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Towards Racial Justice: The Role of Medical-Legal Partnerships

Published online by Cambridge University Press:  04 March 2022

Medha D. Makhlouf
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Abstract

Medical-legal partnerships (MLPs) integrate knowledge and practices from law and health care in pursuit of health equity. However, the MLP movement has not reached its full potential to address racial health inequities, in part because its original framing was not explicitly race conscious.

Keywords

Medical-Legal PartnershipHealth EquityStructural Determinants of HealthRacismPoverty
Type
Symposium Articles
Information
Journal of Law, Medicine & Ethics , Volume 50 , Issue 1: Health Law and Anti-Racism: Reckoning and Response , Spring 2022 , pp. 117 - 123
Copyright
© 2022 The Author(s)

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References

See Ford, C.L. and Airhihenbuwa, C.O., “The Public Health Critical Race Methodology: Praxis for Antiracism Research,” Social Science & Medicine 71 (2010): 1390–1398, at 1396.Google ScholarPubMed
Id.Google Scholar
See, e.g., Jones, C.P., “Confronting Institutionalized Racism,” Phylon 7 (2003), at 7; American Public Health Association, “Research and Intervention on Racism as a Fundamental Cause of Ethnic Disparities in Health,” American Journal of Public Health 91, no. 3 (2001): 515-516; D.R. Williams et al., “The Concept of Race and Health Status in America,” Public Health Reports 109, no. 1 (1994): 26-41. Some empirical studies have begun to investigate and explain the relationship between structural racism and poor health, but there is a need for more research in this area to expand the evidence base. See Z. Bailey et al., “Structural Racism and Health Inequities in the USA: Evidence and Interventions,” Lancet 389 (2017): 1453-1463, at 1457.Google Scholar
See Jones, supra note 3, at 8.Google Scholar
See Benfer, E. et al., “Health Justice Strategies to Combat the Pandemic: Eliminating Discrimination, Poverty, and Health Disparities During and After COVID-19,” Yale Journal of Health Policy, Law, and Ethics 3 (2020): 122–171, at 130.Google Scholar
Yearby, R., “Structural Racism and Health Disparities: Reconfiguring the Social Determinants of Health Framework to Include the Root Cause,” Journal of Law, Medicine & Ethics 48 (2020): 518–26, at 518.CrossRefGoogle ScholarPubMed
Yearby, R. and Mohapatra, S., “Law, Structural Racism, and the COVID-19 Pandemic,” Journal of Law & the Biosciences 7, no. 1 (2020): 1–20, at 3-4.Google ScholarPubMed
Zuckerman, B. et al., “Medical-Legal Partnerships: Transforming Health Care,” The Lancet 372 (2008): 1615–1617, at 1616.10.1016/S0140-6736(08)61670-0CrossRefGoogle ScholarPubMed
Regenstein, M. et al., “Addressing Social Determinants of Health through Medical-Legal Partnerships,” Health Affairs 37, no. 3 (2018): 378–385, at 380.CrossRefGoogle ScholarPubMed
Penn State Dickinson Law, “Medical-Legal Partnership Clinic,” available at <https://dickinsonlaw.psu.edu/medical-legal-partnership-clinic> (last visited December 10, 2021).+(last+visited+December+10,+2021).>Google Scholar
See, e.g., Complaint for Declaratory and Injunctive Relief, Chinatown Service Center v. HHS (D.D.C. 2021), (No. 1:2021cv0031) (challenging a regulation that rolled back protections against discrimination in health care access, including language access provisions, during the COVID-19 pandemic).Google Scholar
See, e.g., National Health Law Program, Administrative Complaint, Discriminatory Provision of COVID-19 Services to Persons with Limited English Proficiency (April 30, 2021).Google Scholar
See C. Goldberg, “Boston Medical Center Turns to Lawyers for a Cure,” New York Times, May 16, 2001, at A20, available at <https://timesmachine.nytimes.com/timesmachine/2001/05/16/339733.html?pageNumber=18> (last visited December 10, 2021). Medical-legal collaborations to improve patients’ health — including joint advocacy by attorneys on staff at the Delta Health Center in Mound Bayou, Mississippi, in the 1960s, and Whitman-Walker Health in Washington, D.C., in the 1980s — existed long before this. See Teitelbaum, J. and Lawton, E., “The Roots and Branches of the Medical-Legal Partnership Approach to Health: From Collegiality to Civil Rights to Health Equity,” Yale Journal of Health Policy, Law & Ethics 17, no. 2 (2017): 343–377, at 355. However, the MLP model developed in Boston was the one which inspired the current movement.Google Scholar
Goldberg, supra note 13, at A20.Google Scholar
National Center for Medical-Legal Partnership, “Medical-Legal Partnerships across the U.S.,” available at <https://medical-legalpartnership.org/partnerships/> (last visited December 10, 2021).+(last+visited+December+10,+2021).>Google Scholar
National Center for Medical-Legal Partnership, “International Medical-Legal Partnerships,” available at <https://medical-legalpartnership.org/partnerships/international/> (last visited June 28, 2021).+(last+visited+June+28,+2021).>Google Scholar
Biden, J.R. Jr., “Memorandum on Restoring the Department of Justice’s Access-to-Justice Function and Reinvigorating the White House Legal Aid Interagency Roundtable,” The White House, May 18, 2021, available at <https://www.whitehouse.gov/briefing-room/presidential-actions/2021/05/18/memorandum-on-restoring-the-department-of-justices-access-to-justice-function-and-reinvigorating-the-white-house-legal-aid-interagency-roundtable/> (last visited December 10, 2021).+(last+visited+December+10,+2021).>Google Scholar
See, e.g., Zuckerman, B. et al., “Why Pediatricians Need Lawyers to Keep Children Healthy,” Pediatrics 114, no. 1 (2004): 224–228, at 226.CrossRefGoogle ScholarPubMed
Id.Google Scholar
J. Trott et al., Financing Medical-Legal Partnerships: View from the Field, National Center for Medical Legal Partnership, April 2019, at 3-5.Google Scholar
Teitelbaum, J.B. et al., “Striving for Health Equity through Medical, Public Health, and Legal Collaboration,” Journal of Law, Medicine & Ethics 47, no. S2 (2019): 104–107, at 106.CrossRefGoogle ScholarPubMed
Tobin-Tyler, E. and Teitelbaum, J.B., “Medical-Legal Partnership: A Powerful Tool for Public Health and Health Justice,” Public Health Reports 134, no. 2 (2019): 201–205, at 201.CrossRefGoogle ScholarPubMed
See, e.g., Teitelbaum and Lawton, supra note 13, at 369.Google Scholar
Zuckerman et al., supra note 8, at 1616.Google Scholar
Id. Less commonly, legal services providers in MLPs facilitate existing or new clients’ access to integrated medical care. One example is Terra Firma, an MLP that serves unaccompanied immigrant children. Terra Firma, available at <terrafirma.nyc> (last visited August 13, 2021).+(last+visited+August+13,+2021).>Google Scholar
See, e.g., Regenstein et al., supra note 9, at 380.Google Scholar
Teitelbaum et al., supra note 21, at 105.Google Scholar
See, e.g., Braveman, P.A. et al., “Health Disparities and Health Equity: The Issue is Justice,” American Journal of Public Health 101, no. S1 (2011): S149–S155, at S151.CrossRefGoogle ScholarPubMed
Teitelbaum and Lawton, supra note 13, at 366.Google Scholar
See, e.g., Teitelbaum et al., supra note 21, at 105.Google Scholar
Martinez, O. et al., “Bridging Health Disparity Gaps through the Use of Medical Legal Partnerships in Patient Care: A Systematic Review,” Journal of Law, Medicine & Ethics, 45 (2017): 260–273, at 261, 269. The authors note the need for more “rigorous, replicable evaluations” of the MLP model generally. Id., at 266. There is evidence that MLPs positively impact patients’ health and wellbeing, housing and utility stability, and access to financial resources and concrete supports; health care systems and workforce; and policies, laws, and regulations. C. Murphy, Making the Case for Medical-Legal Partnerships: An Updated Review of the Evidence, 2013-2020, National Center for Medical-Legal Partnership, January 6, 2021, at 5.Google ScholarPubMed
See, e.g., D. Bowen Matthew, The Law as Healer: How Paying for Medical-Legal Partnerships Saves Lives and Money (January 2017): at 24 (“[C]urrently, no MLP in the nation focuses on reducing health disparities by directly addressing racial and ethnic discrimination in education or any other social determinant of health.”). In a review of 241 MLP websites, only eighteen explicitly stated in their program mission or description an intention to serve Black, Indigenous, Latinx, or people of color (or used terminology such as “marginalized populations” that one might infer to include the forgoing communities). M.D. Makhlouf, S. Carnahan, and P. Dhungana, MLP Mission Survey (June 24, 2021), n.p. This review provides some information about how MLPs are framing their work, but a more thorough study is warranted.Google Scholar
See, e.g., Regenstein et al., supra note 9, at 380; Zuckerman et al., supra note 8, at 224-227. A notable exception is Shek, D., “Centering Race at the Medical-Legal Partnership in Hawai’i,” University of Miami Race & Social Justice Law Review 10 (2019): 109–46, at 112-113, 119 (describing the racial justice vision and community lawyering approach of MLP Hawai’i).Google Scholar
See, e.g., Zuckerman et al., supra note 8, at 1615-16 (stating that MLP “is emerging as a key strategy to combat health disparities,” but referring to the patients served as “on low incomes” and “vulnerable,” without reference to racial health inequities); M.D. Makhlouf, interview with Ellen Lawton, Joel Teitelbaum, and Bethany Hamilton (June 7, 2021) (Ellen Lawton confirming that the foundational MLP articles and research often relied on proxies for race, racism, and even health disparities).Google Scholar
See Makhlouf et al., supra note 32 (finding that 72 of 241 MLP websites reviewed used such phrases without mentioning race, racism, people of color, or other terms connoting a race-conscious approach).Google Scholar
See Healton, E.B. et al., “Training Future Health Justice Leaders — A Role for Medical-Legal Partnerships,” New England Journal of Medicine 384, no. 20 (2021): 1879–1881; S. Foster et al., “Health Justice Is Racial Justice: A Legal Action Agenda For Health Disparities,” Health Affairs Blog, July 2, 2020, available at <https://www.healthaffairs.org/do/10.1377/hblog20200701.242395/full/> (last visited December 10, 2021); Tobin-Tyler and Teitelbaum, supra note 22; E.A. Benfer, “Health Justice: A Framework (and Call to Action) for the Elimination of Health Inequity and Social Justice,” American University Law Review 65 (2015): 275-351.CrossRefGoogle ScholarPubMed
Martinez et al., supra note 31, at 269 (noting that “[n]ot a single study in this review considered race, ethnicity or sexuality as mediating factors impacting health outcomes.”).Google Scholar
See, e.g., Bowen Matthew, supra note 32, at 24; Makhlouf et al., supra note 32.Google Scholar
This brief description of the professional cultures influencing the development of the MLP movement does not mean to ignore the role of dissenting/activist and explicitly anti-racist traditions within those fields. It will be critical to draw upon those traditions when thinking about frameworks for operationalizing racial justice in MLPs.Google Scholar
See Legal Services Corporation, “What Is the Legal Services Corporation?” available at <https://www.lsc.gov/our-impact/publications/other-publications-and-reports/what-legal-services-corporation> (last visited December 10, 2021).+(last+visited+December+10,+2021).>Google Scholar
See Adediran, A.O. and Ossei-Owusu, S., “The Racial Reckoning of Public Interest Law,” California Law Review Online 12 (2021): 1–15, at 4.Google Scholar
Makhlouf, supra note 34; see Adediran and Ossei-Owusu, supra note 41, at 4 (referring to this phenomenon as “presumed intersectionality”).Google Scholar
Makhlouf, supra note 34.Google Scholar
Id.; see Wispelwey, B. and Morse, M., “An Antiracist Agenda for Medicine,” Boston Review, Mar. 17, 2021, available at <http://bostonreview.net/science-nature-race/bram-wispelwey-michelle-morse-antiracist-agenda-medicine> (last visited December 10, 2021).+(last+visited+December+10,+2021).>Google Scholar
Makhlouf, supra note 34. The current and past Directors of the NCMLP describe it as a “big tent” organization that does not speak for all MLPs. Id. At the time of its founding, there were already approximately 75 MLPs around the country. Id. The NCMLP website states that it “leads education, research, and technical assistance efforts to help every health organization in the United States leverage legal services as a standard part of the way they respond to social needs.” National Center for Medical-Legal Partnership “About the National Center,” available at <https://medical-legalpartnership.org/about-us/> (last visited December 10, 2021). The NCMLP has done laudable and groundbreaking work to this end: using the language of public health and health care to talk about poverty-related health inequities and to explain how law is a tool to address SDOH.+(last+visited+December+10,+2021).+The+NCMLP+has+done+laudable+and+groundbreaking+work+to+this+end:+using+the+language+of+public+health+and+health+care+to+talk+about+poverty-related+health+inequities+and+to+explain+how+law+is+a+tool+to+address+SDOH.>Google Scholar
See, e.g., American Medical Association, “Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity,” 2021-2023; National Legal Aid & Defender Association, “Racial Justice Action Plan,” October 2018, available at <https://www.nlada.org/sites/default/files/pictures/NLADA_Racial_Justice_Action_Plan_%28Oct%202018%29.pdf> (last visited December 13, 2021).+(last+visited+December+13,+2021).>Google Scholar
Personal communication from Emily Benfer to author (MDM) (June 23, 2021).Google Scholar
Plough, A. and Christopher, G.C., “The Role of Racial Justice in Building a Culture of Health,” Health Affairs Blog, Sept. 16, 2020, available at <https://www.healthaffairs.org/do/10.1377/hblog20200914.537608/full/> (last visited December 10, 2021).Google Scholar
Kaiser Family Foundation, “Poverty Rate by Race/Ethnicity,” available at <https://www.kff.org/other/state-indicator/poverty-rate-by-raceethnicity/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D> (last visited December 10, 2021).+(last+visited+December+10,+2021).>Google Scholar
See, e.g., Ford and Airhihenbuwa, supra note 1, at 1395.Google Scholar
Shek, supra note 33, at 116. See also Ford & Airhihenbuwa, supra note 1, at 1391 (describing how, in public health research, “racial inequities generally are attributed to non-racial (e.g., socioeconomic) factors while potentially relevant racial factors (e.g., discrimination) remain largely unexamined.”).Google Scholar
Benfer et al., supra note 5, at 134-35.Google Scholar
Id. at 138.Google Scholar
See, e.g., Shek, supra note 33, at 113.Google Scholar
Ford and Airhihenbuwa, supra note 1, at 1393.Google Scholar
Mitchell, F.M. et al., “Health Inequities in Historical Context: A Critical Race Theory Analysis of Diabetes among African Americans and American Indians,” Race and Social Problems 12 (2020): 289–299, at 295.Google Scholar
Chowkwanyun, M. and Reed, A.L., “Racial Health Disparities and Covid-19 — Caution and Context,” New England Journal of Medicine 383, no. 3 (2020): 201–203, at 203.CrossRefGoogle ScholarPubMed
Obasogie, O. et al., “Race, Law, and Health Disparities: Toward a Critical Race Intervention,” Annual Review of Law & Social Sciences 13 (2017): 313–329, at 315 (noting the endurance of biological explanations for racial differences in the public health and medical literature).CrossRefGoogle Scholar
See Boyd, R. et al., “On Racism: A New Standard for Publishing on Racial Health Inequities,” Health Affairs Blog, available at <https://www.healthaffairs.org/do/10.1377/hblog20200630.939347/full/> (last visited December 10, 2021); Chowkwanyun, supra note 57, at 202.+(last+visited+December+10,+2021);+Chowkwanyun,+supra+note+57,+at+202.>Google Scholar
See Boyd, et al., supra note 59.Google Scholar
Id.Google Scholar
Metzl, J.M. and Roberts, D.E., “Structural Competency Meets Structural Racism: Race, Politics, and the Structure of Medical Knowledge,” Virtual Mentor 16, no. 9 (2014): 674–690, at 682 (naming diagnostic criteria, dietary guidelines, and public-health safety precautions as examples).Google ScholarPubMed
Benfer et al., supra note 5.Google Scholar
See, e.g., Merchant, K.J., “Questions for the Law Firm Antiracism Alliance from a Racial Justice Advocate,” Bloomberg Law, available at <https://news.bloomberglaw.com/tech-and-telecom-law/questions-for-the-law-firm-antiracism-alliance-from-a-racial-justice-advocate> (last visited December 10, 2021).+(last+visited+December+10,+2021).>Google Scholar