Addressing Access to Justice as a Social Determinant of Health

Introduction Canadians value a healthy and just society, and our health and justice systems are a point of pride. Despite this pride, inequitable outcomes exist for the most vulnerable groups in society in both realms. Access to the justice system is severely limited for many who require it. As Supreme Court of Canada Justice Thomas Cromwell has stated, [b]y nearly any standard, our current situation falls far short of providing access to the knowledge, resources and services that allow people to deal effectively with civil and family legal matters. There is a mountain of evidence to support this view. (1) There is also irrefutable evidence that marginalised groups tend to experience poorer health outcomes, and widespread agreement that disparity in health outcomes is largely due to the social determinants of health. (2) The connections between health and justice are underexplored, however. (3) In particular, the causal relationship between access to justice and improved health outcomes invites further study. This paper will explore the idea that access to civil justice can be considered, and should be addressed as, a social determinant of health. After an introduction to the concepts of access to civil justice and the social determinants of health, I will explore the relationship between them by discussing three main avenues through which access to civil justice can improve health outcomes. (4) First, Charter litigation can be used as a tool to improve access to healthcare itself. Second, poverty law can help vulnerable groups recognise and tackle legal problems underlying what may appear to be health problems. Third, medical-legal partnerships can be beneficial both for individual patients and for more effective collective action for social change. If access to justice can indeed improve health outcomes, it would have far reaching implications for both health and access to justice advocacy. Part I--Introduction to the Concepts Before delving into the pathways through which access to justice can positively impact health, familiarity with the key concepts is necessary. This section will explain my approach to access to justice and the importance of civil justice specifically. It will then explain the concept of social determinants of health and argue that access to justice should be explored as a discrete social determinant of health. Finally, I give a short overview of the established connections between civil justice and health and the importance of further exploring their links. What is access to justice? Access to justice is a broad topic about which volumes have been written. This paper will focus on access to civil justice; that is, access to tools necessary for the effective resolution of legal disputes outside of the criminal justice system. (5) Although interactions with the criminal justice system undoubtedly affect the health of many vulnerable people, the problems with access and the pathways through which criminal justice and health interact are distinct from those related to civil justice. (6) The interplay between health and justice in the criminal sphere deserves further exploration, but is beyond the scope of this paper. For a legal system to be effective, it must be equally accessible to all, and it must create results that are individually and socially just. (7) Regarding individual outcomes, [q]uite clearly, effective access to justice is a precondition to the exercise of all other legal rights. (8) Without access to the mechanisms for effective dispute resolution and rights enforcement offered by the justice system, rights are abstract and meaningless. Put another way, there can be no legal right without a remedy, and a remedy is meaningless if it is not accessible. (9) On a societal level, the achievement of social justice presupposes effective access to the legal system. (10) The justice system is an essential tool for ensuring that our laws are just and that they are enforced in a way that is fair for all. …