Health justice as a framework for transforming public health practice

Abstract Public health is commonly framed as a vehicle for justice and equity, yet persistent health inequalities raise fundamental questions about its capacity to transform the structural conditions that produce vulnerability. This commentary argues that health justice cannot be realized through ethical commitment or knowledge production alone, because public health itself is a heterogeneous and politically embedded field whose scope of action is shaped by governance arrangements, institutional power, and ideological struggle. Rather than a singular actor, public health operates simultaneously as a discipline, a profession, a set of state institutions, and a form of population governance—dimensions that often function according to different logics and degrees of political autonomy. Drawing on theories of justice from Rawls, Nussbaum, and Holland, the paper shows how dominant distributive approaches, while ethically compelling, remain limited when detached from historical, environmental, and political contexts. Through illustrative cases in maternal health, infectious disease, environmental risk, and digital governance, the analysis demonstrates how public health frequently becomes adept at naming inequality while remaining constrained in its ability to confront the structures that reproduce it. The paper further advances the concept of epistemic justice, highlighting how marginalized communities are systematically excluded from knowledge production, and how transdisciplinary approaches can redistribute epistemic authority by treating research as a civic practice. Taken together, the commentary reframes health justice not as a technocratic solution or moral aspiration, but as a contested political project that unfolds within uneven systems of power. Health justice, in this view, transforms public health from a science of prevention into a political sociology of care—one that situates knowledge, institutions, and civic action within ongoing struggles over whose lives are protected, valued, and made possible.