Health justice in fragile and shock-prone settings: from theory to practice towards building resilient health systems.

Abstract

Health justice is an emerging imperative in global health and health policy and systems research, particularly in fragile and shock-prone settings where inequities are deepened by political instability, conflict and structural violence. This practice paper explores how the ReBUILD for Resilience consortium has sought to operationalise health justice as a guiding principle and embedded practice in four diverse contexts: Myanmar, Nepal, Lebanon and Sierra Leone. Drawing from political philosophy, public health ethics and the capability approach, we outline a framework that positions health justice not only as an aspiration but also as an actionable, community-rooted agenda that centres equity, power redistribution and inclusive governance. Through participatory action research, political economy analysis and embedded learning sites, the ReBUILD teams engaged with communities and health system actors to co-create interventions that respond to local needs while addressing entrenched exclusion and marginalisation. Country experiences demonstrate both the potential and challenges of advancing health justice: from establishing inclusive Municipal Health Committees and revitalising health facility governance to promoting leadership among marginalised groups such as people with disabilities and displaced populations. This paper reflects on tensions around facilitation, participation and positionality and acknowledges the broader political economy, subnational, national and transnational, that shapes opportunities for transformation. We argue that health justice must be pursued through politically astute, reflexive and participatory research approaches, grounded in long-term relationships and a commitment to amplifying community voices. While the road is complex and contested, the pursuit of health justice is essential for building more equitable, inclusive and resilient health systems in the face of protracted crises and global inequities.