Want to understand Medical-Legal Partnership – it’s all here

Having Poverty, Health and Law: Readings and Cases for Medical-Legal Partnership (Carolina Academic Press, 2011) is like winning the lottery. Edited by some of the most familiar names in the Medical-Legal Partnership (MLP) movement in the United States (Elizabeth Tobin Tyler, Ellen Lawton, Kathleen Conroy, Megan Sandel and Barry Zuckerman) it is an invaluable compendium of collective wisdom concerning the theory and practice of MLP – a gift. Those new to the field, whether practitioners, students, academics or bureaucrats, will scarcely believe their luck that such an impressive resource now exists; an exhaustive treatment of MLP from the foundations up.

But Poverty, Health and Law isn’t just an edited collection of pieces from legal and medical practitioners from around the States – it is a thoughtful and strategic treatment of the subject with a unified structure and consistent educative approach. Intended as both a teaching tool and a resource for those engaged or interested in MLP, the book boasts numerous valuable features including:

  • Discussion questions
  • Case studies – to help identify the connections among poverty, health and law
  • Best practices and advocacy strategies to address particular medical-legal issues
  • Practice to policy – providing examples of how MLP practitioners can identify areas in which systemic or policy changes can benefit a wider population of vulnerable patients and communities.

Sketching the evolution of thinking concerning the social determinants of health, Tobin Tyler asks how the law fits in; what is the role of law and public policy in understanding and addressing the determinants? In essence, lawyers concerned with “…improving health for vulnerable populations have a role to play in challenging the social framework underlying health disparities.”  

Poverty, Health and Law:

“…explores how MLP creates the potential for preventative interventions by leveraging the resources of interdisciplinary partners and systems. Because MLPs have the potential to transform practice as well as policy, they also offer a unique training ground for medical, public health, nursing, social work and law students interested in improving care to vulnerable populations. This book, therefore, is intended as both a resource for practitioners and as a learning took for students – the next generation of health and legal professionals.”

With each chapter written by an interdisciplinary team including doctors, nurses, public health practitioners, lawyers and social workers, the book progresses through five parts:

Part 1 explores the socio-legal determinants of health, traditional approaches to addressing the needs of low-income populations and preventative approaches to health and law.

Part 2 overviews MLPs in practice, including the challenges and benefits of collaboration, contextualising service provision, interdisciplinary training and the observation of professional ethical responsibilities.

Part 3 provides a detailed treatment of the contribution of MLP to five areas where poverty, health and law intersect: income and employment, housing, education, legal status and personal safety.

Part 4 explores how the well being of special populations can be improved, including cancer patients, people living with HIV/AIDS, older people, adolescents and young adults.

Lastly, Part 5 is a reflection on how MLPs have and may affect broader policy change to benefit vulnerable populations.

Chapter 18’s overview of how researchers are evaluating the potential benefits of MLP for patients, practitioners and systems is of particular personal interest.  Providers of poverty law legal services in Australia (including Loddon Campaspe Community Legal Centre) have, for too long, prioritized the immediate demands of direct service delivery over evaluating the outcomes of legal interventions. In contrast, this is an area that MLP has nailed. Whether a result of cross-fertilisation with other professional disciplines, a necessity driven by shrinking civil legal aid budgets, the emphasis of early MLP leaders or, in all likelihood, a combination of these, the attention given to evaluation is welcome. MLP does not shirk the difficult questions:

  • How does it change the practice of health care providers and lawyers?
  • Does it improve health outcomes for individual patients and their families?
  • Do systemic changes benefit the public health of particular populations?

While undoubtedly introductory for some, a discussion of the elements of sound monitoring and evaluation is really beneficial for those of us who are stuck in a habit of direct service delivery, where tracking outcomes is an afterthought and reporting case studies a distant aspiration. By describing the members of a sound research team, providing example hypotheses and identifying target metrics, this chapter may well be of the most enduring benefit to those who want to take its message seriously – demonstrating the efficacy of MLP.

Whether you are beginning to explore MLP or wanting to supercharge an existing partnership or alliance, Poverty, Health and Law will prove to be an indispensible reference. Get it and enjoy.

Peter Noble

 

 

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