The World Health Organization ( WHO, 2022a ) defines  health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (para. 2). Note the similarities between this definition of health and the Substance Abuse and Mental Health Services Administration working definition of recovery, the primary goal of behavioral health care (for mental health and/or substance use disorders).  Recovery is not merely abstinence from substance use but rather “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential” ( Substance Abuse and Mental Health Services Administration, 2012 , p. 3). According to the American Nurses Association (ANA), health is a specific social need and  nursing was created to address that need. The ANA refers to this relationship between the nursing profession and society as  nursing’s social contract; it explains expectations about what society and governments expect from nursing and what nursing should expect from them ( Fowler, 2015b , p. xi).

Determinants of health (DOH), including  determinants of substance use and recovery, refer to a wide range of factors that influence health status. Sometimes, the determinants are described using an  upstream,  downstream metaphor, with the determinants referred to as upstream causal factors, and good or poor health being the resulting downstream outcomes. Numerous determinants are responsible for health outcomes (National Academies of Sciences, Engineering, and Medicine [ NASEM], 2017 , p. 2). Many people are familiar with the term  social determinants of health (SDOH). The SDOH are defined as “the conditions in the environments in which people live, learn, work, play, worship and age that affect a wide arrange of health, functioning, and quality-of-life outcomes and risks” (p. xxiv). The SDOH include education, employment, health systems and services, housing, income and wealth, the physical environment, public safety, the social environment, and transportation (p. xxiv).

Although the SDOH are key predictors of health, wellness, morbidity, and mortality, by themselves, they do not adequately explain how individuals and populations achieve and maintain health equity or health inequity. Other DOH also exert  oppressive political, economic, and institutional forces at all levels of the socioecological systems ( Bronfenbrenner, 1977 ) in which humans interact with each other and their environment ( Hofrichter, 2003 ;  McGibbon, 2021a, 2021b ;  Schoon & Krumwiede, 2022 ).  Systematic oppression and  structural power are “further upstream” antecedents of the structural societal and social determinants.

Health equity refers to the absence of avoidable, preventable, or remediable differences in health among groups of people ( Dawes, 2020 , p. 19;  WHO, 2021 )-the state in which the unjust burdens of disease and the just benefits of good health are equitably distributed ( NASEM, 2017 , p. 1). As  equity is closely related to “what is considered fair and just,”  inequity exists when differences in health determinants and outcomes are “systematic, unfair and avoidable” ( Penman-Aguilar et al., 2016 , p. S35). Health inequities are “systemic political obstacles” that are “baked into our systems” by discriminatory standards, practices, and beliefs ( Dawes, 2020 , p. 19).