The Need

Good Health Requires More Than Good Health Care

Health care delivery organizations, policymakers, and patient advocates across the United States are increasingly aware that many factors outside the health clinic’s door affect the health of patients and communities. What is less commonly understood is how law functions as an important social determinant of health, and how lawyers can effectively collaborate with clinicians, case workers, patient navigators, and other members of the health care team to both prevent and remedy the many health-harming factors that have their roots in legal problems.

  • 60% of Health is Social Factors

    60 percentResearch indicates that while only 40 percent of an individual’s health is determined by genetics, medical care, and personal choices, fully sixty percent of health is determined by social and environmental factors such as income, access to health care, access to enough healthy food, housing, education, job stability, and personal safety—in other words, all the things that influence an individual’s well-being in the places where she is born, lives, works, and plays.

    This helps explain why the United States spends far more on health care services than all other industrialized nations, but is not, relatively speaking, particularly healthy, ranking 42nd in life expectancy and 169th in low birth weight; While the U.S. spends just $0.90 on social services for every dollar it spends on health care, countries with better health outcomes spend almost $2 on social services for every dollar spent on health care.

  • Legal Problems are Health Problems

    Often, the services, benefits, and laws in place to help ensure economic stability, healthy housing, and access to health care are wrongfully denied, underenforced, or not enforced – or worst yet, do not exist at all. When this happens – when a woman loses her job because of employment discrimination, when her landlord threatens to illegally evict her from her apartment, or when her health insurance or disability benefits are wrongly denied – her physical and/or mental health often suffer, and she needs more help than health care providers and case workers alone can provide; she also needs a lawyer.

    These problems are not health care problems per se, but rather civil legal needs that profoundly affect health, and left untreated, they can have debilitating effects on individual and population health, which in turn increases health care utilization and costs. Click here for a chart that shows exactly how specific civil legal needs affect health and health care utilization.

  • From Kids to Vets

    VeteranThe Legal Services Corporation and American Bar Association report that every low-income individual in the United States has, on average, two to three of these health-harming civil legal needs.

    Civil legal needs are particularly acute among populations that most frequently use emergency health care services. The U.S. Department of Veteran Affairs’ most recent survey of veterans who are homeless found that five of their top ten needs require legal assistance. And a pilot study at Lancaster General Health found that 95 percent of the hospital’s highest-need, highest-cost patients had two to three unmet civil legal needs, and that addressing those needs not only reduced hospital admissions, but reduced health care costs by 45 percent.

  • The Benefits of Integrated Care

    The health care system works to meet many of the social factors that affect health through social work and case management services. However, the most complex of these problems—the civil legal needs where rights are violated or services are wrongly denied—require legal assistance. Embedding lawyers into the health care team through medical-legal partnerships allows all of the collaborating professions to work at the top of their licenses to provide the highest quality, most efficient, and most equitable care to all. And by training, learning, and working side-by-side and by sharing data and resources, clinicians, allied health workers, and legal aid lawyers can better detect upstream patterns of need.  This, in turn, allows them to collectively advocate for improved policies and regulations that can improve population health. The type of integration just described is essential to MLP practice, because the evidence indicates that the powerful results capable when multiple professions work together to improve individual and population health is not possible through mere referrals.

    Click here to read the research that shows when medical-legal partnerships address civil legal needs as part of health care:

    People with chronic illnesses are admitted to the hospital less frequently;


    People more commonly take their medications as prescribed;


    People report less stress;


    Less money is spent on health care services for the people who would otherwise frequently go to the hospital; and

    Clinical services are more frequently reimbursed by public and private payers.