Environmental Health

This chapter describes the adverse impact of social injustice on environmental health. Environmental pollution is a social injustice for all people, with a disproportionate impact on low- and middle-income countries and, within countries, low-income people, minority groups, and other marginalized populations. The chapter describes the evolution of the environmental justice movement and the studies that have demonstrated disproportionate exposures and the disproportionate occurrence of pollution-related diseases among low-income people, minority groups, and other marginalized populations. A separate section describes the environmental and health consequences of global climate change. Three text boxes focus on childhood lead poisoning, the impact of natural disasters on social justice, and on the new interdiscipilinary field of planetary health.

People Who Are Homeless

An estimated 100 million people globally suffer from absolute homelessness. The estimated number of people who are homeless in the United States at any given point in time is about 550,000. Mortality and disease severity of people who are homeless far exceed those of the general population because of extreme poverty, delays in seeking medical care, nonadherence to therapy, substance use disorders, and psychological impairment. Many of their health problems, such as infections due to crowded living conditions in shelters, hypothermia from exposure to extreme cold, and malnutrition due to limited access to food and cooking facilities are a direct result of homelessness. This chapter addresses in detail infectious diseases, substance abuse, obesity, mental health problems, and causes of death in this population. It also addresses access to and use of healthcare services. It addresses the roots of and underlying issues related to these problems. Finally, it addresses what needs to be done.

The Impact of Social Injustice on Public Health

Social injustice creates conditions that adversely affect the health of individuals and communities. It denies individuals and groups equal opportunity to have their basic human needs met. It violates fundamental human rights. It represents a lack of fairness or equity. This chapter provides two broad definitions of social injustice. It gives examples of social injustice, both within the United States and internationally. It describes adverse health effects related to social injustice. And it outlines ways in which health professionals and others can work to minimize social injustice and its adverse health consequences. Text boxes describe concepts of social justice, as well as the relationship between science and social justice. The Appendix to the chapter contains the Universal Declaration of Human Rights.

A Critical Research Agenda for Social Justice and Public Health

Critical and creative work can and must be done to determine why injustice exists, including who gains and who loses and how it wreaks its woe, thereby generating knowledge for both rectifying harm and creating just and sustainable solutions. Critical research questions focus on: What is the evidence that social injustice harms health? What can be done to prevent this harm? There are four key reasons to develop a research agenda for social justice in public health: (1) ignorance forestalls action. (2) The “facts” never “speak for themselves.” (3) Specificity matters. (4) Research can exacerbate, and even generate, rather than help rectify social inequalities in health. This chapter discusses a proposal for a public health research agenda that advances issues of social justice and includes four components: theory, monitoring, etiology, and prevention. For each component, the author delineates broad principles and provides specific examples.

International and Global Health

Social injustice leads to profoundly increased rates of illness and premature death in low- and middle-income countries related to inadequate public health services and medical care, internal factors such as extreme poverty and unaccountable governments, and external factors such as debt, structural adjustment policies, and trade barriers. This chapter describes the impact of social injustice on public health in low- and middle-income countries, including issues related to endemic and epidemic diseases and health risks associated with poverty, living conditions, occupational health and safety, and violence. It discusses what needs to be done, including promoting approaches that focus on poor people, promoting and protecting human rights, improving healthcare systems, improving education and health literacy, increasing foreign assistance, reducing the import of hazards into these countries, preventing violence, promoting representative government, changing international economic policies, and promoting sustainable development. Text boxes address trafficking in persons, hunger and malnutrition, and the import of hazardous substances from high-income countries to low- and middle-income countries.

Violence

Violence can be both a consequence of social injustice and a tool used to perpetrate it. After describing the World Health Organization’s definition of violence, the chapter describes the public health burden of violence. It then discusses social injustice as a cause of violence, including economic exploitation, poverty and relative deprivation, hate-motivated violence, gender inequality, political repression, and unfair distribution of justice. The chapter concludes with a discussion of what needs to be done, including increasing the cost of injustice, reducing the impact of poverty on violence, reducing social distance, improving gender equality by redefining harmful cultural norms, and strengthening democratic institutions. Three text boxes address war and other forms of armed conflict, the international arms trade, and nuclear weapons and social injustice.

Mental Health

This chapter addresses the needs for preventive measures to improve the unfair—and avoidable—living and working conditions that produce increased rates of mental disorders among poor workers, women, immigrants, and racial and ethnic minorities. It also addressees treatment to narrow persistent mental health disparities by providing high-quality mental health services and psychiatric care. It discusses mental illness in a social justice context; the association between social stratification and mental health; specific dimensions of social injustice that implicate unequal power relations as a determinant of mental health disparities and mental health services and as a source of social injustice; and what needs to be done to achieve a more equal society that will reduce disparities in mental health outcomes. It recommends an action agenda that includes reframing issues of mental health among deprived and victimized populations to include civil rights and human rights as well as a public health approach. A text box describes the opioid crisis in the United States.

Lesbian, Gay, Bisexual, and Transgender/Transsexual People

This chapter describes social injustice experienced by lesbian, gay, bisexual, and transgender/transsexual (LGBT) individuals. It addresses stigma-based violence, HIV/AIDS, and issues related to mental health as well as to alcohol, tobacco, and other drugs. It describes the increased risk that LGBT men and women face for cardiovascular disease and cancer. In addition, the chapter addresses the underlying factors and roots of this social injustice. The chapter addresses what needs to be done, including changes to legislative and other policies, an expanded role for healthcare facilities and organizations, and ongoing research. The authors stress the need for a change in the social environment that creates social injustice against LGBT people—a change that can only be brought about through education and by addressing multiple forms of social injustice.

Older People

This chapter describes how social injustice adversely affects the health of older people and provides a variety of examples. It analyzes the roots and underlying causes of this social injustice, including poverty and inequalities associated with differences in socioeconomic status over the life course, the biomedicalization of aging, and globalization. The chapter asserts that rights for older people must be defined as basic human rights and that social justice for older people must begin with the assertion of the human right to health. The chapter concludes with a discussion of what needs to be done to address social injustice against older people, including reducing disparities in retirement income, quality of medical care, and community integration. It also addresses the importance of raising political awareness about social injustice against older people, including improving policymakers’ understanding about their health status, healthcare, and financial burdens.

Women

This chapter discusses several major issues of social injustice as they adversely affect the health and well-being of women. The chapter begins with a discussion of new modes of social action supporting women and women’s rights, starting with the 2017 Women’s March. Sections of the chapter address violence, war, and forced migration; sustainability and gender equity; family planning and related issues; abortion; infertility and assisted reproduction; and other issues. The final section of the chapter examines what needs to be done to address these issues, with an emphasis on violence, sustainability and gender equity, and reproductive and health issues.