1.4. Investigate the role of social justice principles in promoting an individual and community’s health status

1. Social justice principles

1.1 Participation

Participation means individuals and communities have a real voice in decisions that affect their health. In practice, it means moving away from doing things to communities, and instead working with them. This helps make services more relevant, respectful and more likely to be used.

At an individual level, participation includes shared decision-making in care. This might look like being listened to, asking questions, and giving informed consent. When individuals understand their options and feel respected, they are more likely to attend follow-up appointments, take medications correctly and take part in prevention.

At a community level, participation includes consultation and co-design of services, representation on advisory groups, and community control where appropriate. Participation can improve health status because it increases:

• Relevance of programmes and services to local needs and values
• Trust in services, especially where there is a history of discrimination or harmful experiences
• Uptake and long-term engagement, which is essential for prevention and chronic disease management

A clear Australian example is Aboriginal Community Controlled Health Services (ACCHSs). These services are run by local Aboriginal communities to provide culturally safe primary health care. NACCHO represents 145+ ACCHSs nationally. Research often points to stronger engagement in community-controlled models. For example, one study reported ACCHSs were 23% better at attracting and retaining Aboriginal clients compared with mainstream providers. This supports earlier care and better continuity of chronic disease management.

Example: A Local Health District may improve youth mental health service use by setting up a youth reference group to co-design appointment systems. This might include after-school times, SMS reminders, privacy-friendly waiting areas, and clear explanations of confidentiality. This is participation that can increase individual help-seeking and improve community-level service uptake.

1.2 Equity

Equity means fairness in how resources and opportunities are shared. It is not the same as equality. Equality gives everyone the same support. Equity gives support based on need, because different groups do not start from the same position.

Equity can improve health status by reducing avoidable gaps in outcomes. In Australia, inequities can be seen across many health indicators. For example, Aboriginal and Torres Strait Islander Peoples have a life expectancy around 8 years lower than non-Indigenous Australians (reported for 2020–2022: 71.9 vs 80.6 years for males, and 75.6 vs 83.8 for females). People in very remote areas also experience poorer outcomes. This is often linked to service availability, workforce shortages, transport barriers, and broader socioeconomic disadvantage.

Equity-based approaches can include targeted investment and tailored service design, such as:

• Medicare and public hospitals helping reduce cost barriers to essential care
• The Pharmaceutical Benefits Scheme (PBS) reducing medication costs
• Extra funding and incentives to support rural and remote health workforces
• Targeted prevention programmes in communities with higher burden of disease
• Disability supports that recognise unequal starting positions

The National Disability Insurance Scheme (NDIS) is an equity measure because it provides individualised supports for disability-related needs, rather than giving the same assistance to everyone.

Example: Providing a standard city-based cardiac rehabilitation model to all Australians is equal, but not equitable if people in remote areas cannot attend. An equitable approach may fund outreach cardiac rehab, including telehealth, and transport support so outcomes are not determined by postcode.

1.3. Access

Access is the ability to reach, obtain and use health services, health information and basic supports when needed. Health services can exist, but if barriers stop people using them, health gaps continue.

Common barriers to access include:

• Geographic barriers, such as distance, limited local services, and transport
• Financial barriers, such as gap fees, travel costs, time off work, and medication costs
• Cultural and language barriers, such as lack of cultural safety and limited interpreter availability
• Digital and health literacy barriers, such as internet access, confidence using systems, and understanding information
• Disability access barriers, such as physical access, communication supports, and reasonable adjustments

Australia uses strategies to improve access, including outreach models and telehealth. The Royal Flying Doctor Service (RFDS) provides care across rural and remote regions and reports attending to 900+ patients per day through services such as primary care, retrieval and telehealth. Mobile screening is also used to reduce distance barriers. For example, BreastScreen NSW mobile vans visit 170+ rural towns. The RFDS has also reported 55,000+ telehealth consultations in a year.

Access also includes cultural safety and communication. For people from culturally and linguistically diverse communities, interpreters and translated resources can be the difference between early treatment and delayed care.

Australian laws and policies also shape access for people with disability. Under the Disability Discrimination Act 1992, health services must make reasonable adjustments so people with disability can access care safely and effectively.

Example: If a hospital provides an Auslan interpreter for a Deaf patient and adjusts communication to support informed consent, access improves immediately. This supports safer care, better adherence and a lower risk of avoidable complications.

1.4. Rights

Rights in health are the entitlements and protections people have when seeking care and living in society. A rights-based approach recognises that health is connected to safety, dignity and freedom from discrimination. Rights also include conditions that support health, such as safe housing and protection from violence, because these shape exposure to risk and the ability to access help.

In Australian health contexts, key rights commonly include:

• The right to access appropriate care
• The right to safe and quality care
• The right to respect and dignity, including culturally safe care
• The right to communication and information in a form you can understand
• The right to privacy and confidentiality
• The right to informed consent
• The right to provide feedback and complaints without retribution

These rights are supported through law and policy, including anti-discrimination protections such as the Racial Discrimination Act 1975 and Disability Discrimination Act 1992, and patient rights frameworks like the Australian Charter of Healthcare Rights (which includes access, safety, respect, communication, participation, privacy and comment).

Rights support health status because they affect trust and help-seeking. If people expect discrimination, judgement, breaches of privacy, or lack of consent, they may delay care until problems become serious. When rights are protected, people are more likely to seek early care and preventable harm is reduced.

Example: A young person is more likely to seek sexual health care if confidentiality is explained clearly and upheld. This improves individual outcomes through earlier testing and treatment, and improves community outcomes through reduced transmission and complications.

2. How participation, equity, access and rights work together

In real health settings, participation, equity, access and rights work together and support each other. Improvements in health status are usually strongest when all four are addressed.

• Participation supports equity by ensuring resources match the needs communities identify, not what outsiders assume.
• Equity supports access by funding services and supports that remove barriers, such as outreach, transport subsidies, and culturally safe staffing.
• Access supports participation because communities can only take part meaningfully when they can reach services, information and decision-making processes.
• Rights support access and participation by ensuring people are treated with dignity, can communicate effectively, and can influence decisions without discrimination.

National approaches to Aboriginal and Torres Strait Islander health often emphasise that health improvement needs partnership and self-determination, not only funding. In some settings, shifting service control to community-led models has been linked to large improvements in service use and health indicators. One example reported that after a transition to an Aboriginal community-controlled service, primary health care usage increased by 408%, immunisation improved, and the proportion of low birth weight babies fell to under 10%. This reflects the combined impact of participation and rights through community control, improved access through culturally safe and better-designed services, and equity through resources directed to the greatest needs.