In 2021, decades after Martin Luther King Jr’s (MLK) March on Washington, Black women in the United States faced a mortality rate 2.6 times higher than that of white women. This is not just a tragic statistic; it represents a crisis of autonomy and dignity within the world’s wealthiest nation. This emphasises a profound dilemma; while medicine has advanced enough to save lives and reduce suffering, access to those benefits remains deeply unequal. King’s explanation, hence, encapsulates how health outcomes are symptomatic of much deeper inequalities: racial, socio-economic, gender, and political. Health inequality, then, is not an isolated problem but the visible tip of a much larger scheme of injustice.
King, however, was not alone in discussing the impact of inequality, which has been the subject of sustained scholarly attention. First, as John Locke outlined, freedom is a natural right, yet health inequality robs people of autonomy, limiting their ability to work, learn, and participate in society. Second, drawing on Aristotle’s idea of human flourishing, inequality strips individuals of dignity and human rights, reducing their worth to society’s margins. Hence, this essay will assess whether health inequality - or a different type of inequality - is the ‘most shocking and inhuman’ in terms of its impact on the loss of human autonomy and the loss of dignity. In doing so, this essay will build on MLK’s claim that ‘injustice in health is the most shocking and inhuman’ by demonstrating that healthcare disparities most significantly erode human autonomy through the denial of civic freedoms and the dignity of being treated as lives worth saving. This reveals that health inequity is not merely a technical issue, but a moral one as well.
In terms of the impact on human autonomy, health inequality is the most ‘shocking and inhuman’ because it directly strips individuals of the ability to act independently, trapping them in cycles of dependence. As Rousseau argued, social divisions rooted in inequality enslave individuals to artificial hierarchies, threatening their freedom to live without executive overreach. Health inequality symbolises poverty; in countries without universal coverage, those with fewer resources often forgo treatment. In India, nearly 55 million people are pushed into poverty annually due to the burden of medical expenses, whereas in the United Kingdom, 30 percent of people living in the most deprived areas seek emergency services due to inadequate provision of General Practitioners (GPs). The disparity in health outcomes is stark; in India, the average life expectancy is 67.2 years, whereas in the UK it is 81.8 years. Similarly, Locke emphasizes that liberty is inseparable from independence; when individuals become reliant on others due to extreme inequalities, their capacity for self-determination collapses. For example, in 2022 alone, nearly 100 million Americans reported medical debt. Among this group, about one in five said they were forced to cut back on food or housing to pay medical bills. Amartya Sen argues that health inequality is a restriction of ‘capabilities’, which suggests that freedom is characterised by the positive ability to act. Yet without healthcare, individuals lose the capability to work, learn, or autonomously pursue their lives. This was demonstrated during the Covid-19 pandemic, where poorer communities, lacking access to vaccines and adequate medical facilities, were not free to participate fully in recreational activities and the labour market. For instance, the United Kingdom’s vaccine rollout ensured lockdown restrictions could be lifted by April 2021, whereas in India, major lockdown restrictions persisted well into June 2021 due to low vaccination rates. This demonstrates that health inequality is the most ‘shocking’ and ‘inhuman’ form of inequality in terms of reducing human autonomy because it undermines the very conditions for exercising freedom. Without health, individuals cannot claim independence, economic agency, or civic participation, leaving them trapped in a state that no other form of inequality fully enforces. Hence, it is symptomatic of different forms of socio-economic and racial inequality.
While health inequality restricts freedom, political inequality may have a bigger impact on the autonomy of humans. Alexis de Tocqueville argued that participation in democratic life is essential for liberty; without it, people remain subject to decisions imposed by elites. Despite MLK’s campaign for racial equality, voter suppression persists in the United States where stricter ID laws, gerrymandering, and reduced polling access disproportionately affect Black, Latino, and low-income communities. For example, in Georgia’s 2018 gubernatorial election, approximately 53,000 voter registrations were delayed under “exact match” laws, with nearly 70% belonging to Black applicants. Without an effective political voice, such voter groups are unable to shape policies that govern healthcare, education, or wages. Similarly, between 2012 and 2018, Texas closed over 750 polling stations — mostly in Black and Latino precincts - in what Democrats perceived to be an attempt to silence marginalised voices in a Republican state. In this way, political inequality undermines collective freedom, silencing whole communities regardless of their health status. Similarly, in Hong Kong, Beijing’s 2020 National Security Law stripped people of the ability to protest, speak freely, or run for office. Even those in good health found themselves without political influence. This emphasises how political repression can silence entire communities and prevent individuals from holding the executive to account.
Overall, in terms of the impact on autonomy, health inequality undeniably jeopardizes freedom by restricting individuals’ ability to live freely, pursue opportunities, and make choices about their lives. Thinkers from Rousseau to Sen emphasize that without health, liberty becomes hollow because humans are unable to exercise it. Whilst political inequality is significant, it is ultimately not as important because the right to vote or speak freely becomes meaningless if illness or lack of care prevents people from participating in society at all. Ultimately, health inequality is best understood as symbolic of a wider network of injustices; as it is caused by poverty, systematic racism, and unequal access to education, whilst it also constrains freedom. Thus, health inequality also interacts with other inequalities that magnify its effects.
A second way health inequality inflicts harm is by stripping people of dignity and basic human rights. For Aristotle, justice constitutes giving each person what they deserve; when essential goods such as healthcare are denied, society fails to treat individuals as worthy of equal concern. For example, the death of Shanti Kumari, who died in Uttar Pradesh after being refused medical treatment during India’s Covid-19 surge due to a lack of money and oxygen supplies, is symbolic that health inequality reduces the intrinsic worth of one human life in relation to another. Hegel’s theory of recognition reinforces this point: dignity arises when individuals are valued as full and equal members of society. However, health inequality denies this recognition, leaving people alienated and invisible. For example, during the HIV/AIDS crisis in the 1980s, when marginalized communities were stigmatized and left untreated, individuals were effectively excluded from social recognition as lives worth saving. This demonstrates that health injustice is not only about illness but about the denial of acknowledgment that each human life has equal value. John Rawls, writing in a more modern context, argues that inequalities are only tolerable if they do not compromise equal basic rights and dignity. Yet, health injustice directly violates this principle; for instance, in the United States, Black women are three times more likely to die from pregnancy-related causes than white women. That the poor are more likely to die young, or the fact that minorities consistently face worse health outcomes, demonstrates that society is failing to secure the baseline of fairness that Rawls argues is essential. Health thus becomes a precondition for justice itself; without the ability to survive and function, individuals cannot exercise rights or pursue opportunities in any other domain. Therefore, health inequality most severely undermines dignity because it determines which lives are valued and which are disposable.
While health inequality gravely damages dignity, other forms of inequality may be even more significant in stripping people of their human worth. Racial inequality, for example, has historically denied entire groups recognition as full human beings. W.E.B. Du Bois described the “double consciousness” imposed on Black Americans, who are forced to view themselves through the lens of a racialised society that devalues their identity. For example, Black Americans are incarcerated at nearly five times the rate of white Americans. This demonstrates how racial inequality subverts dignity by creating a highly stratified society that excludes specific groups. Gender inequality offers another striking case. Simone de Beauvoir argued that women have long been cast as the “other,” excluded from recognition as equal human subjects. In the European Union, women earn on average 13% less than men for equivalent work, while in South Africa, over 40% of women report experiencing gender-based violence. This emphasises that gender inequality is not only endangering women's health but also to female dignity of controlling their own bodies. Economic inequality also carries a devastating impact on dignity. Karl Marx noted that capitalist exploitation reduces workers to mere instruments of production, alienating them from their labor and humanity. Today, the working poor often endure indignities such as precarious housing, food insecurity, and unsafe labor conditions that corrode self-respect. For example, one in ten U.S. workers earns less than $15 per hour, leaving many reliant on food banks despite full-time employment. Even when healthcare is available, these deeper economic injustices still leave people without the recognition of equal standing in society. However, these types of inequalities are the roots of health inequality. For instance, socio-economic inequality limits access to nutritious food, clean water, and consistent medical care, which this essay has demonstrated causes geographic disparity in health outcomes. Moreover, the denial of reproductive rights for women and the lack of protection from gender-based violence and racial inequality produce stark disparities in life expectancy. Hence, health inequality can be characterised as what Hannah Arendt described as a denial of ‘the right to have rights’ because it downplays the very dignity that makes one a participant in society.
In terms of the impact of inequality on dignity, this essay has presented the unique harm of health inequality. To deny individuals essential medical care is to imply their lives are worth less than others. This implicates the notion of equal human worth, which, as Aristotle and Rawls suggest, strikes at the foundation of justice. Yet dignity is also deeply compromised by other inequalities; racial, gender, and economic, which deny recognition and respect. However, these are only exposed by health inequality, which is the product of socio-economic deprivation as well as racial and gender bias. Therefore, health inequality exposes the failures of societies that claim to value equality while allowing preventable suffering to persist.
In sum, by examining the impact on human autonomy and loss of dignity, this essay has sought to demonstrate that health inequality is the most ‘shocking and inhuman’ form of injustice. Although it could be argued that political inequality has a greater effect on collective liberty by protecting individuals from government, this is ultimately implausible. This is because the right to vote or speech is insignificant when illness or lack of care prevents people from participating in society. Instead, health inequality is symptomatic of deeper societal inequalities, as it both arises from and amplifies existing inequities. This demonstrates that health injustice is not an isolated problem but the clearest conveyance of structural injustice as a whole. This, therefore, suggests that Bentham’s notion that natural rights are ‘nonsense on stilts’ is implausible; for if human life is to exist at all, it must be built on basic preconditions. Hence, if the right to health is dismissed as meaningless, people are denied the very foundation from which liberty and equality derive. This suggests that the right to healthcare is not an abstract ideal but a practical necessity, without which freedom cannot occur. Thus, policymakers and scholars wishing to address inequality should focus upon securing health injustice, for it is the condition of possibility for all other rights. Without health, there can be no flourishing, no recognition, and no true equality.
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