What Role Does Social Justice Play In Public Health?
The language we use is important for public perception and policy implementation
Despite its widespread usage in current discussions throughout the country, the term ‘social justice’, and by extension the concepts of social justice, remains somewhat ambiguous. This is at least in part due to the use of the term by various groups and political organizations. It has become a buzz word co-opted by different groups to serve their needs and agendas.
For this reason, we should be cautious when we use this word in a professional sense in Public Health, as our language matters (if not, at the very least, for the public perceptions of our discipline). We should seek a clear and concise definition of social justice that adequality conveys the concepts that we are applying in our field.
As Paula Braveman notes when talking about defining ‘health disparities’, “…definitions can have important practical consequences, determining the measurements that are monitored by governments and international agencies and the activities that will be supported by resources earmarked to address health disparities/inequalities or health equity.”
I would add that our language and definitions also have tangible effects on how Public Health policies are received and implemented.
Beauchamp defines justice broadly by noting that “each person in society ought to receive his due and that the burdens and benefits of society should be fairly and equitably distributed.”
Jennifer Prah Ruger argues in her book Health and Social Justice that “all people should have access to the means to avoid premature death and preventable morbidity,” and emphasizes resource redistribution in her paradigm of health capability.
However, Thomas Sowell argues that the concept of social justice is, in its typical formation, an argument for what he calls ‘Cosmic Justice’, assuming a moral high ground that simply cannot be practically introduced, at least not without inconsistencies and authoritarian measures.
It is true that there are health disparities in our communities that need to be addressed, such as higher infant mortality rates for black and American Indian/Alaska Native children compared to white and Asian children (11.4% and 9.4% vs. 4.9 and 3.6% in 2016, respectively). It is also true that there are glaring deficiencies in our communities that lead to poor health outcomes, such as ‘food deserts’ in which a segment of the population has low access to healthy food sources such as supermarkets or large grocery stores.
However, much of the public push back against addressing these issues comes from social justice definitions that are easily associated with partisan politics.
I believe that for practical reasons, we need to define social justice in Public health less in terms of moral outrage, and more in terms of social/moral responsibility.
Along these lines, social justice in Public Health would be defined such as “the idea that societies as a whole have the responsibility to use the resources and skills they have to provide for and help every member of the society live healthy lives.”
In concept, this definition does not vary significantly from those above; however, in practice I think it can remove the outrage tenor that many have when promoting social justice, which should lead to a public that is more willing to accept Public Health policies, decreasing resistance and increasing compliance.
With the conversation reframed in this way, we can work to meet our responsibility of using the resources we have, such as public funding and health-related research (basic, translational, and clinical), to address the issues that threaten the health of our communities.
Thus, we can use clinical and epidemiological data to identify the populations in our communities that have the highest rates of a particular disease, such as cardiovascular disease, and invest public funding to increase access to healthy diet alternatives and health education.
Or we can use the knowledge gained by decades of research on cigarette smoking to make clear, concise, and helpful educational programs on smoking cessation targeted at the most vulnerable groups.
These are just two examples of a great many that could be multiplied to show how we might rise to our responsibility to identify and address the health issues in our communities. This ‘social responsibility’ model can encourage those in our community to improve the community, working together, not in contradistinction with one another. It emphasizes what we can do to help, not what we are lacking (which is then often blamed on one political ideology or another).
I believe one of the biggest hurdles that we are facing in our cultural moment is the conflict narrative (and reality) between political ideologies. If we believe in social justice, then we should work to find practical ways to develop and implement policies that have widespread adoption rates and high efficacy.
This is done through practical mediation (and de-escalation) of political rhetoric and through effective communication and education of the public. Hopefully, with this nuanced definition of social justice, we can work to adequately provide paths to healthier lives of everyone in our communities.
