious racial bias among clinicians has been shown to lead to poorer communication and lower quality of care.7

Criminal justice – Thirty years of “tough on crime” and “war on drugs” public policies8 have resulted in mass incarceration of primarily black and Hispanic males. This discrimination and inequity undermines the social and community fabric that is so vital to public health, narrowing opportunity, disrupting families and social cohesion, and preventing civic participation.

Voting rights. In recent years, there has been a resurgence of activities that make it harder for people to exercise their right to vote, especially in communities of color. Since 2010, about half of the states have passed new laws making it more difficult for voters to access the ballot box.9

What can I do? 

Name and address racism. Acknowledge racism as a system of structured inequity and not an individual character flaw. Name racism as a determining force in the distribution of the social determinants of health and equity. Identify the structures, policies, practices, norms and values in which racism may be operating. 

Start a conversation about health equity within your agency or organization. Health equity is more than one intervention; it’s a lens through which all of your work should be viewed. Foster an open and honest dialogue within your agency (and ideally with your community partners) about historical injustices and present-day racism, bias and inequity and how they contribute to disparate health outcomes.  Use tools such as the documentary “Unnatural Causes: Is Inequality Making Us Sick?” to jumpstart the conversation. 

Promote a health-in-all-policies approach and ensure an equity lens. Seek partnerships across sectors such as transportation, housing, education and law enforcement. Work with these partners to ensure that health and equity are embedded in their decision-making process. All of these sectors and many more have a role in creating the conditions that enable all people and communities to attain and sustain good health.

Demand the fair allocation of community resources. Creating health equity requires targeted investment in marginalized and under-resourced communities. Ensure representation of these groups in decision-making processes. 

Fight against the trend of growing voter restrictions. Everyone needs a voice in improving our communities, and such community participation is intrinsic to achieving health equity. Educate community members about the importance of civic engagement and encourage their participation in grassroots advocacy efforts. 

1 Source

2 Whitehead M. The concepts and principles of equity and health. Int J Health Serv 1992;22:429-45.

3 Jones CP. Confronting Institutionalized Racism. Phylon 2003;50(1-2):7-22.

4 Jones CP, Truman BI, Elam-Evans LD, Jones CA, Jones CY, Jiles R, Rumisha SF, Perry GS. Using “socially assigned race” to probe White advantages in health status. Ethn Dis 2008;18(4):496-504.

5 Source

6 Hall WJ Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. American Journal of Public Health: December 2015, Vol. 105, No. 12, pp. e60-e76.

7 Cooper LA, Roter DL, Carson KA,et al. The associations of clinicians’ implicit attitudes about race with medical visit communication and patient ratings of interpersonal care. Am J Public Health. 2012;102(5):979---987.

8 Dumont DM, Brockmann B, Dickman S, Alexander N, Rich JD. Public health and the epidemic of incarceration. Annu Rev Public Health. 2012;33:325–339.

9 Perez, M. (2016). Election Integrity: A Pro-Voter Agenda, Retrieved from Brennan Center for Justice: