Presidential Memorandum Draws Link Between Civil Legal Aid and Social Conditions of Health

Co-authored by Joel Teitelbaum, JD, LLM, Associate Professor of Health Policy and of Law, The George Washington University

In the U.S., individuals do not have the same right to legal representation under civil law as they do under both federal and state criminal law. Unlike under criminal law, even in complex civil law situations when the most basic human needs are at stake, individuals and families can have no expectation that an attorney will help with unlawful evictions, denials of public benefits like Medicaid or food stamps, domestic violence, disability and workplace discrimination, child custody disputes, and special education needs. And while the need for these services are vast, the resources of the civil legal aid community are so limited that only one-in-five people living in poverty actually receives needed civil legal assistance.

In an effort to close this gap, President Obama issued a Presidential Memorandum in September establishing the White House Legal Aid Interagency Roundtable, the mandate of which is to "increase the availability of meaningful access to justice for individuals and families and thereby improve the outcomes of an array of Federal programs." As it is typically understood today, "access to justice" refers to a movement that aims to create a justice system that delivers outcomes that are fair and accessible to all, regardless of one's socioeconomic status.

As co-directors of the National Center for Medical-Legal Partnership, we were thrilled by the President's announcement. What we know from ten years of leading the health care, legal, and public health sectors in an integrated approach to combat the social conditions that negatively affect health, and what the Presidential Memorandum shone light on, is that a lack of access to civil legal aid isn't just a problem associated with basic fairness and justice; it's a problem for the health of individuals and communities.

Research indicates that while only fifteen percent of preventable illness can be improved with access to quality medical care, fully sixty percent of our health is determined by social and environmental factors related to where we live, work and play. And what are those social and environmental factors? Housing quality, access to public benefits like income and vocational supports, the affordability of and proximity to nutritious food, personal safety at home and in one's neighborhood, and the extent to which students with learning disabilities are being supported in schools. When these elements of everyday life are compromised - when housing codes go unenforced, when qualified individuals are denied insurance benefits and food assistance, when women and children feel unsafe in their homes - health suffers. Yet these problems are outside the scope of what health care professionals are trained to do. These problems can only truly be cured through a different type of care: legal assistance.

President Obama apparently agrees. According to his Presidential Memorandum, "Equal access to justice helps individuals and families receive health services, housing, education, and employment [and] enhances family stability and public safety...Equal access to justice also advances the missions of an array of Federal programs, particularly those designed to lift Americans out of poverty or to keep them securely in the middle class. But gaps in the availability of legal aid for America's poor and middle class threaten to undermine the promise of justice for all...Federal programs that are designed to help the most vulnerable and underserved among us may more readily achieve their goals if they include legal aid among the range of services they provide."

This last sentence strikes us as particularly salient: Last year, the U.S. Health Resources and Services Administration (HRSA), in response to recommendations made by the National Center for Medical-Legal Partnership, revised its policy to allow community health centers to use federal funding to support patient health through civil legal assistance. Based on the early success of this policy shift and the Presidential Memorandum, we hope to collaborate with other federal agencies as we do with HRSA.

Among other things, the Legal Aid Interagency Roundtable is expected to improve coordination among federal programs that help the vulnerable and underserved, and to advance relevant evidence-based research, data collection, and analysis of civil legal aid in order to promulgate best practices. We look forward to seeing the fruits of this work, and working alongside the Roundtable to improve the health and well-being of the tens of millions of low-income individuals who qualify for and seek federally-funded civil legal aid, but who are turned away due to resource limitations.