L O Y O L A U N I V E R S I T Y C H I C A G O S C H O O L O F L AW
Emily A. Benfer
Clinical Professor of Law; Director, Health Justice Project
ebenfer@luc.edu
AGENDA FOR TODAY
1. Community Need: Social Roots of Health
12:00 – 12:15 p.m.
2. Interdisciplinary Response to Improve Health of
Low-Income Individuals
12:15 – 12:30 p.m.
3. Health Justice Project Outcomes
12:30 – 12:35 p.m.
4. Case Study
12:35 – 12:45 p.m.
5. Application
12:45-12:50 p.m.
6. Questions & Discussion
12:50-1:00 p.m.
2
1. COMMUNITY NEED
S O C I A L R O O T S O F H E A LT H
FEDERAL POVERTY
THRESHOLDS & GUIDELINES
2013 Federal
Poverty Guidelines
2011 Federal
Poverty Thresholds
Family
Size
Extreme
Poverty (049% FPL)
Poverty
(0-99% FPL)
Low Income
(100-199%
FPL)
Poverty – Annual
Income
1
$5,742
$11,484
$22,968
$11,490
2
$7,329
$14,657
$29,314
$15,510
3
$8,958
$17,916
$35,832
$19,530
4
$11,511
$23,021
$46,042
$23,550
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 people or 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 NEED
Attorney to Potential Client Ratio
Legal Aid
Attorney
Private
Attorney
= 200 people
SILOS BETWEEN PROFESSIONS
• Lack of interdisciplinary
collaboration
• Assumptions about
other professions
• No referrals
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2. INTERDISCIPLINARY
RESPONSE
T O I M P ROV E H E A LT H O F
L OW- I N C O M E I N D I V I D UA L S
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
11
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 Collaboration
to Improve Community Health
Public
Health
(Loyola)
Loyola University
Chicago/Beazley
Institute for Health
Law and Policy
Erie Family Health
Center
Equip for Equality
Law
Community
Health
AIDS Legal Council
of Chicago
Lawyers’
Committee for
Better Housing
Medicine
Northwestern
McGaw Family
Medicine Residency
Program
Loyola School of
Medicine
Legal Allies
Social
Work
(Loyola)
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
Partnerships to
Develop National
Policy
Creation of Local
Policy
Recommendations
Use of Creative
Advocacy Tools
Health
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
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4. CASE STUDY
CASE STUDY: HJP V. THE RATS
Health Symptom
Underlying
Environmental
Issues
• 1 year-old infant coughs, wheezes, falls in and out of
sleep
• Mother explains apartment is infested with rats (rat
feces on the floor, the furniture; rat in baby’s crib)
• Entire 72-unit building is infested with rats
• All tenants share 3 copies of the front door key
• Child is getting
worse by
dayis abusive
• Father
of the
child
Underlying
• Mother will not discuss the abuse
Social Issues
• Family members are undocumented immigrants
Meanwhile, the child is
getting worse by the day!
21
CASE STUDY: HJP V. THE RATS
• What do you do?
• Who do you want on your team?
• How do you prioritize possible responses?
22
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
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5. SUMMARY &
APPLICATION
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
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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
6. QUESTIONS &
DISCUSSION
L O Y O L A U N I V E R S I T Y C H I C A G O S C H O O L O F L AW
Emily A. Benfer
Clinical Professor of Law; Director, Health Justice Project
ebenfer@luc.edu