Structural Determinants and the Ethics of Health Inequity: Law, Poverty, and Prevention

Health inequity represents one of the most pressing ethical challenges of our time, manifesting as unfair and preventable differences in health outcomes that stem from broader social, economic, and structural conditions. This chapter examines the complex intersection of legal frameworks, philosophical theories, and jurisprudential interpretations that shape our understanding of health equity as both a public health imperative and a fundamental question of justice. Through a comprehensive analysis of international human rights law, declarations, and constitutional provisions, the chapter demonstrates how legal instruments have evolved to recognise health as a fundamental human right while establishing state obligations to address structural determinants of health disparities.

The philosophical foundations underpinning health equity are explored through major normative theories. These ethical perspectives provide moral grounding for legal interpretations that increasingly view health inequities as violations of human dignity and social justice. Jurisprudential analysis reveals how courts worldwide have translated these principles into concrete legal doctrines, with landmark cases from South Africa, Colombia, Brazil, and the United States illustrating both the potential and limitations of law as a tool for advancing health equity.

Five detailed case studies demonstrate the real-world application of these frameworks, showing how legal action has dismantled discriminatory healthcare practices, expanded access to life-saving treatments, and prompted systemic health system reforms. The chapter concludes that achieving health equity requires recognising its indivisibility from broader social justice, necessitating coordinated legal and policy responses across sectors to address the structural determinants that shape health opportunities and outcomes.