Income inequalities impact the right to access health and proper nutrition, leading to unequal distribution of welfare among countries. Therefore, food and health expenditures are important indicators that demonstrate the status of poverty and inequality within societies. Given the role of health and nutrition in achieving welfare-oriented and justice-oriented goals of countries, the aim of this study is to determine the status of justice in the distribution of food expenditures and health expenditures in Iran.

The present study is a cross-sectional one conducted using household income and expenditure data for the year 2023. To assess justice in health, catastrophic health expenditures have been calculated using the capacity to pay approach, differentiating between urban and rural areas as well as income deciles. For food security assessment, the economic vulnerability index due to food insecurity has been used, represented by the share of food expenditures out of the total household expenditures. Additionally, for assessing inequality, the Gini coefficient, concentration indices for health and food expenditures, and the Kakwani indices for both expenditure groups have been calculated.

Results indicate that on average, about 3.5% of people in urban communities and 7% in rural communities face catastrophic health expenditures. In urban areas, the exposure of the poor to catastrophic health expenditures is about 1.5 times that of the wealthy, while in rural areas this gap is larger, around 2 times. Furthermore, household exposure to food insecurity in urban and rural areas is approximately 8% and 34%, respectively. In cities, the poor's exposure to food insecurity is about 9 times that of the wealthy, and in rural areas, it is about 3 times. Additionally, about half of the provinces have food insecurity levels above the national average. The provinces of Ilam, South Khorasan, and Sistan and Baluchestan are the three provinces where 40% to 50% of households experience food insecurity. Moreover, the negative Kakwani index indicates that the distribution of health expenditures and food expenditures is disadvantageous to poor households. The absolute value of this index is higher for food expenditures compared to health expenditures, implying that the financial burden of food costs on the poor is greater than that of health costs, and this financial burden is higher for the poor in rural areas compared to urban areas.