Society has not been kind to the Black being. Centuries of pain have created a caste system in which African Americans are pushed to the bottom with very little recourse for recompense. Black lives are often viewed as important only in relation to death—death that reinforces the value of the lives of those who are not Black, those who do not share a lineage shaped by pain and suffering.
In his paper “Justice, Inequality, and Health,” McKay raises several important questions: Do health inequalities involve injustices that differ from other forms of inequality? Or are unjust health inequalities simply instances of broader principles of equality and justice applied to health? Additionally, are there contributing factors—particularly patterns of behavior—that might justify the existence of health inequities? In other words, do inequalities exist because of injustice, or are they the result of individual behavioral patterns?
As observed in the Whitehall studies and further explicated by McKay, the existence of a social gradient in health suggests that forces beyond health care exert a powerful influence on individual health—forces that correlate strongly with social variables. African Americans are subject to a wide range of circumstances beyond their control that nevertheless shape their overall well-being and quality of life. From domestic terrorism to environmental racism, Black existence is marked by persistent hardship that weathers both emotional and physical health. The gratuitous violence experienced and witnessed within Black communities produces deep trauma and fosters a form of nihilism that degrades and diminishes Black life.
McKay further demonstrates that similar gradients in life expectancy appear when social variables such as income, education, social class, and—within the U.S. context—race are examined. He also notes that while racism directly contributes to poorer health outcomes among racial and ethnic minorities, it simultaneously results in lower income, reduced educational attainment, and diminished occupational status. For African Americans, inequality cannot be reduced to patterns of individual behavior or biomedical factors. Instead, it is rooted in a long history of systemic disenfranchisement across nearly all domains of life, including education, housing, employment, health care, and social mobility.
To fully understand the plight of Black Americans, one must engage deeply with the historical conditions that produced contemporary inequities. As Loewen (2005) asserts, “Neither skin color in itself, nor aesthetics, nor physical characteristics explain racism. History does.” The burden of Blackness is thus not one of diminished capacity due to inherent deficiencies, but rather the result of sustained domestic terrorism, discrimination, dehumanization, and caricaturization that have persisted since the inception of American ideology.
The inequalities experienced by African Americans are, as Hausman argues, incompensable at the individual level and cannot be justified through individualist frameworks of responsibility. McKay draws on Iris Marion Young, who provides a more compelling moral framework by shifting the focus from individuals to groups. While Young agrees that individuals are the basic unit of moral concern, she argues that claims of injustice related to equality must focus on inequalities across groups. Such morally troubling inequalities arise from social structures—defined as enduring relationships among social positions that systematically shape opportunities and life prospects (Young, 2001).
Given the historical experience of African Americans, particularly descendants of enslaved people, the injustice of inequality cannot be denied, nor can the need for compensatory redress. American slavery endured for centuries, followed by decades of Jim Crow segregation, mass incarceration, and systemic neglect, all of which have contributed to the degradation of entire communities. These harms do not affect Black Americans alone; they reverberate throughout society. Rather than continuing to debate a past that many refuse to learn or acknowledge, the focus must shift toward meaningful redress. Social and political capital are finite resources, and justice demands that they be directed toward healing historical wounds and stabilizing the Black American community.
Justice, Inequality, and Health (Stanford Encyclopedia of Philosophy). (2021b, November 1). https://plato.stanford.edu/entries/justice-inequality-health/#SociGradHeal
W. Lowen, J. (2017). Sundown Towns. Touchstone, 2006.
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