Social Injustice and Public Health Barry S. Levy Victor W. Sidel, Editors OXFORD UNIVERSITY PRESS SOCIAL INJUSTICE AND PUBLIC HEALTH This page intentionally left blank SOCIAL INJUSTICE AND PUBLIC HEALTH Edited by Barry S. Levy Victor W. Sidel 1 Published in Cooperation with the American Public Health Association 2006 1 Oxford University Press, Inc., publishes works that further Oxford University’s objective of excellence in research, scholarship, and education. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Copyright Ó 2006 by Oxford University Press, Inc. Published by Oxford University Press, Inc. 198 Madison Avenue, New York, New York 10016 www.oup-usa.com Oxford is a registered trademark of Oxford University Press All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Oxford University Press. Library of Congress Cataloging-in-Publication Data Social injustice and public health / edited by Barry S. Levy and Victor W. Sidel. p. cm. Includes bibliographical references and index. ISBN-13 978-0-19-517185-3 ISBN 0-19-517185-3 1. Social medicine. 2. Social justice. 3. Public health—Social aspects. I. Levy, Barry S. II. Sidel, Victor W. RA418.S6423 2005 362.1'042—dc22 2004065433 987654321 Printed in the United States of America on acid-free paper Dedicated to health workers throughout the world committed to ending social injustice. This page intentionally left blank FOREWORD Despite the tremendous improvements in overall health and life expectancy during the past century, at the start of the twenty-first century there are un- conscionable gaps in health for many vulnerable groups, including racial and ethnic minorities and the poor. These gaps in health thrive in a climate of economic and social inequities. These inequities create the conditions that ad- versely affect the health of individuals and communities by denying individuals and groups the equal opportunity to meet their basic human needs. Minority children and children from low-income families continue to lag behind their counterparts in almost every health indicator. Poor children are at least twice as likely as are nonpoor children to suffer stunted growth or lead poisoning. Black children and children from poor families are more likely to have disabling asthma. Infants born to black mothers are more than twice as likely as infants born to white mothers to die before their first birthdays. Black and Mexican-American children living in older (pre-1946) housing are more than twice as likely to have elevated blood lead levels as are white children living in comparable housing. Quality health care alone, however, cannot prevent children from being poisoned by lead paint in deteriorating homes or developing asthma from fumes emitted by inadequately vented stoves. These disparities in children’s health reflect the inequities in social and economic well-being of children and their families. For example, nearly 13 million American children—more than one in six—lived in families with an annual income below the government poverty level in 2003. In that year, 34 percent of black, 30 percent of Latino, 13 percent of Asian, and 10 percent of white children were poor. The racial gaps in the poverty rate testify to generations of social injustice that have created a system of unequal access to many sectors of American life, including education, housing, employment, finance, and criminal justice. Social Injustice and Public Health calls us to action to improve health through the pursuit of social justice. This book makes a powerful and com- pelling argument that a primary goal of public health is to address the root causes of social injustice: widening gaps between rich and poor, the unequal distribution of resources within our society, discrimination, and the disen- franchisement of individuals and groups from the political process. This system of social injustice has contributed to disparities not only in health but also in childhood development, education, employment, income, housing, and family and community safety. The racial and social progress of the last half-century is in peril of being lost. This would be a moral, social, and economic catastrophe for America. If we can remove children from the dangerous intersection of race, poverty, and poor education where so many young lives are wrecked, we would not only improve children’s health but we would also help all Americans realize the core values of freedom and justice that make America America. —Marian Wright Edelman viii FOREWORD PREFACE Social injustice underlies many public health problems throughout the world. It is manifested in many ways, ranging from various forms of overt discrimina- tion to wide gaps between the ‘‘haves’’ and ‘‘have-nots’’ within a country and between rich and poor countries. It leads to higher rates of disease, injury, disability, and premature death. Public health professionals as well as students of the health professions need a clear understanding of social injustice in order to address these problems, but relatively few books address the wide range of issues involved. The aim of this book is to offer a comprehensive approach to understanding social injustice and its impact on public health. Part I explores the nature of social injustice and its adverse effects on public health. Part II describes in detail how the health of 10 specific population groups is affected by social injustice. Part III explores how social injustice adversely affects health in 10 different areas, ranging from infectious diseases to mental health, from prevention of assaultive violence and war to occupational health and safety. Part IV provides an action agenda for what needs to done to prevent social injustice and to minimize its impact on health. This book arose from our experience and observations of the ways in which social injustice underlies public health problems. Previously we edited War and Public Health and Terrorism and Public Health, in which we identified [...]... (box 1-2) and the International Declaration of Health Rights (box 1-3) provide a foundation for reducing, and ultimately eliminating, social injustice (also see chapter 22) Promoting social justice by public health policies, programs, and services: Public health departments and other government bodies at the local, state, national, and international levels can reduce social injustice and promote social. ..x PREFACE social injustice as a principal causative factor and as a consequence of war and terrorism The current book examines social injustice as a principal causative factor and as a consequence of many public health problems We conceived this book with the goals of stimulating a better understanding of the relation between social injustice and public health, promoting education and research on... Strengthening communities and the roles of individuals in community life: Communities—as well as civil-society organizations and individuals within communities—can play vital roles in addressing social injustice and its impact on public health (see chapter 24) Promoting social justice through education in public health: Schools of public health and educational programs in public health can promote social justice... chapters and boxes that reflect their observations, insights, and expertise Their commitment to social justice and to public health is evident in their work and in their contributions to this book We thank many people for their insights that helped extend our knowledge and sharpen our thinking about social injustice and public health These include Philip Brachman, Paula Braveman, Jack Geiger, and Nancy... Global Health Division Yale School of Public Health College Street, Room 320 New Haven, CT 06520 203-785-2866 203-785-6193 (fax) nora.groce@yale.edu Sofia Gruskin, JD, MIA Associate Professor of Health and Human Rights Program on International Health and Human Rights Francois-Xavier Bagnoud Center for Health and Human Rights Department of Population and International Health Harvard School of Public Health. .. society Among the roots of social injustice are Nature of Social Injustice and Impact on Public Health 7 poverty and the increasing gap between the rich and the poor; maldistribution of resources within the society; racism and other forms of discrimination; weak laws or weak enforcement of laws protecting human rights and other rights; and disenfranchisement of individuals and groups from the political... definitions of social injustice, concepts and definitions of social justice are based on justice, fairness, and equity (box 1-1) Social injustice leads to a wide range of adverse health consequences, as reflected by disparities in health status and access to health services within or between populations Within the United States, there have been and still are—many disparities with regard to health status,... protecting the public s health giving highest priority to reducing death and disability and protecting all humankind against hazards.2 What Needs to Be Done Humanity, for the first time, has the technical capacity and the human and economic resources to address poverty, ill health, human rights violations, and the social injustice that helps spawn and promote these problems Some forms of social injustice. .. and public health, promoting education and research on these issues, and facilitating effective measures to minimize the impact of social injustice on health and well-being B.S.L and V.W.S Sherborn, Massachusetts The Bronx, New York May 2005 ACKNOWLEDGMENTS Developing Social Injustice and Public Health has involved the combined skills and resources of many people, to whom we are profoundly grateful We... Mental Health, 277 Carles Muntaner and Jeanne Geiger-Brown 17 Assaultive Violence and War, 294 James A Mercy Box 17-1 War and Public Health, 298 Box 17-2 Genocide, 306 18 Environmental Health, 318 Colin D Butler and Anthony J McMichael 19 Occupational Safety and Health, 337 Andrea Kidd Taylor and Linda Rae Murray Box 19-1 Epidemic of Toxic Liver Disease, 346 Box 19-2 Economic Globalization, 348 20 Oral Health, . Social Injustice and Public Health Barry S. Levy Victor W. Sidel, Editors OXFORD UNIVERSITY PRESS SOCIAL INJUSTICE AND PUBLIC HEALTH This page intentionally left blank SOCIAL INJUSTICE AND PUBLIC. experience and observations of the ways in which social injustice underlies public health problems. Previously we edited War and Public Health and Terrorism and Public Health, in which we identified social. understanding social injustice and its impact on public health. Part I explores the nature of social injustice and its adverse effects on public health. Part II describes in detail how the health