In a recent post, I described the unique opportunity for medical-legal partnerships (MLPs) to help identify ways in which laws harm population health and perpetuate health disparities. But that is only the beginning: MLP practitioners are also key partners in changing harmful laws and practices and can amplify their impact by doing so. Over the past year, the Network for Public Health Law, the National Center for Medical-Legal Partnership (NCMLP), and MLPs from across the country have explored ways to strategically combine efforts to address health-harming legal needs at the population level.
How do MLP and public health fit together?
Public health practitioners may be familiar with former CDC director Dr. Thomas Frieden’s Health Impact Pyramid. The pyramid illustrates the increasing public health impact as interventions progress from individually-focused (e.g., patient counseling/education and clinical interventions) to population-focused (e.g., changing contextual factors that affect health and addressing socioeconomic factors). In addition to producing widespread impact, population-focused interventions (once they are implemented) require less individual input to yield significant health improvements.
MLP interventions work the same way: individual legal representation requires significant effort by (1) the clinician responding to the health-harming consequence, (2) the attorney representing the patient in an adversarial proceeding or negotiation, and (3) the patient trying to simultaneously manage health and legal challenges. But if patterns among patients inform population level interventions, other patients may entirely avoid similar legal and health challenges, freeing clinicians and attorneys to tackle other pervasive needs. Thus, changing socioeconomic factors produces widespread impact with less individual input required. Among MLPs, the NCMLP has championed this public health approach as a shift from patients to policy. (See the NCMLP’s recently published Patients-to-Policy Stories, showcasing examples of MLPs that have spearheaded policy change in their communities and beyond.)
Public health and medical-legal partnership goals align at this lowest, most impactful level of the health impact pyramid: both approaches will improve health faster and among more people if they are able to change the socioeconomic factors that are causing poor health. And as I mentioned in my last post, Professor Scott Burris has explained that socioeconomic factors—or social determinants of health—are affected by both “the law of the books” and “the law of the streets,” so both factors must be considered to improve health.
How can MLP and public health work together?
The Five Essential Public Health Law Services framework provides a model for achieving “better health faster for all” through strategic legal change. It illustrates how crafting, implementing, and spreading effective public health legal interventions requires five distinct, core legal services: (1) accessing evidence and expertise to define the problem, (2) designing legal solutions that are legally sound and enforceable, (3) engaging communities and building political will to turn a good idea into law, (4) implementing, enforcing, and defending the legal solution, and (5) conducting policy surveillance to evaluate legal solutions and spread the ones that work. The framework also demonstrates that the timely spread of effective public health legal interventions is a transdisciplinary and cross-sectoral endeavor, requiring input from and action by diverse stakeholders.
MLP and public health partners can each contribute unique skills and knowledge to this process of legal change. For example, MLP partners can offer unique insights into how laws produce and perpetuate inequity to help define the legal problem. Public health attorneys can research and design legal solutions that are enforceable and defensible. MLP and public health partners can all play a role in engaging communities and building political will (often without lobbying!) by educating and mobilizing their different networks to understand the nature and scope of the problem. Once a law or policy is changed, public health practitioners can facilitate effective implementation, while MLP attorneys may enforce laws on behalf of individual clients and public health attorneys may defend laws against legal challenges. And finally, each partner can offer important insight into how well the law is addressing the problem and how it can be improved going forward.
One of the collaborative projects that emerged from the NCMLP / Network collaboration has focused on improving lead screening rates in Ohio and Illinois. MLPs in those states recognized that childhood lead poisoning was a pervasive problem, but suspected that the scope of the problem was in fact significantly underestimated due to inconsistent lead screening. The MLPs were already working on legal approaches to reduce lead exposure among clients, but they identified a lack of routine lead screening as an obstacle to pursuing wider-spread legal interventions. In response, Network attorneys developed an issue brief examining existing legal screening requirements in the two states and exploring a range of legal and non-legal solutions. Next steps include disseminating the brief, Legal and Non-legal Strategies to Improve Childhood Lead Screening Rates in Illinois and Ohio, among public health and MLP stakeholders across the two states to identify and pursue the most promising strategies.
Network attorneys are available to answer questions on this and other public health topics at no cost to you, and can assist you in using law to advance your public health initiatives. Visit the Network’s website for a list of Network attorneys in your area.
This post was developed by Colleen Healy Boufides, Senior Attorney, Network for Public Health Law – Mid-States Region Office. The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this post does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF.