The debates that typify the modern health justice movement are more refined than ever before. Participants on all sides of the issues now benefit from increasing access to data, improved connectivity and the ability to create effective memes at an unprecedented rate. For these reasons, now is an ideal time to assess the state of the health justice movement by asking its actors a very basic question—what does health justice mean? Movements like health justice are, after all, defined by the beliefs and actions of its constituents in the biomedical, medical, social justice, legal, and political arenas.
Where would I begin? My interpretation deconstructs the question (“what does health justice mean?) into as a set of smaller, more manageable questions: is health justice governed more by the general principles and trends of social justice movements, or of health movements? Is there an emergent property in “health justice” that carries meaning independent of the individual components (health and social justice)? A full examination of the changing definitions of “health” and “justice” is beyond the scope of any textbook, let alone single opinion piece.
Thankfully, the defining characteristic of health justice is, in my opinion, its evolvability—the ability to incorporate new ideas, visions, and goals as setting and context change. For this reason, addressing the true meaning of “health justice” is not about examining its ideological ontogeny, but rather, in understanding how health justice must adapt.
In the context of health specifically, health justice must incorporate our evolving ideas of what constitutes illness and wellness. These debates span metaphysical and biophysical circles, and involve debates as disparate as “what is a man?” to “how relevant are systems biology approaches to understanding hypertension?” These modern debates about health also include the varying definitions of risk. In today’s world, “at risk” can mean that an individual possesses a certain single nucleotide polymorphism (SNP) associated with a chronic disease. Alternatively, risk is also defined by living in the presence of previously under-examined social causes of disease (e.g. homophobia as it relates to depression in adolescents).
How our understanding of the “cause of disease” can evolve is embodied in the racial health disparities movement. With the Institute of Medicine’s 2003 publication of Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, race became the canonical domain for health inequalities. With this report and the action-oriented initiatives that followed, racism was fortified as a cause of disease, rather than a social phenomenon into which illness was merely embedded. Health justice, consequently, must continue to adopt anti-racism stances and lobby for policies that detrimentally affect communities of color.
Social justice is similarly affected by moving targets, populations, events, and settings. New states are born and boundaries re-written; the global response to ecological catastrophes is redefined in light of human rights; immigration and admixture give rise to new social dynamics (e.g. multiracialism, assimilation, and multiculturalism); social movements give rise to legal movements (e.g. the queer rights movement birthing the marriage-rights movements). Health justice needs to keep pace with social justice so as to be proactive and prescriptive rather than reactive and descriptive.
To remain influential, health justice must remain both principled yet labile, willing to re-imagine itself regularly, adopt new approaches and engage new communities. This also involves a willingness to prioritize its many foci, as health justice’s resources (intellectual, and monetary) are finite.
How can the actors in the health justice movement further fortify this ability to adapt? Through honest discourse on the salient issues and by consistently evaluating the evidence that informs these debates. For example, the evidence might suggest novel clinical regimen, expose new at-risk populations, create vehicles for healthcare delivery and models for healthcare financing. For health justice to find continued relevance in a changing society, it must be evolvable across time and space while keeping the needs of everyday people at the center of its many causes.