A healthy partnership when traditional medicine can't do it all

A farmers market. Social conditions, such as poverty and poor nutrition, contribute greatly to one's health.
A farmers market. Social conditions, such as poverty and poor nutrition, contribute greatly to one's health. (APRIL SAUL / Staff)
Posted: May 24, 2012

Our clinic recently saw a mother whose 5-year-old daughter has severe, persistent asthma. The mother reported that the mold and unrepaired cracks in her drafty apartment windows were making it very difficult to keep the daughter's asthma under control.

Our physician referred her to Room 14. There, the examining table has been replaced by a desk, a laptop, a file cabinet, and dozens of post-it notes scattered along the walls. Instead of seeing a doctor in Room 14, the mother saw an attorney.

Traditional medicine has long focused on identifying and then treating various medical conditions. We now know that social conditions, such as disparities in income, education, and access to health care, coupled with unsafe housing and neighborhoods, contribute more to an individual's health than traditional medicine. In fact, a 2009 Robert Wood Johnson report demonstrated that only 15 percent of preventable mortality is attributed to medical care alone.

At St. Christopher's Hospital for Children, and in similar offices throughout the country, many of the resources our patients need to be healthy are not under physicians' direct control.

I can easily write a prescription for an asthma-controller medication but cannot write a prescription to rid the child's home of the many toxins that contribute to a child's worsening asthma. I can refer a child to a mental-health provider but cannot write a prescription to decrease a child's exposure to toxic stressors such as interpersonal violence, bullying, and poverty.

In fact, for the first time in history, the United States is raising a generation of children who may live sicker, shorter lives than their parents.

These children are falling through the cracks of traditional medical care as well as traditional legal care. Both realms have relied on crisis-driven care. A child comes in to a pediatrician malnourished. A parent calls a legal clinic to get the utilities turned back on so there is power to run the child's nebulizer machine. Preventable illnesses arise from unaddressed legal needs.

Several studies have demonstrated that more than half of low- to moderate-income families have an unmet legal need, such as income and insurance supports or housing and utility issues, that adversely affects the health of their family. An astonishing 15 percent of lower-income families have three or more unmet legal needs.

Enter Barry Zuckerman.

Dr. Zuckerman, a developmental and behavioral specialist in pediatrics at Boston Medical Center, is an innovator. His knowledge of early literacy and word gaps in lower-income families led to the highly successful "Reach Out and Read" program that is in more than 4,000 doctors' offices in all 50 states.

Zuckerman's profound understanding of how social conditions influence health also propelled him to bring together two sometimes-adversarial professions: law and medicine. In 1993 in Boston, the first Medical Legal Partnership (MLP) was born.

Nineteen years later, there are MLPs in more than 235 health-care centers in more than 40 states across the country ( www.medical-legalpartnership.org). In Philadelphia, there are legal partnerships at Magee Rehabilitation Hospital and Family Planning and Counseling Network. At St. Christopher's Hospital for Children, we recently established the first pediatric MLP in the region. There we partner with the Legal Clinic for the Disabled and Reed Smith L.L.P.

We have screened more than 1,700 families for legal issues that affect the health of the families we serve. More than 60 percent of families screened identified at least one unmet legal need that has the potential to threaten a child's health. With almost 63 percent of our population in eastern North Philadelphia living below the poverty line, this is no surprise.

Besides helping families get the services they are entitled to, these partnerships also train health-care providers on how to advocate more effectively for individuals and families they serve. Drawing on their shared expertise, MLPs work together to improve laws and regulations that protect people at risk.

Back to Room 14. After discovering that the landlord had failed to make the necessary repairs to our patient's apartment, the Legal Clinic for the Disabled attorney helped obtain a new housing voucher so the family could move. The attorney also worked closely with the pediatrician to compile a letter of medical necessity so that the family's security deposit could be used to move into housing where our little patient could finally breathe through uninflamed lungs.

Medical-legal partnerships across the country offer a new, more effective way of practicing medicine. You might say they're a breath of fresh air.

Daniel Taylor, a pediatrician

at St. Christopher's, can be reached at Daniel.Taylor @DrexelMed.edu.


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