Can Public Health Really Transform Social Inequalities?

Public health is often presented as a lever for greater justice and equality. Yet, despite ethical commitments and accumulated knowledge, health inequalities persist. The reason is simple: public health is neither a neutral nor an all-powerful actor. It operates within a complex web of power relations, political choices, and institutional constraints that limit its ability to address the root causes of inequality.

Take the example of maternal care in rural areas. A clinic may exist, but dilapidated roads, high transportation costs, or restrictive social norms prevent women from accessing it. Justice in health is not merely about the presence of a service. It requires transforming the economic, social, and environmental conditions that make some lives more precarious than others. Thus, ensuring equitable access to care also means combating poverty, discrimination, and food insecurity.

Traditional approaches, such as those proposed by John Rawls, advocate for redistributing resources to help the most disadvantaged. During the COVID-19 pandemic, healthcare workers, the elderly, and those with chronic illnesses were prioritized for vaccination. However, this logic faces structural obstacles. For example, vaccine patents limited their production in poor countries, showing that global economic rules can hinder health justice.

Martha Nussbaum goes further, emphasizing that health depends not only on access to care but also on individuals’ ability to live in dignified conditions. In slums, where overcrowding, lack of clean water, and unsanitary conditions are common, distributing medication is not enough. Residents may lack identity papers, making them invisible to public policies and complicating access to health programs. Health justice must therefore include the recognition of fundamental rights and the fight against systemic exclusion.

The environment also plays a key role. Communities exposed to floods, heatwaves, or pollution face constant health risks, often ignored by policymakers. In the small island states of the Caribbean, hurricanes destroy homes and disrupt agriculture, plunging populations into food insecurity and precarity. Environmental justice thus becomes inseparable from health justice.

Finally, the production of knowledge in public health raises questions. Marginalized communities are rarely involved in research, leading to policies that are poorly adapted to their realities. A transdisciplinary approach, where researchers, professionals, and citizens collaborate, better addresses local needs and redistributes decision-making power.

Public health cannot, therefore, be content with being a science of prevention. It must become a political project, where the fight against inequalities involves transforming the social, economic, and environmental structures that determine who can be healthy and who cannot. This requires action on care, rights, the environment, and citizen participation, so that health ceases to be a privilege and becomes an effective right for all.

Documentation and Sources

Reference Document

DOI: https://doi.org/10.1186/s12982-026-01827-z

Title: Health justice as a framework for transforming public health practice

Journal: Discover Public Health

Publisher: Springer Science and Business Media LLC

Authors: Gilbert D. Bernardino; Ferdinand C. Tercero; Jonathan H. Ilagan; Julie E. Padilla; Sonia C. Olnanigon; Reuben Victor M. Laguitan; Don Eliseo Lucero-Prisno