While public health practitioners and social workers know that the social determinants of health — social and economic factors such as where and how people work and live — influence both individual and population health as much as any other factors, healthcare and social service providers often aren’t equipped to meet those needs. Physicians can treat illness and steer patients towards ways to improve their health, but they can’t necessarily provide access to the necessities, such as housing, nutrition assistance, transportation, and social services, that can reduce health disparities and keep patients healthy in the first place.
A newer form of healthcare delivery may provide a solution: Medical Legal Partnerships, or MLPs, integrate legal aid into healthcare under the idea that attorneys can provide the support needed to address these social determinants of health in a way that traditional healthcare providers cannot. That is, access to affordable housing, citizenship, employment, and other determinants are all within the domain of those practicing law. In MLPs, physicians, social workers, community health workers, and attorneys work together to provide holistic care and health promotion.
Dr. Omar Martinez and Dr. Miguel Muñoz-Laboy, assistant and associate professor in the Temple University School of Social Work, respectively, are both principal investigators in the first federally funded study of MLPs. Through a two-year, $275,000 grant from the National Institutes of Health, the researchers will survey those in MLPs across the country; after the survey, they will interview healthcare providers, attorneys, and their clients — both in groups and individually — to assess the impact of the MLP on their overall health. Then, they’ll apply those findings to the development of an MLP model for people who are HIV positive.
“MLPs offer an integrated approach to healthcare delivery that seems promising for meeting the needs of people living with HIV/AIDS, but it has yet to be rigorously assessed within this population,” said Dr. Martinez.
The research builds on a systematic review of MLP research that Dr. Martinez, Dr. Muñoz-Laboy, and other researchers conducted (the results of which were published in The Journal of Law, Medicine and Ethics in 2017). Of the 13 studies they reviewed, none included race, ethnicity, or sexuality as a factor impacting health outcomes, but members of ethnic and gender/sexual minorities are far more prone to HIV infection and comprise a disproportionate number of AIDS diagnoses, another reason that suggests MLPs could prove beneficial for HIV prevention.
“When you address those social determinants through legal aid, then you ideally can improve outcomes,” said Dr. Martinez. “We want to know what this model looks like in the context of HIV prevention and treatment.