Why providers, lawyers and community-based workers are the public health dream team

PHOENIX—The things we generally view as determinants of health—genetics, personal choices, and access to high-quality care—really only play a supporting role. In fact, social, economic and environmental factors determine as much as 60% of an individual’s health status.

Those factors can make it difficult for vulnerable populations to improve their health, but with the help of medical-legal partnerships (MLPs), it’s not impossible, according to presenters at the Public Health Law Conference on Friday.

MLPs give legal and community-based professionals a voice in the healthcare realm, paving the way to remedy health disparities through civil law.

“We are one of the only countries in the world that separates access to legal services based on whether it is a criminal matter or a civil matter,” pointed out Joel Teitelbaum, co-director of the National Center for Medical-Legal Partnership. MLPs close that gap, making it easier to address the civil legal matters that influence the social determinants of health, he said. 

RELATED: To really improve patients’ health, address poverty and other social needs, physician group says

"If you consider a holistic healthcare team … it would make sense for certain segments of that patient population to have a lawyer on that team as well,” Teitelbaum said.

“This model allows everybody in the structure to work at the top of their license," added Dennis Hsieh, a physician with Harbor-UCLA Medical Center who helped launch an MLP in Los Angeles County in March.

A new study in Health Affairs highlighted evidence that links income to morbidity and mortality. Poor health also leads to lower income, which creates a "negative feedback loop."

But physicians are “not paid to think about the social determinants and to ask about the social determinants,” Hseih said. Although that’s starting to change, he advocated incorporating social factors into a quality metric or as a requirement for reimbursement.

Despite the high need for MLPs, providers often operate on limited budgets and serve a broad geographical area. LA County’s MLP and Health Forward/Salud Aledante, an MLP in the Chicago area, have devised innovative solutions to reach the most people possible in spite of these challenges.  

RELATED: Doctors say social determinants matter to patient health, but not their responsibility

LA County uses a telehealth-esque approach by accepting referrals, meeting with clients and speaking with community partners online and via phone (in addition to in-person). They also provide legal technical assistance to community-based staff to build capacity.

Health Forward/Salud Aledante worked with public health agencies to select priority neighborhoods and medical-legal issues, explained Alice Setrini, an attorney with LAF of Chicago who supervises those efforts.

An evaluation of Health Forward/Salud Aledante’s first year showed “the legal interventions are tending to improve health and patient perception of health,” Setrini said.

This success, she said, stems from its high-level, community-focused, public health approach.