CBA Sept.-Oct. 2020


equity. We know that more than 60% of health is determined by social—not clini- cal—factors. Where people live, work, and play make up these social determinants of health, and racism exacerbates the hazards in each. Access to income, healthcare, safe housing, quality education and employ- ment, decision-making authority, and immigration status, all have a deep impact on health and well-being. Racism has lim- ited this access in pervasive and persistent ways. For example, consider the case of a child with asthma who is insured by Medicaid because structural racism limited their par- ents’ access to employment that provides private health coverage. Her Medicaid is improperly terminated by an administra- tive error, and thus she can’t see her doctor, obtain vital prescriptions, get vital health instructions for her school, putting her at grave, unnecessary risk and chipping away at her chance to reach her full health and human potential. Racism’s pernicious effects are writ large across healthcare. The United States significantly outspends peer nations on healthcare, but does do not get better

outcomes or longer life expectancies. And that burden is not borne equitably. In Chicago, life expectancy maps directly and unforgivably along our own Red Line tracks, rising nearly 20 years with affluence and changing race demographics as it heads south to north. Medical-Legal Partnerships What can change that? Access to legal aid, for a start. Most people living in poverty have at least one civil legal problem that negatively affects their health but aren’t reaching traditional legal aid resources. Bringing legal care and health care together can help. MLPs are innovative, evidence-based models of civil legal aid that partner health systems and legal services organizations to enhance patient and community well- being. They are part of a growing move- ment to use the power of the law to make people and places healthier. Like other specialists, MLP legal staff consult with providers about individual, systemic, and policy barriers to health. Legal teams help with income and health insurance, housing and utilities, education and employment,

legal status, and personal and family stabil- ity. Taking on this aspect of care, the legal team allows providers to focus on clinical issues during short appointments and to practice top of license. MLPs strengthen legal aid because they reach clients who otherwise would not seek legal assistance. In addition, MLPs bring legal services out of downtown office buildings back into neighborhoods. Finally, MLPs reach clients where they are, which is often in the midst of crisis, easing the burden of reaching out to a lawyer. The warm handoff from a health provider to an on-site legal helper connects clients and legal advocates who otherwise simply wouldn’t have reached each other. And we know that MLPs work. Studies have shownMLPs help people stay engaged in health treatment, reduce healthcare spending for high-need, high-use patients, and increase critical reimbursement for safety net providers. A 2016 survey show that of patients engaged with MLPs 86% reported improved health outcomes for patients.

26 September/October 2020

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