Health equity can sometimes be discussed in terms of access, but at its core, it is a social justice issue. It reflects who has been systematically excluded from the conditions that make health possible: safe housing, stable income, reliable employment, clean environments, and freedom from targeted harm.
These inequities are not accidental. They are the result of decades of policy decisions. They come from economic structures and corporate practices that have shaped who gets access and who doesn’t.
For business leaders, that reality can feel distant. But it isn’t. Health inequities show up every day in the workforce, through absenteeism and burnout. They also show up through rising healthcare costs and in unequal opportunities for employees to thrive. Estimates show that poor mental health and chronic diseases contribute to billions of dollars in lost productivity and millions of missed workdays annually. With health inequities, there are no universally accepted statistics for these costs. But health inequities span chronic diseases, mental health, access to health, and other factors; it is not hard to infer the related high costs. Ignoring those issues isn’t just unjust; it’s unsustainable.
TOBACCO ADDICTION
Few broader issues illustrate this more clearly than tobacco addiction.
For decades, tobacco use has disproportionately harmed communities that have been targeted, underserved, or under-resourced. Lower-income populations, communities of color, LGBTQ+ community members, and people facing behavioral health challenges have experienced higher rates of use and tobacco-related disease. This pattern is the result of targeted marketing and limited access to cessation resources. It is also the result of structural barriers that make quitting harder.
While smoking rates in the overall population have declined, the burden has not been shared equally. The same communities that have historically borne the brunt of tobacco-related harm continue to face higher exposure and impact. For example, communities of color and LGBTQ+ individuals are still smoking at higher rates than their counterparts.
If health equity is a social justice issue, then addressing it requires more than incremental change. It demands a willingness to examine how systems contribute to unequal outcomes, and to act toward changing them.
In the context of tobacco, that means supporting strong, consistent regulation that protects communities from predatory marketing and reduces access to addictive products. It also means investing in prevention and cessation programs that are accessible, culturally relevant, and grounded in the realities people face.
CHRONIC STRESS AND MENTAL HEALTH
But tobacco is just one part of a broader picture.
Health outcomes are deeply tied to social and economic conditions. And things like chronic stress, which can be driven by financial instability, discrimination, unsafe environments, and lack of access to care, play a significant role in shaping behavior and long-term health. When people are under sustained pressure, they look for relief. Too often, available and addictive products are positioned to fill that gap.
Expanding the range of real, accessible alternatives is one way of addressing health equity. That includes strengthening mental health support, creating safer and more supportive workplaces, and ensuring people have access to basic resources that enable healthier choices. It also means recognizing that small, everyday comforts like time to rest and the ability to step away from work if needed are not luxuries. Access to community and connection falls into that category too: They are foundational to health.
PRIVATE SECTOR AND POLICY
The private sector has a critical role to play. Employers influence the conditions that shape health, from wages and benefits to workplace culture and flexibility. Companies that take this responsibility seriously can help reduce disparities by addressing the root causes that drive inequity in the first place.
Policy also matters. Strong public health protections help level the playing field, particularly for communities that have been historically marginalized. These policies must be paired with sustained investment in communities and a shared commitment from corporations and organizations to operate with accountability.
HEALTH EQUITY IS NOT A NICHE ISSUE
Tobacco is a powerful example of what happens when inequities go unaddressed: Harm falls hardest on the communities that are already most vulnerable. When they are addressed, the benefits extend far beyond individual health. They reach families, communities, and the broader economy.
The path forward requires a deeper understanding that health equity is not just a goal, but a larger matter of justice.
Kathy Crosby is CEO and president of Truth Initiative.