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Issues and Trends in Health Law: Interdisciplinary Health Partnership to Address Health Disparities Public Interest Law Initiative Fellowship Program July 9, 2013. Loyola University Chicago School of Law. Emily A. Benfer Clinical Professor of Law ; Director, Health Justice Project

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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


Agenda for Today

1. Community Need

Social Roots of Health

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

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)

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

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

Overwhelming legal NeedAttorney to Potential Client Ratio

Legal Aid Attorney

= 200 people

Private Attorney

Silos Between Professions

  • Lack of interdisciplinary collaboration

  • Assumptions about

    other professions

  • No referrals

2. Interdisciplinary response

To improve health of

low-income individuals

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

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

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

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

Policy Advocacy

3. Health justice project outcomes

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

Result: Break Down Silos

Source: National Center for Medical-Legal Partnerships

4. Case Study

Case Study: HJP v. The Rats

  • Child is getting worse by the day

Meanwhile, the child is getting worse by the day!

Case Study: HJP v. The Rats

  • What do you do?

  • Who do you want on your team?

  • How do you prioritize possible responses?

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

5. Summary & Application


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


  • 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

6. Questions & Discussion

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


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