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Loyola University Chicago School of Law

Issues and Trends in Health Law: Interdisciplinary Health Partnership to Address Health Disparities Public Interest Law Initiative Fellowship Program July 9, 2013. Loyola University Chicago School of Law. Emily A. Benfer Clinical Professor of Law ; Director, Health Justice Project

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Loyola University Chicago School of Law

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  1. Issues and Trends in Health Law: Interdisciplinary Health Partnership to Address Health DisparitiesPublic Interest Law Initiative Fellowship ProgramJuly 9, 2013 Loyola University Chicago School of Law Emily A. Benfer Clinical Professor of Law; Director, Health Justice Project ebenfer@luc.edu
  2. Agenda for Today

  3. 1. Community Need

    Social Roots of Health
  4. Federal poverty thresholds & Guidelines 2013 Federal Poverty Guidelines 2011 Federal Poverty Thresholds Source: Federal Register, Vol. 78, No. 16, January 24, 2013, pp. 5182-5183; United States Census Bureau
  5. Social Roots of health Disparities in Chicago 1,513,538 peopleor 57% at or below the poverty line in Chicago 3rd highest rate of extreme poverty in the nation at 10.4% Source: Heartland Alliance, Illinois’s 33%: Report on Illinois Poverty (January 3013)
  6. Social Roots of health Disparities in Chicago Poor Housing Conditions Lead poisoning Asthma Physical and Mental Disabilities Developmental Delays Injury Lack of Income (Public Benefit/Disability Denials) Hunger and Malnutrition Low-birth Weight Developmental Delays Chronic Health Conditions Depression 81,000 children harmed by lead paint Higher asthma mortality rate and double hospitalizations than rest of U.S. 383,954 Chicagoans live in a food desert 581,558 (20.6%) people are food insecure 124,228 children live in food desert(enough children to fill 2,484 school buses) Large immigrant population
  7. Singular Approach to Health “Medicine, if it is to improve the health of the public, it must attend at one and the same time to its biologic and to its social underpinnings. It is paradoxical that, at the very moment when the scientific progress of medicine has reached unprecedented heights, our neglect of the social roots cripples our effectiveness.” Dr. Paul Farmer paraphrasing Dr. Rudolf Virchow, 19th Century German Physician
  8. Overwhelming legal NeedAttorney to Potential Client Ratio Legal Aid Attorney = 200 people Private Attorney
  9. Silos Between Professions Lack of interdisciplinary collaboration Assumptions about other professions No referrals

  10. 2. Interdisciplinary response

    To improve health of low-income individuals
  11. Components of Response Interdisciplinary partnership to address whole patient Early identification of health-harming legal issues  before they proliferate Engage in preventative lawyering and advocacy Surface systemic issues and engage in policy reform Train students of law, medicine, social work and public health to work together to address health disparities among low-income populations
  12. Interdisciplinary Example:Health Justice Project To address poverty and achieve health justice through social, legal and systemic solutions by Providing students of Law, Medicine, Public Health and Social Work with an intensive, challenging education in the fundamentals of practice, effective problem-solving, leadership, and interdisciplinary collaboration; Collaborating with other disciplines, community members, advocates and stakeholders to employ a comprehensive approach to eliminate social determinants of health; Shaping public policy to create health justice; Providing highly effective, quality legal representation to low-income individuals to address health harming legal and social issues; and Promoting best practices to achieve widespread social change
  13. Interdisciplinary Collaborationto Improve Community Health Loyola University Chicago/Beazley Institute for Health Law and Policy Erie Family Health Center Northwestern McGaw Family Medicine Residency Program Equip for Equality AIDS Legal Council of Chicago Loyola School of Medicine Lawyers’ Committee for Better Housing Legal Allies
  14. Addressing Health-Harming Legal Needs Income– applications, medical debt forgiveness Housing–conditions, utilities eviction defense,homelessness Education–disabled, pregnant and homeless students Appeals–public benefits and disability denials Legal Referrals to Partners and Allies
  15. Policy Advocacy

  16. 3. Health justice project outcomes

  17. Select Outcomes Trained over 200 health care providers in identifying health harming legal needs and health advocacy Addressed approximately 1,200 legal issues for patients/clients Contributed equivalent of over $4 million in attorney’s fees $600,000 in medical debt forgiveness $550,000 in Medicaid reimbursement $200,000 in Social Security Disability income 100% success on Social Security Appeals Reduced housing expenses by $38,000 Created interdisciplinary teams to address local and national policy issues
  18. Result: Break Down Silos Source: National Center for Medical-Legal Partnerships

  19. 4. Case Study

  20. Case Study: HJP v. The Rats Child is getting worse by the day Meanwhile, the child is getting worse by the day!
  21. Case Study: HJP v. The Rats What do you do? Who do you want on your team? How do you prioritize possible responses?
  22. Case Outcome: HJP PREVAILS! Social Work Team Members counseled mother on domestic violence issue and assisted with housing search Legal Team Members protected family’s right to vacate the unit without penalty and negotiated return of security deposit and damages Medical Team Members continued to monitor child’s respiratory distress (marked improvement) Partners worked to identify other tenants in building and possible interventions

  23. 5. Summary & Application

  24. Conclusion The Problem Low-income individuals and families encounter negative health outcomes at a higher rate than the rest of the population All legal aid clients are at risk of poor health outcomes Majority of health problems among low-income individuals require more than medical intervention Current system forces attorneys to become “Downstreamers” The Solution Early identification to meet the client before problem proliferates Interdisciplinary and “whole” patient intervention (say no to the silo!) Surface patterns Collaborate on policy reform
  25. Application Know your motivation (What drives you toward social change?) Identify the problem and root causes Identify what victory looks like Conduct a stakeholder analysis Be creative; use all your advocacy tools Join forces

  26. 6. Questions & Discussion

  27. Issues and Trends in Health Law: Interdisciplinary Health Partnership to Address Health DisparitiesPublic Interest Law Initiative Fellowship ProgramJuly 9, 2013 Loyola University Chicago School of Law Emily A. Benfer Clinical Professor of Law; Director, Health Justice Project ebenfer@luc.edu
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