Social Justice and Public Health: A Public Health of Consequence, April 2024

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

—Martin Luther King Jr.

Martin Luther King Jr. delivered this well-known quotation March 25, 1966, at the second convention of the Medical Committee for Human Rights. This quotation resonates as strongly today as it did almost 60 years ago—not only because of steadfast recognition of the multiple systems of oppression that create and sustain social inequality and social injustice but also because of how these coalesce to perpetuate health inequities. In emphasizing health and health care, King recognized that high-quality health care—especially for those most marginalized in our society—was a right that had to be protected and valued as a public good.

This Public Health of Consequence looks at AJPH publications that extend and build on King’s words and his work as it evolved and connects the complex, complicated, and insidious ways systematic inequality and oppression undermine health equity and social justice. I use examples from this issue of AJPH to highlight social determinants of health and how high-quality health care needs to be accessible to all to achieve population health.

SOCIAL DISADVANTAGE AND ADVERSE HEALTH

First, Koester et al. (p. 366) address the intertwined issues of food insecurity among low-income families and children and how childcare centers can help reduce this insecurity by participating in the Child and Adult Care Feeding Program (CACFP). Unlike the Supplemental Nutrition Assistance Program and the Special Supplemental Nutrition Program for Women, Infants, and Children, the CACFP is a less well-known program that subsidizes healthy meals for children by reimbursing licensed childcare centers and daycare homes for those meals—sites that are more likely to serve children of low-income parents.^1,2 Koester et al. note that concerted efforts to make childcare providers aware of the CACFP and provide guidance on how to overcome administrative hurdles to enrollment are necessary, highlighting how difficult it can be to access federal food assistance programs.

Next, Ward et al. (p. 387) provide the first, to their knowledge, multiyear and nationwide analysis of fatal and nonfatal police shootings, providing evidence of racial disparities in total injury burden that are more severe than shown in previous studies that examined fatal shootings alone. These findings, as summarized by Zare (p. 384) and Nix (p. 382), are evidence of the lack of accountability at local, state, and federal levels for police officers’ use of deadly force—reflecting the structural racism that is deeply rooted in efforts to control and subjugate people of color and people from low-income communities.

Finally, two research articles that merit recognition deal with issues that affect historically marginalized people. Tran et al. (p. 424) report findings showing that transgender and nonbinary people, particularly those from minoritized racial and ethnic backgrounds, experience greater exposure to conversion practices that begin at younger ages. These findings are especially troubling in the current US sociopolitical landscape, where more and more states are passing legislation that is hostile to transgender and nonbinary individuals as well as the broader sexual and gender minority community. Facente et al. (p. 435) show that funding for syringe exchange programs, one of the most cost-effective HIV prevention interventions, does not meet the level necessary and recommended by the Centers for Disease Control and Prevention to offer comprehensive programming to reduce HIV and other physical and mental health burdens among injection drug users.

In addition, an editorial by Wagner and Michaels (p. 372) highlights the importance of occupational safety as fundamental to public health. Although the COVID-19 pandemic prompted attention to the health and safety—both physical and mental—of frontline essential and health care workers, who are overwhelmingly of low income and people of color, the integration of occupational safety and public health beyond emergency situations is necessary. And as occupation and occupational hazards are social determinants of health, government agencies that provide oversight and protect against occupational hazards require greater funding and resources to protect and promote the health of workers, their families, and their communities.

SOCIAL DISADVANTAGE TO SOCIAL JUSTICE

The articles in this issue add to the growing body of literature on the social, political, and economic policies and practices that continue to contribute to and exacerbate health and health care inequities. They further highlight how the patterns of social disadvantage are sharper and more damaging to health among minoritized racial and ethnic groups, sexual and gender minorities, and people who use drugs.

For public health professionals, a social justice approach to promoting health and well-being requires that we continue tackling structural racism and discrimination in all its forms, income and educational inequality, housing and food insecurity, and occupational and environmental hazards—the fundamental drivers of health inequalities in our population. Continuing to do so is our shared responsibility if we seek to uphold King’s legacy of fighting for health as a public good for all people.