Addressing Social Injustice in Rural Japanese Healthcare: A Narrative Review Informed by Fraser’s and Sen’s Frameworks

Rural regions in Japan continue to experience significant health inequities despite universal health insurance coverage. These disparities disproportionately affect older adults, foreign residents, and socially isolated individuals, whose help-seeking is often delayed by structural, cultural, and informational barriers. This narrative review synthesizes empirical research, theoretical perspectives, and practice-based insights to clarify how social injustice manifests in rural Japanese healthcare and to identify strategies for more equitable care. Literature on rural health, health literacy, self-medication, mobility, and community participation was examined and interpreted through the frameworks of redistribution, recognition, and representation, as well as the capability approach. Across studies, persistent geographical barriers, transport limitations, and shortages of healthcare professionals restricted residents' access to timely and appropriate care. Low health literacy, cultural differences, and weak social networks further hindered early help-seeking, particularly among foreign residents and older adults. Opportunities for participation in health decision-making were limited, reinforcing patterns of marginalization. Emerging community-based innovations-including non-profit-hospital collaborations, structured community dialogues, and digital consultation platforms-show potential to redistribute information, enhance cultural understanding, and strengthen residents' capabilities to engage with the healthcare system. These findings suggest that achieving social justice in rural healthcare requires both structural reforms and capability-enhancing interventions that support meaningful participation by marginalized groups. Enhancing transportation, interpreter availability, community health worker programs, and co-designed communication pathways may contribute to a more inclusive and responsive rural healthcare system. This review provides a conceptual foundation for developing multilevel strategies to reduce inequities and promote social justice in rural Japan.