Health Justice & the Drivers of Inequity

Two complementary frameworks for improving community health

At a Glance

  • The health justice framework is an approach to eliminating health disparities based on law and policy reforms that center subordination as a key driver of disparities.
  • Centering subordination as a driver of structural inequities helps raise awareness of how our institutions and systems are rooted in racism, social control, bias, and privilege, resulting in poor health outcomes.
  • The health justice framework aligns with ChangeLab Solutions’ primary principles for addressing inequity through changes in systems, laws, and policies.

Health Justice & the Fundamental Drivers of Health Inequity

Inequities in our society’s systems and structures lead directly to unjust disparities in health outcomes among different population groups. To elevate awareness of the underlying causes of health inequities, in 2019, ChangeLab Solutions released A Blueprint for Changemakers — a guide to help changemakers advance law and policy changes that improve health for all.

Specifically, the Blueprint emphasizes the role of fundamental drivers of health inequity in creating, replicating, and reinforcing discrimination in our systems, institutions, policies, and practices, which over time becomes further embedded and harder to detect and undo. Due to the structural nature of these inequities, identifying and dismantling existing discriminatory laws and policies are the most powerful way to undo historic harm and improve health and equity across the nation. The Blueprint outlines ways to leverage the efficacy of local policy innovations, center communities in policymaking, and advance legally viable and practical solutions.

To further explore ways to make structural change concrete and effective, ChangeLab staff members have partnered with public health practitioners, academics, and legal scholars to explore the intersections between the health justice framework, a burgeoning approach to reducing societal inequities, and the approaches outlined in A Blueprint for Changemakers. The health justice framework is an approach to eliminating health disparities based on law and policy reforms that center subordination as a key driver of disparities. The health justice framework’s emphasis on subordination closely aligns with the Blueprint's five fundamental drivers of health inequity: structural discrimination, income inequality and poverty, disparities in opportunity, disparities in political power, and governance that limits meaningful participation.

Health Justice Broadens Traditional Legal Concepts of Discrimination

Centering subordination as a driver of structural inequities highlights how our systems and institutions are rooted in racism, social control, bias, and privilege, resulting in poor health outcomes. The health justice framework is unique and radical in how it both broadens and complicates traditional legal concepts of discrimination and common domains of health care and public health.

Using a health justice framework allows an examination of discrimination in relation to the social determinants of health by grounding modern-day health disparities in historical and contemporary subordination of groups, communities, and individuals based on characteristics such as race, gender, sexual orientation, immigration status, disability status, age, and others. This grounding helps to identify the public health and health law problems to be addressed and the “structural, supportive, and empowering” legal and policy interventions that practitioners and communities can advance so that everyone can attain their full potential, free of disadvantage due to their social circumstance.

Three Tenets of Health Justice & ChangeLab’s Equity Approaches

Three tenets of the health justice approach assert that . . .

  1. Legal and policy responses must address the social and political mechanisms that generate, configure, and maintain social hierarchies;
  2. Health interventions should be holistic and supportive — offering legal protections, providing financial supports, and fostering material and environmental contexts that facilitate compliance and minimize harms; and
  3. Frontline communities must be prioritized as critical partners in the development and implementation of health interventions.

These tenets of health justice complement and expand on the equity-informed approaches in ChangeLab’s Blueprint for Changemakers. The three tenets of health justice are aligned with application of the Blueprint’s fundamental drivers of health inequity framework through their mutual emphasis on (1) advancing systems change, (2) using legal pillars, and (3) engaging community members.

First, health justice focuses on subordination — the act of placing or treating a person or group of people as if they are in a lesser position, status, or class than another — as a central factor of systemic discrimination. As such, health justice advances the notion that in order to address the root of inequities, health-harming laws and policies must be identified and replaced with others that advance health. Similarly, the five fundamental drivers of health inequity name “disparities in political power” and “governance that limits meaningful participation” as possible lenses to help identify and address uneven distributions of power, resources, and opportunities within our systems and structures. While many of our overtly discriminatory laws and policies have been overturned, if policy- and decision-making bodies are not assessing the structural nature of subordination through historical and contemporary analysis, power differentials and thus health disparities are likely to be furthered and exacerbated.

Second, the health justice framework’s guidance on holistic and supportive health interventions dovetails with the Blueprint’s promotion of three legal pillars — legal integrity, legal innovation, and legal intervention — to ensure that law and policy solutions adequately address past wrongs as well as embrace current opportunities. ChangeLab’s legal pillars posit that law and policy solutions should be grounded in practice and precedent as well as bold and innovative legal possibilities and that interventions must imbue communities with the power of implementation. This approach will ensure that interventions are informed, embraced, and implemented by and for the communities that have been most harmed by structural discrimination and racism.

Third, both the health justice framework and ChangeLab Solutions’ equity-informed approach to policymaking elevate the crucial importance of working in close partnership with community members — especially those who have traditionally been marginalized and excluded from policymaking processes — when seeking to advance health equity. ChangeLab’s Blueprint recognizes that to be effective and inclusive, community engagement must center trust, build on community strengths and assets, and ensure that all relevant parties are trained in and aware of applicable practices, potential biases, and decision-making processes.

Taken together, the tenets of health justice and ChangeLab’s equitable policymaking processes provide complementary and reinforcing approaches to addressing unjust health disparities from a community-led, person-centered, and integrity-focused perspective.

Read Our Articles Integrating Health Justice & the Blueprint

Through our partnership with health justice scholars, ChangeLab staff members have explored the application of health justice to several issue areas that support good health: housing, child care, school discipline, and community engagement. We at ChangeLab Solutions hope that these articles inspire you and other changemakers to take action and consider incorporating health justice into your practices and your work:

As you explore these resources on health justice, please also consider reviewing ChangeLab Solutions’ new tools for addressing the fundamental drivers of health inequity in your work:

Finally, ChangeLab Solutions would like to thank and highlight some of the health justice scholars who have been our co-authors or partners in fruitful collaborations: Lindsay Wiley, Ruqaiijah Yearby, Emily Benfer, Seema Mohapatra, Rachel Davis, Kiran Savage-Sangwan, Thalia González, Angela P. Harris, Liz Tobin-Tyler, and Aysha Pamukcu.

By Sarah de Guia