The innovation of health justice partnerships is collaboration that embeds legal help into healthcare services and teams. It is now a movement attracting interest from practitioners, researchers, policymakers and funders.
Since the World Health Organization’s groundbreaking report from the Commission on Social Determinants of Health (2008), evidence has continued to grow regarding the importance of social and environmental factors in driving poor health outcomes for individuals and communities. These factors include poor-quality housing, unstable or insecure work, limited income and low social support.
Meanwhile, in 2012 a landmark Australian study into legal need established that over one-fifth of people in Australia experience three or more legal problems in a given year, many of which are associated with increased risk of physical or mental illness. Many people seek no advice for these problems, but when they do, they are more likely to ask a non-legal advisor, such as a health professional, than a lawyer. Taken together, the health and legal research points to common groups of people who are vulnerable to intersecting health and legal issues, but are more likely to turn to a non-legal advisor, such as a health professional, than a lawyer.
In response to this evidence, health and legal services have come together in a range of ways, including as health justice partnerships. Since 2012, this evolving practice has seen a growing number of service collaborations across Australia. However, Health Justice Australia’s 2017 survey of services that identify as health justice partnerships revealed no single or unanimous understanding of what a health justice partnership is. On the contrary, it indicated a range of service models on the health justice landscape that, while all seeking to bridge the divide between health and legal silos, had some key points of difference. Importantly, while research indicates the value of health and legal services collaborating to address unmet health harming legal need, we do not yet know what works best, for whom, in what circumstances and at what cost. This is a key agenda for Health Justice Australia. If we want to know and promote what works, we need to be clear about what the ‘what’ is: what makes a service a health justice partnership and what features are key to its effectiveness. This clarity of definition is important for planning, implementation, evaluation and improvement, in addition to explaining the rationale for policy and funding support.
The purpose of this discussion paper is to propose a definition of a health justice partnership and to identify key features of this model. The paper explores what takes a health justice partnership beyond standard services in terms of purpose, structure, activity and resourcing, and notes points of difference with other service models on the health justice landscape.
Broadly speaking we propose that ‘health justice partnerships’ are collaborations to embed legal help in healthcare services and teams. While models vary and evolve over time, HJPs commonly work to improve health and wellbeing: for individuals, through direct service provision in places that they access; for people and communities vulnerable to complex need, by supporting integrated service responses and redesigning service systems around client needs and capability; and for vulnerable populations through advocacy for systemic change to policies which affect the social determinants of health.
For some on the health justice landscape, the health justice partnership features we outline will be reflected in their current service. Others may be working towards those features. For others again, the health justice partnership model proposed here may contrast with a model of service they are operating or that they aspire to. The choice of approach will depend upon the needs of clients or patients, the intent of the service and/or partners, and the resources and commitment available to develop the service model. As evidence becomes available, decisions will also be influenced by the relative cost and impact of each service model in each context. We hope the ideas we have set out in this paper provide a useful starting point for dialogue, as we move towards a shared understanding between practitioners, researchers, policymakers and funders of what it means to be a health justice partnership.
