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CHAPTER 2 HEALTH PROMOTION, EQUITY, AND SOCIAL JUSTICE
Holly E. Jacobson, Francisco Soto Mas, and Laura L. Nervi
LEARNING OBJECTIVES
Explain the intersection of health promotion, equity, and social justice.
Describe how health status and healthcare vary among individuals and groups of people within the same community.
Identify actions health promotion programs take to advance health equity and social justice.
Summarize how the Health in All Policies guideline created conditions to facilitate greater health equity and social justice.
Health Promotion, Equity, and Social Justice Intersection
Effective health promotion programs strive to promote health equity and social justice. Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and healthcare. Health equity means reducing and ultimately eliminating disparities in health and its determinants that adversely affect excluded or marginalized groups. 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. 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.
Opportunities to be healthy depend on the living and working conditions and other resources that enable people to be as healthy as possible. A population’s opportunities to be healthy are measured by assessing the determinants of health (i.e. income or wealth, education, neighborhood characteristics) that people experience across their lives. Individual responsibility is important, but too many people lack access to the conditions and resources that are needed to be healthier and to have healthy choices. A fair and just society means that everyone has the opportunity to be as healthy as possible. Being as healthy as possible refers to the highest level of health that reasonably could be within an individual’s reach if society makes adequate efforts to provide opportunities.
A health promotion program working to achieve health equity and social justice for the individuals and communities they service requires action. Required is improving access to the conditions and resources that strongly influence health—including good jobs with fair pay, high-quality education, safe housing, good physical and social environments, and high-quality healthcare—for those who lack access and have worse health. While this ultimately improves health and well-being for everyone, the focus of action for equity and social justice is with those groups who have been excluded or marginalized. Program move from providing equality in services and care to equity in services and care and then to social justice (Figure 2.1).
Figure 2.1 Equality, Equity, Justice
Health equity can be viewed both as a process (the process of reducing disparities in health and its determinants) and as an outcome (the ultimate goal: the elimination of social disparities in health and its determinants). Progress