The Health Law Partnership: An Innovative Vehicle to Address the Impact of the Social Determinants of Health on the Care of Children

IntroductionThe Health Law Partnership (HeLP), a medical-legal partnership (MLP), exists to improve the health and well-being of low-income children and their families living in Georgia. HeLP's primary premise is to provide a holistic set of services to address the multiple determinants of children's health by combining the healthcare expertise of physicians and hospital professionals with the legal expertise of specially trained lawyers. The social and economic conditions in which many low-income people live can seriously affect their health and well-being. Poor housing conditions, such as mold and unsanitary conditions or lack of heat, air conditioning, electricity, or refrigeration can exacerbate health problems such as asthma and sickle cell disease. Poverty too often erects barriers to medical treatment and medications required by patients. Attorneys in concert with their healthcare partners can intervene to address such issues and improve the physical, social, or economic environments in which many children live, resulting in their improved health and quality of life.The secret is to gang up on the problem, rather than each other Thomas T Stallkamp (an American business executive)Identifying and addressing social determinants of healthIn Georgia, there is no shortage of opportunity to make a difference. Georgia ranks 50th in Medicaid spending per patient and 5th in both the number of residents living in poverty and the number of residents living without health insurance (1). In addition, funding for the Georgia Department of Human Services has fallen by 20 percent from 2009 to 2014. As a result, fewer state workers are available to protect children and assist families with applications for important benefits, such as Temporary Assistance for Needy Families (TANF), Supplemental Nutrition Assistance Program (SNAP), Medicaid, and other programs, despite the 128 percent increase in SNAP cases between 2007 and 2012 (1). While these programs do not solve the challenges and barriers experienced by low-income individuals, they certainly provide a minimal safety net. Reductions in service and cuts in benefits exacerbate disparities.According to data compiled by the Kids Count Data Center, Georgia children ranked 43rd overall in their economic well-being in 2013 (2). Twenty-six percent of Georgia's children are living in poverty and 59.7 percent are eligible for free/reduced cost school meals in 2013 (2). Policy makers, elected officials, health professionals, and poverty lawyers, at times separately and at times in coordinated efforts, agree that health disparities exist and socio-economic issues contribute to poorer health outcomes for vulnerable populations. It is widely believed that factors, such as race, class, language, literacy, citizenship status, and stress affect health status, access to care, and the ability to follow a care plan (3, 4). A recent study found that African-American youth presenting to a physician or emergency room with asthma or bronchodilator-responsive wheezing were significantly more likely to report lower income and educational attainment and greater difficulty finding work. Financial hardships explained why greater than 40 percent of the children in the study were twice as likely to be readmitted to the hospital for care; housing quality also was found to be an additional factor (5).Too many health care providers experience the frustration of providing quality care only to discover their patients' unfortunate return visits to the emergency department, readmissions to the hospital, extended stays in the hospital, and/or their inability to follow a care plan due to exigent social circumstances beyond their control. Too often, social determinants account for failure to resolve or effectively manage patients' illnesses while expending limited resources very inefficiently.Medical-legal partnershipsIn 1991, a Boston pediatrician frustrated with the revolving door of avoidable patients' revisits to the emergency department of the hospital, devised a solution-the Medical-Legal Partnership (MLP) (6). …