Medical-Legal Partnership|Philadelphia: Meeting Basic Needs and Reducing Health Disparities by Integrating Legal Services into the Healthcare Setting

Abstract

Summary

Adverse social conditions make people vulnerable to poor health, and poor health makes people even more vulnerable to adverse social conditions. This cycle of vulnerability drives health disparities in the United States: Low-income individuals and racial/ethnic minorities are disproportionately affected by a range of acute and chronic medical conditions such as asthma, diabetes and hypertension, and suffer worse health outcomes. In urban centers like Philadelphia, there is significant overlap between these two populations, resulting in concentration of risk in medically underserved communities.

Data have also shown that health and the quality of health care are a function of not only access to health care, but also of social determinants—including socioeconomic status, race/ethnicity and the physical structure of communities—that directly and indirectly affect the health and well-being of individuals and communities. The social and material needs that correlate with the social determinants are intended to be met by government and public programs designed to increase access to food, housing, income, utilities and insurance. Unfortunately, safety-net programs have become so complex as to be inaccessible to those who need them and are inconsistently implemented and enforced.

At the same time, our nation’s current legal system does have the capacity to meet the civil legal needs of low-income people. A low-income household has, on average, between one and three unmet civil legal needs. However, 80 percent of these problems go unaddressed by a legal aid organization or pro bono attorney. Many people do not recognize their problem as a legal one or seek legal services. And despite an almost 20 percent increase in the number of legal aid attorneys between 2002 and 2007, there is only an estimated 1 legal aid attorney for every 6,415 low-income individuals..

Traditional law and health care treat the problems of poor health and adverse social conditions in isolation; however, breaking this cycle of vulnerability is more likely if the professions marshal their collective resources to improve both health and social well-being. Medical-legal partnerships (MLPs) bring the legal community together with health systems and health providers to harness the power of two disciplines toward the improvement of individual and community health and well-being. MLPs integrate lawyers into the healthcare setting to reduce barriers to health care and help patients navigate the complex legal systems that often hold solutions to problems associated with many social determinants of health.

MLP|Philadelphia, a partnership between the Legal Clinic for the Disabled and the Family Practice & Counseling Network (FPCN), is the first MLP in the nation to integrate legal services into a nurse-managed healthcare setting. FPCN serves over 13,000 of Philadelphia’s most vulnerable individuals each year, the significant majority of whom have multiple coexisting social and legal problems. Nurse practitioners provide high-quality, comprehensive primary care and are able to diagnose and treat illnesses as well as prescribe medications to treat acute and chronic illnesses. FPCN takes a holistic approach to care and also offers its patients behavioral, dental and prenatal services. A lawyer has been added as an integral part of this interdisciplinary healthcare team to provide more comprehensive patient care and reduce health disparities.