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Effective health promotion programs strive to promote health equity and social justice. Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and healthcare. Health equity means reducing and ultimately eliminating disparities in health and its determinants that adversely affect excluded or marginalized groups. Social justice is the view that everyone deserves equal rights and opportunities—this includes the right to good health. Yet today there are inequities in health that are avoidable, unnecessary, and unjust. These inequities are the result of policies and practices that create an unequal distribution of money, power, and resources among communities based on race, class, gender, place, and other factors.

Opportunities to be healthy depend on the living and working conditions and other resources that enable people to be as healthy as possible. A population’s opportunities to be healthy are measured by assessing the determinants of health (i.e. income or wealth, education, neighborhood characteristics) that people experience across their lives. Individual responsibility is important, but too many people lack access to the conditions and resources that are needed to be healthier and to have healthy choices. A fair and just society means that everyone has the opportunity to be as healthy as possible. Being as healthy as possible refers to the highest level of health that reasonably could be within an individual’s reach if society makes adequate efforts to provide opportunities.

A health promotion program working to achieve health equity and social justice for the individuals and communities they service requires action. Required is improving access to the conditions and resources that strongly influence health—including good jobs with fair pay, high-quality education, safe housing, good physical and social environments, and high-quality healthcare—for those who lack access and have worse health. While this ultimately improves health and well-being for everyone, the focus of action for equity and social justice is with those groups who have been excluded or marginalized. Program move from providing equality in services and care to equity in services and care and then to social justice (Figure 2.1).

Figure 2.1 Equality, Equity, Justice

Health equity can be viewed both as a process (the process of reducing disparities in health and its determinants) and as an outcome (the ultimate goal: the elimination of social disparities in health and its determinants). Progress toward health equity is assessed by measuring how these disparities change over time, in absolute and relative terms. The gaps are closed by making special efforts to improve the health of excluded or marginalized groups, not by worsening the health of those who are better off. Key insights in addressing health equity focus on health, which is more than healthcare. Consider these five key insights (Braveman et al., 2017):

 Health inequities are neither natural nor inevitable.

 Your ZIP code may be more important than your genetic code for health.

 The choices we make are shaped by the choices we have.

 Structural racism acts as a force in the distribution of opportunities for health.

 All policy is health policy.

Health equity and social justice are values that imply a pledge to eliminate health inequities and its causes, most of which are rooted in the structural determinants of health. From this perspective, the pursue of health equity and social justice are associated with ethics and human rights. Achieving health equity and social justice occur when all individuals and groups have the opportunity to attain their full health potential regardless of their social position or other socially determined circumstance (Arcaya et al., 2015).