Health Justice Strategies to Combat the Pandemic: Eliminating Discrimination, Poverty, and Health Disparities During and After COVID-19

Abstract

Experience with past epidemics made it predictable that people living in poverty, people of color, and other marginalized groups would bear the brunt of the coronavirus pandemic due to the social determinants of health (SDOH). The SDOH are subdivided into structural and intermediary determinants. Structural determinants include forms of subordination (discrimination and poverty) that influence intermediary determinants (health care, housing, and employment). The COVID-19 pandemic has magnified and accelerated the harms caused by these determinants, limiting health equity among historically marginalized groups and low-income populations. Black, Latino, and Indigenous populations have higher COVID-19 infection and mortality rates, higher rates of unemployment, less access to health care, and greater risk of eviction during the pandemic, among other significant inequities. Without robust and swift government interventions, the impacts of the pandemic will be wide and deep. This Article analyzes mechanisms of these determinants in the pandemic setting and provides solutions using the health justice framework. The health justice framework offers three principles: structural, supportive, and empowering. First, legal and policy responses must address the structural determinants of health. Second, interventions mandating healthy behaviors must be accompanied by material support and legal protections to enable compliance while minimizing harms. Third, historically marginalized communities must be engaged and empowered as leaders in the development and implementation of interventions and the attainment of health justice. To demonstrate the application of these principles, this Article focuses on two structural determinants of health (discrimination and poverty) and three intermediary determinants (health care, housing, and employment).