Civil Legal Assistance as a Health Intervention: Evidence, Access, and Measurement

Session Submission Type: Panel

Abstract

Housing instability, benefit disputes, and eviction are increasingly recognized as drivers of poor health outcomes, yet civil legal assistance remains largely absent from the public health policy toolkit. Each year, millions of low-income households face legal proceedings that threaten their housing, income, and access to services, proceedings whose consequences extend well beyond the courtroom. A growing body of evidence links eviction and housing insecurity to elevated mortality, worsened mental health, and increased healthcare utilization. At the same time, the programs designed to help households navigate these crises, legal aid and right to counsel initiatives, have expanded rapidly across U.S. jurisdictions and faced significant retrenchment in other countries, creating natural variation that researchers are only beginning to exploit.

This panel brings together four contributions that collectively make the case for treating civil legal assistance as a domain of health policy. The papers span national contexts, populations, and methods, but converge on a shared question: what happens to health when people gain or lose access to legal support in civil matters, particularly housing? The panel examines the causal effects of legal aid provision and withdrawal on mortality, homelessness, and mental health; investigates the downstream consequences of housing court proceedings for children's wellbeing; identifies barriers that prevent marginalized populations, including people who use drugs, from accessing the legal representation to which they are formally entitled; and interrogates what legal services do and do not measure about disability at intake, surfacing gaps in data infrastructure that limit our understanding of how people with disabilities experience the system.

Together, these papers challenge the siloed treatment of legal aid as a justice issue and housing policy as separate from health. They demonstrate that legal assistance operates as an upstream intervention: resolving financial distress, preventing displacement, reducing psychological burden, and connecting households to services they would not otherwise access. They also reveal that the promise of legal representation depends critically on implementation, on whether eligible populations can reach services, whether providers have the capacity and data to serve them, and whether intake systems capture the complexity of the needs they encounter.

The panel speaks to multiple APPAM constituencies. For health policy researchers, it identifies a modifiable determinant of health that operates outside the healthcare system. For housing scholars, it documents the health externalities of eviction policy and tenant protection. For those concerned with program design and equity, it highlights barriers to access that formal entitlements alone do not resolve. As right to counsel programs expand across U.S. states and cities, and as other countries revisit the scope of publicly funded legal assistance, the question of whether and how these programs affect health is both timely and consequential.

Policy Area

• Housing, Community Development, and Urban Policy

Chair

• John Pollock, National Coalition for a Civil Right to Counsel

Discussants

• Leah Robinson

• Kathryn M Leifheit, University of California - Los Angeles

Organizer

• Juliet-Nil Uraz, London School of Economics and Political Science

Individual Presentations

• Justice Under Austerity: Evidence from Legal Aid in England and Wales - Presenting Author: Juliet-Nil Uraz, London School of Economics and Political Science

• Disability Data in Eviction Right to Counsel Programs - Presenting Author: Neil Steinkamp, Stout Risius Ross LLC

• Right-to-Counsel: Impacts, Implementation Challenges, and Implications for People Who Use Drugs - Presenting Author: Hridika Shah, Johns Hopkins University

• Universal Access to Counsel, Housing Court, and Child Mental Health: Evidence from New York City - Presenting Author: Michael Thomas Cassidy, Icahn School of Medicine at Mount Sinai