Health problems? You might need a lawyer after you see that doctor. That’s the rather disturbing conclusion of a report issued last week by the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at The George Washington University School of Public Health and Health Services. The researchers found that between 50 and 85 percent of people visiting community health centers - between ten and seventeen million people – experience unmet legal needs that often negatively impact their health. Often, these people need advocacy to change the things in the social and physical environment that influence their health, called social determinants of health, as much or more as they need medical care. That number is likely to increase, they predicted, “given the profound changes in eligibility, plan enrollment, provider selection, and service delivery embodied in the newly enacted health reform law.”
Translation: Health-care reform means that more poor people are going to have access to health care, and once they start walking into doctors’ offices, we won’t be able to ignore the social underpinnings of poor health. In the public health world, those differences in health status are called “disparities.” We know that in the United States, if you happen to be a minority and low income (which often go hand in hand), you’re likely to have poorer health than your white, middle- or upper-class counterparts. People in low-income communities are more likely to live in substandard housing, unsafe neighborhoods, be exposed to environmental toxins, have less access to fresh foods, are exposed to more advertisements for tobacco, alcohol, and other health-degrading substances, and… and… and…
Ouch. The report focuses on an important distinction between health and health care, one that’s rather uncomfortable to talk about here in the land of opportunity and freedom. As the researchers note, “Though the consequences of complex social problems and associated health disparities – such as substandard housing and environmental conditions – can be treated medically, their causes are social and are often more successfully remedied through legal, rather than medical channels.”
The researchers propose that medical-legal partnerships (MLPs), which are now available at over 180 hospitals and health centers across 38 states, are one way to address the legal needs of low-income and vulnerable patients. In MLPs, health-care staff identify legal problems, refer patients to an affiliated lawyer or legal services team, and work alongside attorneys to mitigate or resolve problems that negatively affect patient health. People can receive help getting health-care and other public benefits, addressing housing issues, and obtaining support for family and domestic crises. The GWU research team also said they thought community health centers are the no-brainer places to start fostering more of these MLPs. Community health centers, they said, “could serve as an excellent entry point for low-income populations to legal services, with medical-legal partnerships serving as important catalysts to improve the overall health of their low income and vulnerable patients.”
All I can say is hats off to the GWU research team. We need to stop talking about who is going to pay for health care and start addressing the social determinants of health — the true underlying causes of poor or good health. In the long run, this study may be more important to the overall health of people in the United States than the inevitable host of clinical studies examining new drugs, vaccines, and other medical treatments. We may have health-care reform in the making, but we don’t yet have health reform on the way. The health status of the U.S. population will improve only when we accept that health should not — and in an ethically and morally sound world, cannot — be determined by the happenstance of being born poor, an ethnic or racial minority, or in a certain geographical area. And that may take as many lawyers as health-care providers.