Legal aid cuts will add up to poorer health for vulnerable people

They may look like savings, but in the end cuts to legal clinics will end up costing much more

I’m not a lawyer — I’m a doctor. But I was near stunned by the announcement of deep cuts to Ontario’s legal aid system.

I have worked closely with legal aid clinics and legal aid-funded practitioners for more than a decade, to improve the health of my patients and of our society.

Many of my patients have legal needs that require expert intervention to maintain their social and medical stability. This is not news. Almost every doctor is asked to help their patients navigate the legal system, for issues ranging from family discord to accessing disability supports.

In 2013, legal and health practitioners came together to discuss how to better collaborate to improve our low-income clients’ health and access to justice. From these meetings emerged the Health Justice Program, which embeds a legal aidfunded lawyer right in our health team.

This lawyer is focused on the legal needs of our most vulnerable patients, and demand for her services is high and growing. Similar initiatives are emerging across Ontario.

I have also collaborated with legal aid clinics. Neighbourhood legal clinics, which are deeply knowledgeable about the threats to health faced by my patients and community, are now facing crippling funding cuts.

And specialty legal clinics, including those focused on poverty, disability, HIV and Indigenous peoples, are also facing devastating cuts.

As a doctor, I spend my time immersed in patients’ stories, and I hear how laws and government regulations directly impact people’s lives. For example, challenges people with disabilities face in ensuring social services are accessible, or fears people with HIV have that they could face prosecution if they reveal their status to partners.

Legal aid clinics are particularly well positioned to see the patterns of impact on their clients. They hold the expert knowledge to advocate for change and are essential to ensuring those who are most vulnerable are treated fairly under the law.

Access to justice has been recognized in the scientific literature as a social determinant of health. When people are denied the ability to advocate for their legal rights, they are left with high levels of stress, in worse poverty, and in increasingly vulnerable situations. This leaves them in poorer health and puts a higher demand on the health system.

As with most cuts to essential social services, policies that look like savings from one angle often cost us more, in increased health costs and lost productivity. My workload as a doctor increases. My patients’ health worsens.

And our social fabric frays, as it has with each of this government’s cuts to essential social services and supports.

Some have called this death by a thousand cuts. I call this a thousand deaths by a thousand cuts.

This so-called drive to austerity results in real and tangible impacts on our health — we get sicker faster, and we die sooner.

This is not hyperbole. This is the reality of ignoring the evidence that tells us that access to basic social supports, including access to legal aid, is a true and essential determinant of our health.

Some have called this death by a thousand cuts. I call this a thousand deaths by a thousand cuts.