# Access to civil justice as a social determinant of health: a legal epidemiological cross-sectional study

## TL;DR

This study shows that access to civil justice affects health outcomes like quality of life and mental health, supporting its role as a social determinant of health.

## Contribution

The study provides the first empirical evidence linking access to civil justice with specific health dimensions using legal epidemiological methods.

## Key findings

- Perceived access to civil justice was negatively linked to quality of life, except for social relationships.
- Access to civil justice was positively associated with anxiety, depression, and comorbidities.
- Improving access to civil justice could promote public health through health-justice partnerships.

## Abstract

Although it is widely acknowledged that access to civil justice (ATJ) is a key social determinant of health (SDOH), the existing literature lacks empirical evidence supporting ATJ as a SDOH for specific dimensions of health.

A legal epidemiological, cross-sectional, postal survey was conducted on n = 908 randomly sampled participants in Hong Kong in March 2023. Data collected were perceptions of the civil justice system, health, and sociodemographics. Perceived ATJ was assessed using a modified version of the Inaccessibility of Justice scale (IOJ) and Perceived Inequality of Justice scale (PIJ), i.e. the “modified IOJ-PIJ”, consisting of 12 of the original 13 items from both scales divided into two subdomains: “procedural fairness”, and “outcome neutrality”. For health data, quality of life was assessed using the Hong Kong version of the Abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-BREF(HK)), psychological distress (including symptoms of anxiety and depression) was assessed using the four-Item Patient Health Questionnaire (PHQ-4), and having comorbidities was assessed using Sangha’s Self-Administered Comorbidity Questionnaire (SCQ). Structural equation modelling (SEM) was used to investigate the relationships between perceived ATJ and the measured health outcomes.

SEM demonstrated that both subdomains for ATJ had significantly negative associations (B < 0; p < 0.05) with all quality-of-life subdomains, except for between outcome neutrality with social relationships; both subdomains for ATJ had significantly positive association (B > 0; p < 0.05) with both anxiety and depression; and, after adjusting for age, only “procedural fairness” had significantly positive association (B > 0; p < 0.05) with having comorbidities.

This study provided empirical evidence that ATJ is a SDOH for specific dimensions of health. The results of this study encourage laws, policies, and initiatives aimed at improving ATJ, as well as collaborative efforts from the legal and health sectors through health-justice partnerships, and from the broader community, to safeguard and promote public health by strengthening ATJ.

The online version contains supplementary material available at 10.1186/s12939-024-02205-4.