Dame Hazel Genn
The traditional division between justice and health is “damaging and confusing and cannot be allowed to stand”, leading legal and medical academics have argued.
Dame Hazel Genn, professor of socio-legal studies at UCL in London, and Sir Michael Marmot, professor of epidemiology and director of UCL’s Institute of Health Equity, said one of the “central lessons of public health scholarship” was that “social injustice is making people sick and ultimately costing lives”.
The academics said it was “generally accepted that an overwhelming proportion of health problems trace to social roots, rather than depending only on the biology of the individual in isolation”.
Only “society as a whole” could fix social problems. “And here’s the thing. If we can factor the law and justice system into our thinking about health in the right way, there should be less for medics to do, rather than more.”
Going right back to “crude polling questions about voter priorities”, in which GPs and hospitals “always rate highly, but courts and legal advice never register – recognising the damage that the inadequacies of legal support are doing to health services could be a way to reset the political discourse (or rather the lack of it) around civil law.”
The academics said that even a decade ago, the time GPs spent on social issues – not principally about health – was already estimated to cost the health service almost £400m a year.
“The top categories of non-medical issues involved were found to be personal relationship problems, housing, unemployment/work related issues and welfare benefits.
“Patient demand for such ‘non-health’ work places extra strains on GPs and their practices, particularly in deprived areas, and so exacerbates health inequalities.”
The academics said that recent data collected directly from GPs suggested that “one in five GP appointments (amounting to 200,000 consultations every day) are taken by ‘patients’ with non-medical issues such as seeking advice about debts, relationships or housing”.
In an essay for the collection Why Justice Matters [1], published by the Nuffield Foundation, Dame Hazel and Sir Michael said “the right framework of laws and social entitlements, together with effective and accessible courts and tribunals” was “one important means” of moving towards social justice and bolstering health.
“From the point of view of civil justice practice and advice, we can see that the law touches upon virtually every imaginable health-harming social problem – from poor housing to debt, to unfairly withheld medical services.
“To optimise population health, reduce health inequalities and relieve the crisis in primary care, something more than increased expenditure on treating disease is needed. The need is for a truly strategic approach addressing all the social causes of health problems.”
The paper pointed to grassroots efforts to develop so-called health-justice partnerships, which have been touted for some time.
In 2023, Ministry of Justice research indicated [2] that co-locating legal and health support services was producing results, with some clients saying they would not have accessed support without a healthcare professional directing them to it.
Dame Hazel and Sir Michael added: “The Labour government’s talk of making a ‘pivot’ towards prevention in the NHS could be taken as a nod in that direction. But many other governments have made similar noises before.
“If this is to become a real shift backed by serious interventions and a suitably rewired health service – the sort of shift that might stand a real chance of making the health service work better – then the law and justice system will need to be a big part in making it happen.”
Last year, Dr Liz Curran, associate professor at Nottingham Law School, wrote on Legal Futures [3] that it was time to embrace such partnerships.