Distributive equity and equal recognition: Demands of and challenges to social justice in public health

The chief demand of social justice in public health commonly is framed in the language of “health equity.” Although the concept is complex and its meaning subject to debate, the pursuit of a fair distribution of health (however defined) is widely embraced as the primary goal of social justice in public health. This distributive goal, however, does not exhaust the requirements of justice. Social justice in public health also demands the demonstration of respect for persons and the communities to which they belong. Although theories of justice generally and in public health more specifically may integrate respect for persons within their distributive goals or interpret distributive equity as its expression, the two goals often exist in tension. This is particularly the case in public health where health equity is often argued to depend both on structural reforms whose health benefits are universal and on reforms that target groups disproportionately burdened by or vulnerable to avoidable morbidity and premature mortality. Drawing on the scholarship to date on social justice in public health and public health ethics more generally, this presentation will (1) defend the thesis that distributive equity and equal respect constitute the overarching demands of social justice in public health, (2) show how the well-intentioned practice of targeting minority and marginalized populations can express disrespect, and (3) argue for an understanding of respect that meets the requirements of what some theorists call “recognition” and may not only reduce the risk of disrespect but also advance the cause of health equity.