COMMENTARY: Addressing Social Determinants Of Health Through Medical-Legal Partnerships

• Published in: Health affairs (Millwood, Va.) Va.), 2018-03, Vol.37 (3), p.378-385A
• Main Authors: Regenstein, Marsha, Trott, Jennifer, Williamson, Alanna, Theiss, Joanna
• Format: Article
• Language: English
• Subjects: Asthma; Attorneys; Clinical outcomes; Education; Employment; Environmental conditions; Fairness; Field study; Fieldwork; Food; Food security; Government grants; Health care; Health care policy; Health disparities; Health facilities; Health status; Healthy food; Home health care; Homeless people; Housing; Influence; Infrastructure; Insecurity; Intervention; Legal aid; Legal medicine; Legal system; Low income groups; Partnerships; Patients; Polls & surveys; Primary care; Pro bono services; Professionals; Public health; Questionnaires; Site visits; Social conditions; Social factors; Social problems; Social workers; Substandard; Veterans; Workforce planning
• ISSN: 0278-2715; 1544-5208
• DOI: 10.1377/hlthaff.2017.1264

The US health care system needs effective tools to address complex social and environmental issues that perpetuate health inequities, such as food insecurity, education and employment barriers, and substandard housing conditions. The medical-legal partnership is a collaborative intervention that embeds civil legal aid professionals in health care settings to address seemingly intractable social problems that contribute to poor health outcomes and health disparities. More than three hundred health care organizations are home to medical-legal partnerships. This article draws upon national survey data and field research to identify three models of the medical-legal partnership that health care organizations have adopted and the core elements of infrastructure that they share. Financing and commitment from health care organizations are key considerations for sustaining and scaling up the medical-legal partnership as a health equity intervention. Clinicians have long recognized the role that social determinants play in the health and well-being of individuals and communities. Despite these connections, the US health care system struggles to deliver comprehensive care that accounts for the social and environmental conditions of patients' lives. his article draws upon field research from the National Center for Medical-Legal Partnership at the George Washington University Milken Institute School of Public Health. We synthesized findings from two 2016 national surveys of 275 health care and 150 legal organizations that participated in a medical-legal partnership.7 (For the survey methodology, see the online appendix.)8 We also included findings from site visits and interviews with dozens of health and legal professionals involved in medical-legal partnerships nationwide in 2017. Survey responses were analyzed to identify partnerships with sufficient levels of activity for us to study their operational patterns, financial investments from health care and legal partners, and mechanisms for sharing information across organizations.