Background There is an increasing interest in the literature to examine plausible mechanisms explaining social inequalities in health above and beyond income. We propose “sense of injustice”, coined by Cahn, a sociologist, in 1950, and denoting a cognitive process rather than a psychological individual reaction to unjust social and economic structures in society while reckoning that people regard themselves in relation to each other, as a community.

Methods The data used are from the Ras Beirut well-being survey designed for this purpose by a cross-disciplinary research team and conducted in 2009 in a socially and economically diverse neighbourhood of Beirut, Lebanon. To measure sense of injustice, a 17-item instrument with five-point Likert scale responses was developed trough an engaged reiterative qualitative and quantitative process. A random sample proportional to cluster size of 1200 households sample was drawn using spatial sampling techniques to maximise contextual variability. A proxy was interviewed on the household social, economic and demographic variables and one randomly chosen adult member (>21 years) answered the individual questionnaire. The vast majority of interviews were conducted in Arabic and the response rate was 56.25%.

Analysis Exploratory factor analysis was used to identify the common factors among the measured variables for sense of injustice. Using ecosocial theory of disease distribution, specifically the notion of embodiment, the association between sense of injustice and self-rated health was examined adjusting for relevant exposures.

Implications Proposed interventions to reduce health inequalities should address the structural issues of economic inequality and power imbalance.