The Legal Aid Effect on Health Outcomes

A study recently published in the Canadian Medical Association Journal (CMAJ) showed that every dollar spent on social programs is associated with a 0.1% decrease in potentially avoidable mortality and a 0.1% increase in life expectancy. Both results were statistically significant. This analysis of social and health care spending in 9 provinces from 1981 to 2002 concludes that population health outcomes would be improved if government spending were reallocated from health to social spending (“Effect of provincial spending on social services and health care on health outcomes in Canada: an observational longitudinal study”, Daniel J. Dutton et al, CMAJ 2018 January 22:190:E66-71.doi: 10.1503/cmaj.170132; also “Prescription for a healthier population: spend more on social services”, Monday January 22, 2018, Further, the Canadian Forum on Civil Justice’s Cost of Justice “Overview Report” and recently published Cost of Experiencing Everyday Legal Problems reports related to Physical and Mental Health, Social Assistance, Loss of Employment and Loss of Housing offer additional quantitative data and insights on the economic, social and health-related consequences of experiencing civil and family justice problems in Canada. These (and other) Canadian studies add to the growing body of research in support of boosting civil legal aid.

Civil legal aid assists people in obtaining access to benefits and entitlements that are among the important social determinants of health. Accessing government benefits, assuring employment protections and obtaining housing without discrimination can contribute to improvements in health outcomes and theoretically reduce costs.

However, there is more to it from the legal aid perspective. We know from legal problems research that large numbers of people do not identify the problems they experience as legal and do not seek or obtain assistance to protect their rights and obtain benefits and entitlements. Civil legal aid delivery that is built on outreach might further enhance the legal aid effect on health outcomes by learning from communities about the problems affecting individuals then engaging those communities to develop appropriate and effective solutions. The writer is currently working with one of the many innovative community legal clinics in Ontario, Halton Community Legal Services, as that clinic develops multiple, interconnected forms of outreach to identify hidden legal need and provide assistance to hard-to-reach populations, focusing to a large degree on those legal problems that are social determinants of health.

Governments should recognize the societal and, particularly, health care benefits that could be gained from a greater investment in civil legal aid. Legal aid should develop forms of outreach that would maximize the legal aid effect.

Ab Currie, Ph.D.
Senior Research Fellow
Canadian Forum on Civil Justice


  1. So $1,000 spent on social programs will decrease mortality by 100% and double life expectancy. That’s very impressive, especially since it’s “statistically significant”

  2. What about the question of providing Legal Aid as a disability accommodation for those who can not mount a full answer and defence and secondly what about giving public access to the research that is available to Legal Aid lawyers, precedents and case law? Might make self-represented respondents a small touch better informed and better informed to make decisions about their case or lack of case?

  3. The manner in which you characterize the CMAJ paper is almost totally inaccurate. That paper addresses the *ratio* between social spending and healthcare spending. The results in the paper are expressed *per cent*, not *per dollar*, and the increase in life expectancy is *0.01%*, not 0.1%.