Social Justice and Health Equity: Core Ethical Values in the Health Sciences

Abstract Social justice and health equity are frequently invoked in the health sciences. They are commonly referred to as ‘core values’ or ‘central aims’ that health research, medicine and other health interventions should seek to realise. Yet, despite their ubiquity and stature in the health sciences, it is rarely made clear exactly what these values mean and how they ought to be reflected in practice. If the ethical commitments of social justice and health equity are not articulated or are unclear when they are invoked, it is unlikely that these ‘core values’ will meaningfully guide work in the health sciences, and it is even less likely that progress will be made towards health equity and social justice. It is therefore imperative to understand the ethical foundations of these concepts, some prominent ways that they might be interpreted in the health sciences and the important differences between health equity and social justice. Social justice and health equity are frequently identified as ‘core values’ in the health sciences, yet it is often not made clear what these values should mean in practice. Because health inequities are differences in health that are considered to be ‘unjust’, clarity is required about what makes a difference in health unjust and what a ‘just’ state of population health should look like. Failing to clearly and explicitly articulate the ethical norms or standards that health equity and social justice should commit health scientists to is likely to lead to ethically dubious, inconsistent and unsound policy and practice decisions, which may in turn contribute to the creation, maintenance or exacerbation of social injustice and health inequities – the very outcomes health equity and social justice are trying to address. Broadly speaking, conceptions of justice tend to address the following dimensions: distributive justice, relational justice and procedural justice. Each of these dimensions is relevant to considerations of health equity and social justice in the health sciences. Evidence suggests that explicit consideration of the normative dimensions of health equity is not the norm. As a result, a term that superficially gestures towards ‘fairness’ and ‘social justice’ can be invoked without being forced to meaningfully engage with phenomena that are central to the concerns of social justice: racism, sexism, colonialism and other forms of oppression.

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