Social Justice Is Not a Power-Driven Charity: The Problem With “Equity-Deserving” Terminology in Health Equity Literature

Abstract

This commentary critiques the growing use of the term “equity-deserving” in health equity literature, academic institutions, and policy research. The term was originally intended to frame equity as a right rather than a request. However, we argue that “equity-deserving” is a conceptually flawed term that reinforces a charity-based model of social justice by positioning institutions as benevolent givers and marginalized groups as passive receivers. This, in turn, results in obscuring the structural causes of inequality, risking the creation of meritocratic gatekeeping in clinical care and jeopardizing the validity of health equity research through the use of monolithic, performative labels.

Implications for Practice, Education, Research, or Policy

The term “equity-deserving” focuses the lens on the identity of the marginalized person rather than on the failure of the system, society, and sociocultural structures.

Equity-deserving is a conceptually flawed term, and its usage does no justice in addressing systemic inequities.

We should instead use precise, structural language such as “systemically excluded” or “historically marginalized.”

In the current health-care landscape, the language used to describe social issues or phenomena is often misconstrued as a measurement of progress in achieving equity. Many view the adoption of precise terminology as a necessary step in dismantling stigma (Volkow et al., 2021; Raney et al., 2021; Younas & Kvist, 2025). For example, we have seen an evolution in the use of the term “homeless individuals” to “individuals experiencing homelessness,” and more recently, to “unhoused individuals” (Reeb, 2024). Person-first language is sometimes useful for reducing stigma and bias by avoiding disease labels such as diabetic patients. However, not all shifts in terminology necessarily advance social justice. In recent years, the term “equity-deserving groups” has gained prominence in policy, health care, and academic discourse. Although often intended to highlight populations that experience structural disadvantage, the term may inadvertently reinforce problematic assumptions about power and entitlement. Specifically, framing certain populations as “deserving” of equity risks centering the authority of institutions or dominant groups to determine who merits attention or resources, rather than recognizing equity as a fundamental right grounded in justice. The purpose of this commentary is to argue against the use of the term “equity-deserving groups” by outlining the problems with its usage, exposing its inherent power imbalances, and failure to address the structural causes of inequality. By shifting the focus from “worth” to “rights,” we argue for a more honest, accountability-driven language in social justice work.

Origins of the Term “Equity-Deserving”

Wisdom Tettey, the Vice-President and Principal of the University of Toronto Scarborough from 2018 to 2024, first used this term to replace “equity-seeking” groups. The term equity-seeking emerged in the late 1980s and early 1990s within Canadian feminist and legal advocacy circles, as an alternative to the passive, deficit-based label of disadvantaged groups (Keene, 1996). While intended to highlight the active pursuit of systemic reform following the 1984 Abella Report on employment equity (Abella, 1984), the term has faced criticism for implying that the burden of labor rests on marginalized groups to seek rights that should be inherent. Tettey challenged the academic community to move toward “equity-deserving” to acknowledge that fairness is not a request to be made, but a right that is already owed (Litchmore & Scobie Edwards, 2020). The intention was arguably correct; however, the term ignores the intentional actions underlying the power imbalance created and maintained by those who benefit from it to oppress others. Rather than inspiring action, it implores the powerful to merely agree that those who are disadvantaged by systems of oppression are to be regarded as deserving of equity. Herein, we outlined three issues with the use of term “equity-deserving” populations in health equity and social justice work.

Social Justice Becomes a Charity: The Problem of the “Giver” and the “Receiver”

The term “equity-deserving” reinforces a rigid power imbalance, suggesting a charity model of social justice in which certain institutions or groups act as benevolent “givers” of rights while marginalized communities are positioned as passive “receivers” of grace. This language strips agency (i.e., individuals’ ability to have control over their lives; (Marmot, 2021) from the very people who have fought, and continue to fight, for systemic change. It ignores the fact that equity is not a gift to be granted; it is a debt owed by an unjust system that has historically excluded and exploited specific populations. This dynamic can be illustrated by Stephanie Nixon's Coin Model of Privilege and Critical Allyship (Nixon, 2019). Nixon conceptualizes various forms of inequality as distinct coins, representing the societal structures and norms that give privilege to certain groups and marginalize others. Within this model, these systemic forces operate independently of an individual's awareness or personal desires. Put simply, Nixon argues that the problem of inequity is not the people at the bottom of the coin, but the coin itself the systems of oppression that create hierarchy. By labeling certain groups as equity-deserving, institutions and groups can remain focused on the people at the bottom of the coin, rather than analyzing their own position at the top or the structure of the coin that supposedly grants them the power to give or withhold rights.

The focus on perfecting the language can become a performative act because changing the language is ultimately pointless if there is no actionable change to the underlying structures of oppression and racism (Younas & Kvist, 2025). We define performative acts as initiatives that prioritize symbolic gestures like isolated diversity hires or celebratory events to cultivate an appearance of inclusion while failing to dismantle an organization's underlying structural inequities. Without a shift in policy, resource allocation, and power-sharing, “equity-deserving” is merely a linguistic facelift for the same exclusionary practices. True justice requires more than a polite vocabulary and/or language or conceptual advancement; it requires the tangible dismantling of the barriers that the language only seeks to describe (Younas, 2025; Creary, 2021). This aligns with Creary's (2021) concept of bounded justice, which posits that “it is impossible to attend to fairness, entitlement, and equity when the basic social and physical infrastructures underlying them have been eroded by racism and other historically entrenched -isms” (p. 242).

Erasing the System and Labeling the Person

The term “equity-deserving” focuses the lens on the identity of the marginalized person rather than on the failure of the system, society, and sociocultural structures. It creates a linguistic “othering” that groups vastly different experiences, such as Indigenous sovereignty and disability rights, under one monolithic banner. If we truly wish to dismantle the barriers within our institutions, we must stop using language or speech acts (i.e., how institutions use language to stall rather than facilitate social change; Ahmed, 2006), which may sound like a merit test. We should instead use precise, structural language such as “systemically excluded” or “historically marginalized.” These terms place the burden of proof where it belongs: on the structures that created the inequality, not on the people who suffer from it.

By creating a false monolith that flattens vastly different experiences under a single, reductionist label, the term “equity-deserving” fundamentally contradicts an intersectional approach to health equity and social justice. By grouping these diverse communities together, the label ignores the unique structural mechanisms at play, failing to recognize, for example, that a Black woman with a disability in a rural setting is not facing a generic lack of equity, but rather the specific, overlapping impacts of medical racism, misogyny, and ableism. Similarly, a South Asian transgender man is not facing a generic lack of equity, but rather the specific, overlapping impacts of racialization, transphobia, and linguistic or cultural barriers within a Western medical framework.

The Meritocratic Risk in Clinical Care

Willen (2012) argues that “conceptions of deservingness are distinct from formal assertions of entitlement” (p. 806). While entitlement refers to a legal right, deservingness is a subtler, subjective moral judgment made by individuals (e.g., clinicians in the context of clinical care). By introducing the concept of deservingness into health care without critically examining its impact on the delivery of health care, we create a risky meritocracy (Holmes et al., 2021). If equity is something an individual deserves, it implies there are criteria they must meet to earn it. In high-pressure clinical settings, this allows rights to be treated as privileges granted only to those who comply with some arbitrary criteria. This shifts the focus from a universal right to care toward a subjective judgment of an individual's worth. It is also unclear what criteria are used by the groups who employ this term to decide who “deserves” equity and who does not. This allows an institution or group to designate itself as the “norm,” regarding anyone different as an “other” who must prove their deservingness to be treated fairly; thus, implicitly reinforcing the institution's or group's position at the center of power. By acting as the gatekeepers of equity, the institution or group preserves the right to change the criteria as it sees fit. This allows the system to avoid true accountability; instead of admitting the system is broken, it focuses on whether the people seeking care or employment meet a certain institutional standard of deservingness.

Impact on Health Equity Research

Use of this terminology in research is also controversial. Often, individuals in a position of power who make necessary health-related policy changes to alleviate the ramifications of systematic health inequities rely on the use of systematic reviews of practice interventions to guide evidence-informed clinical decisions (Baranowski et al., 2024; Campbell et al., 2025). The continued use of stigmatizing language can directly impact the accuracy of research findings applied to broad populations, unless authors intentionally consider that the studied interventions themselves may be inherently inequitable when implemented in marginalized populations (Baranowski et al., 2024; Campbell et al., 2025). Without a more standardized approach to equitable, diverse, and inclusive research terminology, the validity of research findings may be jeopardized. Without a true equity, diversity, and inclusion perspective, health disparities that are identified and brought forward by those in positions of power often fail to accurately address these existing inequities (Baranowski et al., 2024; Campbell et al., 2025; Spencer et al., 2024).

Concluding Remarks

In conclusion, our intent in this commentary is to argue that “equity-deserving” is a conceptually flawed term when referring to historically marginalized and underserved groups. Its usage does no justice in addressing systemic inequities, and gives the impression that social justice is a charity. By framing health equity as something to be deserved, it puts the power in the hands of the very individuals and institutions who may have been responsible for the historical and/or ongoing marginalization of certain groups. It positions individuals in authority to decide who is worthy of equity, consequently acting as benevolent gatekeepers. Lastly, the term “equity-deserving” reframes the fundamental rights of social justice and equity as discretionary gifts; therefore, it should be abandoned. We assert that continued dialogue and discursive evolution are needed to ensure that health-care systems and professionals are tasked with holding up a mirror to their own roles in oppression and marginalization.