Examining the Social Determinants of Health Through a Reproductive Justice Lens

The Social Determinants of Health (SDOH) are often framed as conditions that only matter when discussing marginalized communities. This has been a pet peeve of ours at RJ Squared. Housing instability, food insecurity, inadequate transportation, exposure to environmental hazards, and limited access to quality healthcare are routinely cited to explain poor health outcomes among low-income populations and Black, Indigenous, and People of Color (BIPOC) communities. Yet everyone has social determinants of health. What differs is not their existence, but their quality. When SDOH are discussed exclusively through the lens of deficit, scarcity, and dysfunction, we obscure the ways in which privilege itself functions as a powerful and protective health determinant. This selective framing not only distorts our understanding of health inequities, but also allows the systems that create and sustain advantage to remain invisible and unchallenged.

High-quality social determinants of health operate quietly and efficiently for those who benefit from them. Stable housing in safe neighborhoods, intergenerational wealth, access to well-resourced schools, reliable transportation, clean air and water, and social networks that offer political and economic leverage are not typically labeled as SDOH when they are present. Instead, they are normalized as individual achievement or good decision-making. This normalization masks the structural nature of advantage and allows health outcomes among white populations to be interpreted as the result of personal responsibility rather than systemic support. As Rhua Benjamin explains in her book Viral Justice, racism is a producer. In this case racism is producing systemic advantage masked as good choices.

By framing SDOH primarily as markers of deficiency, public health and healthcare systems inadvertently reinforce a narrative that positions marginalized communities as inherently vulnerable or incapable. This deficit-based framing shifts attention away from the policies, practices, and power structures that produce unequal living conditions in the first place. Redlining, residential segregation, labor exploitation, underfunded schools, mass incarceration, and exclusionary immigration policies are not simply historical artifacts; they are active determinants that shape who has access to safety, stability, and opportunity today. Ignoring the role of advantaged SDOH allows these systems to persist without accountability.

Reproductive Justice (RJ) offers a critical framework for reframing this conversation. RJ expands beyond the narrow focus on reproductive health rights access to encompass three core human rights: the right to personal bodily autonomy, the right to have children, the right not to have children, and the right to raise the children we have in safe and sustainable communities. It is this last tenet that demands a fundamental reexamination of how SDOH are understood and addressed. Safe and sustainable communities are not optional benefits or aspirational goals; they are human rights.

When viewed through a RJ lens, poor SDOH experienced by historically marginalized and minoritized communities are not unfortunate circumstances or inevitable outcomes. They are human rights violations. Communities that lack access to safe housing, living wages, quality education, environmental protection, and culturally responsive healthcare are systematically denied the conditions necessary to support family stability and well-being. This denial is not accidental. It is the result of deliberate policy choices that prioritize profit, property, and political power over collective care and equity.

Centering RJ requires a shift from asking why marginalized communities experience poor outcomes to asking how systems are structured to produce and protect advantage for some while extracting resources from others. It requires naming whiteness, wealth, and social capital as, what Jessica Roach coined, Structural Determinants of Health and not as neutral backdrops. It also demands that accountability be placed where it belongs: on institutions and policies rather than on individual behavior.

Ultimately, advancing health equity requires more than improving access to services or teaching resilience to those most harmed by inequity. It requires dismantling the conditions that make resilience necessary in the first place. By acknowledging advantaged SDOH as drivers of health outcomes and recognizing inequitable SDOH as human rights violations, RJ provides a moral and analytical framework for transforming how we understand health, responsibility, and care. 

We encourage you to begin your journey of transformative practice by engaging with the Critical Foundations of Reproductive Justice in- person or online training.