Legal Determinants of Health

Social determinants of health are the social and economic conditions that have a determining impact on health at an individual and population level. Working within this framework, in 2019 the O’Neill Institute for National and Global Health Law at Georgetown University and The Lancet published The legal determinants of health: Harnessing the power of law for global health and sustainable development. This report identifies and promotes four legal determinants: provision of universal health coverage under the Sustainable Development Goals; governance of national and global health institutions; implementation of evidence-based health interventions; and building legal capacity. These determinants are dominated by the role of law in founding and governing health institutions and regulating their interventions. Such work is essential. However, the relationship between law, health improvement, and health equity articulated through these four determinants risks marginalising questions of disadvantage and inequality that social determinants of health research—and the report itself—mandate we attend to. Addressing the UK experience of COVID-19, and how social inequalities profoundly impacted experiences and outcomes in the first year of the pandemic, this article builds on the Lancet-O’Neill Commission’s important work to argue that any articulation of legal determinants of health must foreground law’s role in improving fairness in social arrangements and the distribution of resources.