When police officers arrest or harass those who try to access needle-exchange services, they force people who use drugs to choose between their health and their liberty. When women are denied access to land and property, they face poverty, increased risk of HIV infection, and a diminished ability to cope with illness. When doctors violate Roma patients’ consent and confidentiality, they imbue medical care with humiliation and abuse. When dying patients and their families are too uninformed or overwhelmed to confront complex legal questions, they may leave inheritance questions unresolved, children uncared for, and social benefits unclaimed. Thankfully, programs that improve people’s access to justice can help.
Since 2007, Open Society and our partners have experimented with a variety of approaches to improving access to justice for people who are socially marginalized – from people who use drugs and sex workers, to Roma, palliative care patients, and people living with HIV. We have found success with peer paralegals who are trusted members of the community being served. We’ve engaged lawyers who take their practice beyond the office walls and nine-to-five workday, to connect with communities where they are. We have integrated legal services into medical settings, bringing counselors into the doctor’s office. We have supported web-based legal advice, and harnessed traditional authorities – like local chiefs – to strengthen human rights understandings.
In our new publication: Justice Programs for Public Health: A Good Practice Guide, we take stock of our work and draw lessons to share more widely. In particular, six key findings emerge:
1. Raising rights awareness is a prerequisite to legal services
Raising rights awareness for socially excluded groups is essential to effective justice programing. People will not access legal services until they understand that they have rights that are being violated. They need to be able to connect their experiences with the law and available remedies. Moreover, human rights trainings for duty bearers – such as law enforcement agents, government officials, and community leaders – are critical to creating an environment where rights are protected and enforced.
2. Peers play a critical role
Paralegals drawn from the communities they serve have the community’s trust and, therefore, better access. They also have greater familiarity with community needs. As one sex worker said: “We speak the same language.” Community paralegals are particularly well placed to deliver rights education and provide ‘legal first aid’, responding quickly to violations, addressing multiple needs that are not just legal, and connecting their peers to further support as needed.
3. Lawyers need to meet communities where they are
Lawyers can best serve socially excluded groups when “lawyering for the marginalized.” This entails working outside regular office hours, engaging in outreach, and meeting clients ”where they are at,” embracing a non-judgemental, harm reduction philosophy. To address the needs of sex workers or people who use drugs, legal support must be available when abuse and arrests take place late at night. Similarly, to support people in need of palliative care or people living with HIV, legal services must be brought to the community, rather than requiring them to make a special trip. This means engaging clients through support groups and at street-based locations, harm reduction sites, detention centres and more.
4. Integrating law and health services leads to better access and care
Integrating legal services into trusted community health services increases access to justice, as well as enabling holistic care. Just as HIV-specific clinics can tailor their medical care to the specific health needs of their patients, HIV-specific legal services housed in these clinics can provide customised services in a climate of respect and trust. In the context of harm reduction, palliative care, or HIV care, people are already accessing medical services. When legal services are added, it is possible to address some of the underlying determinants of ill health, such as discrimination, violence, and lack of housing, rather than just the symptoms. Justice serves as a powerful medicine, helping to heal.
5. Legal services are not enough
Legal services for socially excluded groups generally work best when paired with psychosocial support and other services. Sex workers and people who use drugs may benefit from the services of a social worker to help stabilize their lives. Palliative care patients may need pain relief, as well as psychological and spiritual support. When these additional services are provided, people are in a better position to follow up with a case. Effective referral networks and follow-up are thus essential.
6. Legal services are a step towards systemic change
It is not possible to strive for systemic change without addressing a community’s pressing daily concerns, including basic safety. Individual-level legal services further lay the groundwork for addressing systemic abuse by surfacing issues for broader advocacy. Legal services and advocacy are thus interlinked and complement each other.
Access to justice in palliative care
Access to justice is critical to palliative care’s holistic approach relieving not just physical pain, but also providing psychosocial support. Common legal problems impacting patient well-being include:
- navigating regulations to access pain relief
- dealing with debt and accessing social benefits
- planning for children and the disposition of property; and
- combating discrimination, particularly in HIV cases.
When these issues are addressed, justice can serve as medicine, contributing to peace of mind and quality of life. The Good Practice Guide showcases innovative models by groups in different parts of the world integrating legal services into palliative care. It also includes reflections and good practices based on years of work in this area. Hopefully, this will be a resource for others interested in bringing justice to palliative care patients and families.
We hope the Good Practice Guide will inspire others to recognise the critical importance of justice for health, leading to expansion of this work and interest by investors in health. We hope others will build on our lessons, sharing their own insights and good practices, bringing justice to health in other regions, as well as to socially excluded populations more broadly.
Tamar Ezer is deputy director of the Law and Health Initiative of the Open Society Public Health Program.
This article is based on an Open Society Foundations ‘Voices’ blog, entitled: ‘Injustice Is Bad for Your Health’.