What’s Law Got to Do With It? How Medical-Legal Partnerships Reduce Barriers to Health

Jul 8, 2015, 4:59 PM, Posted by Ellen Lawton, Megan Sandel

Civil legal aid agencies are a proven resource for clinics to support patient needs and achieve health equity by addressing the social barriers to health.

Dr. Alicia Turlington consults with attorney Randy Compton at the Medical-Legal Partnership for Children at Kokua Kahili Valley health center. (Image via Joseph Esser)

A lawyer as part of the health care team? It's not as strange as it sounds. Many of the social conditions that impede health, such as housing, education, employment, food and insurance, can be traced to laws unfairly applied or under-enforced, often leading to the improper denial of services and benefits designed to help vulnerable people.  

There are eight thousand civil legal aid lawyers in the U.S., and much of their work is directly related to improving health. They ensure access to food, health benefits and insurance for their clients. By fighting for better housing conditions and preventing evictions, they help create healthier physical environments. They help keep families safe and stable by establishing guardianships.

There is evidence that lawyers are more critical than ever to the health of vulnerable people. Each year the Department of Veterans Affairs surveys homeless veterans; the most recent CHALENG survey found that six of the top 10 barriers to housing were legal in nature. And a recent study at Lancaster General Hospital found that each of the hospital's highest-need, highest-cost patients had two to three health-harming civil legal problems.

To address these issues, health care institutions are increasingly forming medical-legal partnerships (MLP) with civil legal aid agencies, where lawyers work on-site at clinics to help screen for and treat patients’ social problems. Lancaster General introduced an attorney into its care team for high-need, high-cost patients. The lawyer helps identify legal problems, supports and extends the work of the case management team, and represents patients with housing, insurance, disability, safety, and employment-related legal needs. Once legal problems were resolved, hospital admissions for these patients dropped dramatically, and costs fell 45 percent per patient.

There are now 273 hospitals and health centers in 36 states partnering with civil legal aid agencies and law schools to screen for and remedy the social barriers that affect the health of vulnerable people. And in April, more than 400 doctors, nurses, social workers, lawyers and public health professionals gathered for the 10th annual MLP Summit to discuss the next frontier for these cross-sector partnerships. The vision: moving from one-on-one interventions to detecting and addressing systemic inefficiencies in clinics and public policies that impact population health.

For example, at Cincinnati Children’s Hospital Medical Center three patients were being threatened with eviction for asking their landlords to improve substandard housing conditions. Doctors there sent the patients to an on-site attorney from Legal Aid Society of Greater Cincinnati. The lawyer discovered that all three lived in buildings owned by the same landlord. By sharing data about asthma admissions and housing code violations, they were able to “hotspot” substandard housing clusters, and together helped get 19 buildings rehabbed and under new management. The reconditioned buildings did not just help those three families; they stocked the healthy housing pharmacy for more people in the community.

Cross sector partnerships like these have the potential to help professionals create health equity, and a build a Culture of Health in which everyone has the opportunity to attain his or her full health potential, and where no one is disadvantaged by social conditions.