Loyola University Chicago School of Law

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

14. 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

15. 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

16. Policy Advocacy

17. 3. Health justice project outcomes

18. 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

19. Result: Break Down Silos Source: National Center for Medical-Legal Partnerships

20. 4. Case Study

21. Case Study: HJP v. The Rats • Child is getting worse by the day Meanwhile, the child is getting worse by the day!

22. Case Study: HJP v. The Rats • What do you do? • Who do you want on your team? • How do you prioritize possible responses?

23. 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

24. 5. Summary & Application

25. 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

26. 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

27. 6. Questions & Discussion

28. 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