Injustice Is Bad for Your Health

Violations of rights pose a fundamental threat to people’s health and well-being.

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 nonjudgmental, 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 centers, 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 enables 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 customized 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.

We hope the Good Practice Guide will inspire others to recognize 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.

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Thank you, Tamar, for this great post! It was a rewarding experience to learn from OSF's staff, partners and grantees in preparing this publication together with you.

There really is something for everyone in this Guide--from the “Laying the Groundwork” chapter on starting up programs that integrate legal and health issues as these affect socially excluded groups, to the later chapters that address monitoring the effectiveness of these programs, giving them broader voice through advocacy initiatives, and considerations relevant to program scale-up.

I found it especially inspiring to learn about so many of Open Society's diverse grantees and their amazing work in the case studies peppered throughout the Guide. It really seems that the best practices in running law-and-health programs for--and with--socially excluded communities emerge most when the implementers of these programs and their funders allow themselves to learn from one another.

Here's hoping that this Guide is disseminated far and wide and spurs many more people to recognize the importance of access to justice to public health--and particularly the health of socially excluded populations.

These words are so true and beautiful as to make me cry. For the past 6 years, no-one has mentioned [social justice, spiritual justice, physical justice, and environmental justice as holy and whole as you have. Thank You for giving me back my mind, soul, and spirit. I will gratefully volunteer in anyway I can when I am healthier.

Thank you for the kind words!

Thank you Tamar for your post on this very important practice.Integration of legal issues in palliative care services has not only empowered communities but has also improved their quality of life. Once a patient writes a will or subdivides his or her property they get contented that every thing will go according to their own wish and they have nothing to worry about. They will experience what we call "a good death" when the time comes.

This is great. Thank you for sharing!

Extremely interesting and helpful. Thanks much.

Hi Tamar,thank you for sharing your insights on the interface between health and human rights.I work with clients with substance use disorders and by the time they access treatment and rehabilitation services they have seen it all.

Persons with substance use disorders are among the socially excluded groups whose rights are greatly violated in our society and most interventions don't always ensure that this violations are addressed as part of the restitution process.

Ofcourse we need to enhance the capacity of the duty bearers to ensure that they are at the forefront of protecting this rights

Hi Adrian,

Thanks for your post – we couldn’t agree more. The complex social and health issues experienced by people who use drugs are compounded by criminalization and rights violations – making people who use drugs extremely vulnerable.

The Good Practice Guide dedicates a section to the complex interaction of health and rights for people who use drugs; and describes the integration of legal services into harm reduction services to counter discrimination, police violence, and other abuses.

We also highlight an example of an organization implementing online legal services to support people who use drugs – to ensure they understand the law and can challenge duty bearers enforcing the law. These services are equally useful for the families of people who use drugs and people in detention / prison for drug-related offences.

Naomi and Tamar

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