 We can distinguish two fundamentally different approaches to bringing verdicts of fairness or justice to bear on a given health inequality. On the free-standing approach, the injustice of an unjust health inequality is the primary injustice, although a verdict of injustice can also be spread backwards from this primary injustice to its causes. By contrast, on the derivative approach, the injustice of an unjust health inequality is not the primary injustice. Rather, the primary injustice is some unjust cause of a health inequality, although a verdict of injustice can also be spread forwards from this primary injustice to the health inequality itself. In this way, the injustice of an unjust health inequality derives from the primary injustice of its cause(s). (This distinction between free-standing and derivative approaches closely matches Peter’s [2004: 94–95] distinction between direct and indirect approaches). Suppose, for example, that part of the difference in life expectancy between white and Black men in the United States is caused by racial discrimination. On the derivative approach, this part of that inequality in health is unjust because its cause is unjust, and this verdict holds even if inequalities in health are not otherwise unjust (e.g., even if no valid principle of equality applies directly to health). On a free-standing approach, by contrast, this difference in life expectancy may itself be unjust, regardless of its cause. We discuss each approach in turn.