Is Preventing Injustice Possible?

What if preventing injustice, not treating it, was the key to equitable communities?

Whatever you may think about how we pay for health care, everyone can agree that staying out of the emergency room is a good thing. Maintaining good health through access to primary care and healthy policies is better not only for individuals, but also for health care's bottom line.

We are pretty good at "emergency room" style civil justice in the U.S. If you live in poverty and are being wrongfully evicted, or discriminated against at work, or unlawfully denied access to a benefit or service, civil legal aid agencies across the country expertly step in. They are, of course, deeply underfunded and only able to meet about 20 percent of the need that exists, but they are very good at what they do.

But in the U.S., we pour our far too limited resources exclusively into treating these acute needs at the expense of prevention. There is no primary care for civil legal problems. Wouldn't justice be better served if someone never ended up homeless in the first place, or if she had access to services from the onset? I'm not saying we shouldn't fund programs and approaches that provide acute legal care to those facing discrimination or those whose housing and safety is threatened; no one who advocates preventive health care says we should close down every emergency room. But can't we do both?

I used to work at an urban safety net hospital as the "patients' lawyer." It's there where I met Dora, a single mom of three young kids. Her child's pediatrician was worried because Dora didn't have any income after securing a restraining order against her violent husband, and she and her children were on the edge of homelessness. Working with the hospital's case manager, we quickly found a temporary income benefit designed to prevent her eviction, giving the family time to stabilize after a traumatic event and Dora the chance to seek employment.

Five years later, I heard from Dora out of the blue. I feared the worst and braced myself; lawyers rarely get anything but bad calls. But Dora was calling to tell me that she now owned her own child care business. She beat the odds, and wanted me to know that the work we did together not only prevented her from becoming homeless, but empowered her to make changes to take care of her family.

Situating precious civil legal aid services in health care settings through medical-legal partnerships like this is one way we can detect and address problems sooner. Just imagine how different Dora's life might have been if her family had become homeless before there was a way to help. Imagine not only the injustice, but also the poor health that might have resulted.

Of course the biggest opportunity for promoting justice happens at the policy level. And what do countries around the world who have lower rates of homelessness and better health outcomes do differently than the U.S.? They spend more money on social services, and they do it further upstream. Widely cited research from The American Health Care Paradox confirms this reality; these countries invest in housing, employment benefits and food, and it's linked to better health outcomes.

On Wednesday, I'll be at the Organisation for Economic Co-operation and Development's Access to Justice Roundtable in Paris, where countries from around the world are gathering to talk about innovations in the delivery of justice. Front and center must be this question: how can we make prevention the driving creed of the access to justice movement?