1.4 Understanding social justice and health inequities

A socially just society is one that is based on principles of equality and fairness for all. An understanding and recognition of human rights is particularly important. The four principles of social justice are: equity, access, participation and rights.

Social justice means that the rights of all people in the community – particularly the groups that are marginalised and disadvantaged – are treated in a fair and equitable manner. Public policies should ensure that all people have equal access to health care services. For example:

  • Someone with a low income should receive equity in the same quality health services that a person with a higher income receives.
  • Someone living in a geographically isolated community should have the same access to clean water and sanitation as a person living in an urban area.
  • Information designed to educate the community must be provided in languages that the community can understand rather than the preferred language of the governing class, enabling them to participate in the learning.
  • The right of a child to health is as important as the right of any adult.

Social justice is what faces you in the morning. It is waking up in a house with an adequate water supply, cooking facilities and sanitation. It is the ability to nourish your children and send them to a school where their education not only equips them for employment, but reinforces their knowledge and understanding of their cultural inheritance. It is the prospect of genuine employment and good health: a life of choices and opportunity, free from discrimination.

Source: Mick Dodson, Annual Report of the Aboriginal and Torres Strait Islander, Social Justice Commissioner, Australian Museum, 1993.

In reality, as you will know from your own experience, many people do not experience social justice. There are huge differences in health between different groups in society. These differences affect groups who are marginalised because of poverty, race/ethnicity, gender, disability, or where they live, or some combination of these. People in these groups not only experience worse health but also tend to have less access to the things that support health. For example, healthy food, good housing, good education, safe neighbourhoods, freedom from gender and other forms of discrimination. As we discussed, these are called the social determinants.

These disparities or differences in health are described as health inequities when they are the result of the systematic and unjust distribution of these social determinants. Health equity is when everyone has the opportunity to reach the best possible health, and no one is prevented from being healthy just because of their social situation.

Activity 1.3: Role play on disclosing and identifying social determinants that deepen child health inequalities

This activity is an option for those students who are studying the module with a group and not just as an individual. If you are not studying with a group you can still think about how the exercise would play out. You may even be able to try it with some willing friends or colleagues.

Please refer to Resource 1 on page 63, we have provided the activity template for you to print or draw and allow you to cut out each box. Each of the boxes represents a card. Hand out one card to each participant. Ten participants should be asked to study the information about the child on the card. Participants should not share which child they have been given and should line up in a row with backs against a wall or (imaginary) line on the floor.

Process for the exercise

The facilitator reads out the statements below. Considering the information on their card, each person should take a step forward each time they believe that the statement applies to the child they have chosen. If the statement does not apply then they should not move.

  1. My parents are mindful and support me to access health services whenever I am not feeling well.
  2. I get new clothes whenever I need them.
  3. I eat at least two meals a day and rarely feel very hungry.
  4. I sleep in a good house with clean and safe water and a toilet.
  5. I have access to and can read newspapers regularly bought by my parents/guardians.
  6. I have access and time to listen to the radio in our house.
  7. I can access/negotiate for youth-friendly health services from our community health centre.
  8. I go to school and my fee is paid promptly.
  9. I expect to finish my education and get a job.
  10. I feel I have positive choices about my own future.
  11. I am consulted on issues affecting young people in our community.
  12. My parents can pay for treatment in a private hospital, if necessary.
  13. I am prepared for and understand the changes that have happened/will happen to my body as I mature.
  14. I have access to plenty of information about health issues.
  15. My local health centre has staff who are medically trained, and it is less than 20 km away.
  16. I have a low risk of being sexually harassed or abused.
  17. My experience suggests to me that health workers are good people and are supportive when I go to a health centre.

At the end of the exercise, other participants might like to guess at the general conditions for each of those who were in the line up, based on their final position. When all the conditions are revealed, you can explore:

  • What is the position of girls and boys from well-to-do backgrounds compared to those from deprived backgrounds?
  • The wide distance between participants shows lots of real distance or inequalities in communities. What are they (social-economic, cultural, rural/urban, status, etc.)?
  • Would the distance between people be different if more people/groups were communicating and sharing with each other? What would have happened to the ‘shape’ of the group at the end?
  • What can be done to address the inequalities that are demonstrated in the exercise?


At the end of the activity some people will be a long way from the starting line whilst others may not have moved from the start position. You can ask each participant to explain who their child was and why they are positioned where they are at the end of the game. This activity makes it apparent, very visibly, that children’s different life chances create inequalities between them and shows how some children get left behind. You can use this activity to explore the factors that lead to those inequalities and to think about which children lose out and how.

1.3 What are the social determinants of health?

1.5 Taking action to address the social determinants of health