By Lou Lamari, Articling Student-at-Law (University of Manitoba Faculty of Law)
The Community Advocacy & Legal Centre (CALC) has released a report titled Measuring What Matters: Exploring Evaluation Frameworks for Justice & Health Partnerships, focused on improving access to justice through collaboration between legal and health professionals.[1] This report is the outcome of collaboration between many access to justice professionals from across Canada, Australia, US, and UK. This blog post is intended to provide some highlights from the 2024 revision of the original report which was published in 2021.
Justice and Health Partnerships (JHPs) have emerged as a strategy to address unmet civil legal needs and health-harming legal issues among marginalized populations. By bringing together legal and healthcare professionals, JHPs address the intersection of health and justice, recognizing that healthcare providers can serve as trusted intermediaries for patients navigating legal challenges. Access to justice is increasingly being recognized as a social determinant of health (SDoH), highlighting the role of legal support in promoting health equity for low-income and marginalized communities. These partnerships aim to reduce the negative impact of justiciable problems and, while historically practitioner-led, are now drawing increased interest from policymakers and government organizations.[2]
The origins of Justice-Health Partnerships date back to the 1960s in the U.S., when a health center in Mississippi hired a lawyer to help patients with food and housing issues. These partnerships continued to evolve during the AIDS epidemic of the 1980s, where legal support was provided to patients needing assistance with end-of-life arrangements. In 1993, the Boston Medical Center and Greater Boston Legal Services established the first official Medical-Legal Partnership, addressing poor housing conditions for children with asthma. Since then, the U.S. has seen steady growth in JHPs, with nearly 75 partnerships formed between 2001 and 2006. Evidence shows that patients receiving joint services are more likely to adhere to prescribed medications, report reduced stress, and experience improved mental health. These programs also contribute to more stable housing and financial benefits for patients.[3]
Despite the growing momentum for JHPs internationally, Canada has been slower to adopt these partnerships. The report emphasizes the need to expand and evaluate JHPs in Canada, noting the importance of legal professionals aligning their practices with evidence-based healthcare research standards.[4]
JHPs address a wide range of legal issues, including but not limited to housing, income security, health insurance, immigration, and family law. Studies have demonstrated positive outcomes, such as better chronic disease management, improved mental health, and enhanced housing stability. These collaborations between healthcare and legal services often lead to more holistic, client-centered, and cost-effective outcomes.[5]
In cases involving immigrants, including refugees and asylum seekers, legal outcomes improved when medical professionals participated in legal proceedings. Clients often felt more comfortable disclosing personal trauma to healthcare providers, underscoring the need for a trauma-informed, community-centered approach. Justice-Health Partnerships also provide critical legal support to patient groups who might otherwise not seek assistance for social welfare-related issues.[6]
The report identifies seven key stakeholders in these partnerships: the user (patient/client), the health sector, the justice sector, researchers, evaluators, funders, and government/institutional actors. To be effective, evaluation frameworks must consider the diverse perspectives of these fields and foster a common language to enhance collaboration across disciplines.[7]
In 2015, the College of Family Physicians of Canada issued Best Advice: Social Determinants of Health to address health equity. Recommendations included screening for poverty and precarious employment and training medical students on how SDoH impact patient health. Evidence suggests that early intervention in legal issues can improve income security, housing stability and overall health, making services more cost-effective and enhancing collaboration between healthcare and legal professionals.[8]
However, challenges remain in demonstrating the impact of JHPs. For instance, physical health improvements can be slow, and it’s difficult to show health gains in populations whose health may decline regardless of intervention.[9]
The Canadian leg of the study focused on Ontario, where a growing JHP movement exists, but it lags behind the more numerous partnerships in Australia, the UK, and the US. The report suggests Ontario has significant potential for expanding the health justice model, given its established network of over 70 independent community law centers that offer free poverty law services. However, expanding legal assistance to include more family law services could further strengthen the health justice approach.[10]
While it’s crucial to measure anticipated outcomes, the report also highlights the importance of recognizing “value-added” benefits—unexpected positive outcomes that arise from cross-disciplinary collaboration. These complex interventions may result in unforeseen advantages for the communities they serve.[11]
The report’s recommended next steps, beginning on page 87, focus on collaborative efforts to secure funding, disseminate information, and scale up health-justice partnerships across Canada.[12]
In my opinion, the report was extremely effective at outlining the research that has been done in this area, providing background on where these initiatives originated and documenting how they have evolved. Something I would like to see is more research of this kind that applies specifically to the needs and experiences of Manitobans. Healthcare is province-specific and the Manitoba legal community is much smaller than that of Ontario, where this report is focused. I would be curious to discover how a similar report would look if it exclusively focused on the health-justice experiences of Manitobans. In terms of next steps, I wonder what funding opportunities may exist in Manitoba to initiate a project focusing on a collaboration between the health and justice sectors, and authorship of a similar report.
The report can be found here.
[1] Michele M. Leering, “Measuring What Matters: Exploring Evaluation Frameworks for Justice & Health Partnerships – Background & Discussion Paper” (March 2024) online (pdf): <communitylegalcentre.ca/tcodownloads/Measuring-what-matters-background-paper-2024>.
[2] Ibid at 1.
[3] Ibid at 38.
[4] Ibid at 3-4.
[5] Ibid at 9, 29, 39.
[6] Ibid at 8.
[7] Ibid at 16.
[8] Ibid at 26.
[9] Ibid at 65.
[10] Ibid at 76.
[11] Ibid at 84
[12] Ibid at 87.