Until structural inequalities are addressed, policies promising health equity or reparations will continue to be limited

Photo: @jontyson

Longstanding calls for justice and equity in health have taken on new meaning as the COVID-19 pandemic continues to exacerbate existing structural inequalities, locally, nationally and globally. 

But are current health policies and programs even capable of delivering justice or promoting health equity, given the social and historical context of the systems in which they are embedded? And if not, what does that mean for the practice of making health policy going forward?

Lab collaborator Professor Melissa Creary explores these themes in a new, free to access article in the journal Law, Medicine and Ethics, titled “Bounded Justice and the Limits of Health Equity”. 

Using the guiding concept of “bounded justice”, Dr. Creary argues that policies and programs that attempt to bring about greater health justice or provide reparation are limited in their scope and effectiveness by broader social, economic and political institutions that are fundamentally unjust. 

Using bounded justice as a conceptual framework and diagnostic tool, Dr. Creary examines both recent demands for justice in response to the COVID-19 pandemic in and the trajectory of repeated “calls to action” to address Sickle Cell Disease in the United States. 

Health sectors, health agencies and the health professional discourse in many countries have generated many examples of policies and programs motivated by social justice and health equity goals. But many of these initiatives turn out to be little more than band-aids applied to the existing scar tissue caused by ongoing structural inequalities. Few, if any, live up to their grand and important goals. The result can be a toxic combination of public performativity or lack of progress that actively creates barriers to social justice.

As Dr. Creary explains, bounded justice is useful as a framework for diagnosis and praxis -an integrated and iterative process of reflection, learning and action- because it highlights ‘how embodied outcomes of accumulated injustice and exclusion inhibit the receipt of justice even via intentional, well-meaning, well-researched programs, policies, and technologies.’

Health policymakers, health professionals and advocates for health justice and equity need to take note: health equity is not, by itself, an achievable goal. Without addressing broader structural inequalities and the metaphorical ‘scar tissue’ they create, it will remain elusive. Recognizing and reflecting on the bounded nature of justice can bring us closer to the praxis we need to tackle those boundaries.