Setting the Health Justice Agenda: Addressing Health Inequity & Injustice in the Post-Pandemic Clinic

Emily A. Benfer (Wake Forest University), James Bhandary-Alexander (Yale Law School), Yael Cannon(Georgetown University), Medha D. Makhlouf (Pennsylvania State University), Tomar Pierson-Brown(University of Pittsburgh), Setting the Health Justice Agenda: Addressing Health Inequity & Injustice in the Post-Pandemic Clinic, Clinical L. Rev. (forthcoming Fall 2021):

Among the tenets of clinical legal pedagogy is the goal of teaching students about the lawyer’s role in both ensuring the quality of and access to justice for historically marginalized populations. The COVID-19 pandemic illustrated how, for far too many, justice is inaccessible, inequity is rapidly increasing, and health justice is out of reach. Historically marginalized groups experienced disproportionate infection and mortality rates from COVID-19, as well as the highest rates of unemployment, barriers to healthcare access, food insecurity, and extreme eviction risk during the pandemic. These disparities stem from the social determinants of health . Social determinants of health “encompass[] the full set of social conditions in which people live and work,” and drive health inequity for people living in poverty, people of color, and other historically marginalized groups. Structural determinants of health, including the political and legal systems in which discrimination can become embedded, influence poor health outcomes. No other profession bears more responsibility for the role of law in lifting or oppressing members of society. It is upon the legal profession to uncover how the law, laden with bias and discrimination, can operate as a vehicle of subordination, creating barriers to opportunity, long-term hardship, and poor health. The pandemic-related increase in the need for legal services highlighted the urgency of not only providing the next generation of lawyers with foundational lawyering skills, but also imbuing them with a sense of legal stewardship. In this way, the pandemic underscored the need for clinical legal education to adopt strategies that both increase lawyering skills and directly address the structural determinants at the root of the justice crisis.

Health justice is the eradication of unjust health disparities caused by discrimination and poverty. The health justice framework provides a model for training students to recognize the structural and intermediary determinants of health at the root of their clients’ hardship, and to actively work with the community to address barriers to health equity and social justice. The authors have used the health justice framework to conceptualize and explain the work of MLPs. The framework is centered on engaging, elevating, and increasing the power of historically marginalized populations to address structural and systemic barriers to health, as well as to compel the adoption of rights, protections, and supports necessary to the achievement of health justice. In the law clinic setting, health justice offers a holistic, interprofessional, and proactive approach to addressing social injustice. It teaches students to investigate the roots of their clients’ legal crises and to identify leverage points to shift the deeply connected health disparities and injustices that plague marginalized communities. A holistic understanding of social injustice and health inequity prepares students to seize those opportunities for leverage and to develop proactive—rather than reactive—legal interventions to address potential health crises.

This Article arose from a discussion of five clinicians who, combined, have over three decades of experience designing and working in medical-legal partnerships (MLPs) to address health-harming legal needs for low-income and historically marginalized patients. The Article provides our reflections on the successes and challenges of the MLP model in achieving health justice during the COVID-19 pandemic. Part I describes the relationship between structural injustice and the health impacts of the pandemic. It also describes individual-level responses to these crises that have largely failed to protect the populations that are widely considered marginalized in U.S. society, and the role of legal interventions in combatting racial health inequity. Part II explains how MLPs employ a health justice framework to address “wicked problems” at the intersection of law, health, race, and poverty. Part III proposes maxims for achieving health justice for law clinics generally, drawn from the authors’ experiences over the past fourteen months.

We believe that the health justice framework and our reflections could be useful to all clinicians because of the relationship between unmet legal needs and poor health: When clinics intervene to help clients address financial or food insecurity, unstable or unsafe housing, employment discrimination, inadequate educational supports, immigration issues, and interpersonal or community violence, among other legal needs, we address SDOH. Because we are, in a sense, all working for health justice, this framework may provide helpful insights to clinicians working across a range of legal issues. In the midst of the global COVID-19 pandemic, the link between health justice and access to justice is clearer and more salient than ever before.