By Yael Cannon
Health justice begins with exploring and understanding health disparities and the role of law in facilitating the social, political, and economic determinants at their roots. It requires naming structural racism — and the many forms of subordination that flow from it — as a public health crisis and recognizing that health justice is racial justice. Most importantly, health justice requires us to partner with affected communities to leverage law and policy to address and eliminate the root causes of disparities.
Those of us at schools of law and medicine, and other academic institutions who are training the next generation of lawyers, policy advocates and policymakers, doctors, nurses, and other health professionals have a special responsibility to equip our students with the knowledge, skills, and values they need to ensure that everyone has an equal chance at health and well-being.
At the Georgetown University Health Justice Alliance Law Clinic, a medical-legal partnership between Georgetown’s Law and Medical Centers, this responsibility drives our work. We teach our students that our patients/clients are at the center of all we do, beginning with our use of low-barrier models of access to health care and justice, which offer health and legal care right where patients live and learn. Through its Kids Mobile Medical Clinic and school-based health centers, the Georgetown Division of Community Pediatrics brings pediatric and behavioral health care to the doorsteps and schools of children who live in health care deserts and face a double-burden of marginalization by virtue of race and class.
Access to health care then serves as a gateway to access to justice. At their health care visits, families receive a “legal check-up” in the areas of housing, public benefits, Medicaid, and education. Our students learn that such unmet legal needs are known drivers of poor health for the patient populations we serve and are closely connected to laws and policies that have structural racism at their core. Indeed, life expectancy in some of the neighborhoods we serve is fifteen years shorter than life expectancy near Georgetown University’s main campus.
When pediatricians refer families for legal assistance following these legal check-ups, our law and medical students head to the neighborhoods we serve to create deep partnerships with our clients and others in their communities. The students pursue health justice on multiple levels: by enforcing existing laws to remove legal barriers that operate upstream of poor health and disparities, by identifying opportunities to change law and policy to advance structural reform, and by working with community members so that they are armed with the knowledge and tools to assert and protect their rights.
Applying this framework at the Kids Mobile Medical Clinic, a health and legal check-up revealed a child was severely lead poisoned and experiencing educational delays. Her Medicaid had been terminated, making needed treatment more difficult to access. A law and medical student team visited her home, the health clinic, and her school. Working with the child’s mother, Ms. “Cooper” (whose name has been changed to protect her privacy) the students successfully advocated for lead remediation to make the home safe, restored the child’s Medicaid, obtained comprehensive educational and developmental evaluations, and advocated for robust special education services to help the child thrive in school.
Back in the classroom at Georgetown, the law and medical students explored the why behind the Cooper family’s story: the role of structural racism in redlining, restrictive covenants, and gentrification, and the laws and policies that segregated Black families into neighborhoods with poor housing stock and without robust prevention and enforcement mechanisms to ensure the housing was safe. Together, the students advocated for systemic reform in lead prevention and enforcement laws before the Washington D.C. Council and prepared their client to testify in support of a bill to that end. The students grew to appreciate that their professional training and community-based partnerships allowed them to identify gaps, patterns, and problems with the law and pursue reforms to advance health justice.
Throughout their advocacy, the students learned to recognize the humble role that we play in our patients’/clients’ lives as we very intentionally pursue their stated goals. They worked both to arm Ms. Cooper with the knowledge and tools to assert her rights under D.C.’s housing, Medicaid, and special education laws after our work with her is done, and to play a role in systemic reform. The students stepped out of their silos and collaborated not only with each other, but with their client, whose leadership was central. They saw access to justice as a vehicle for health justice. As academic health justice efforts evolve, we can pave the way for our students to lead hospitals, courthouses, and statehouses — and to step back and support the leadership of affected communities — in a collaborative pursuit of health justice.
Yael Cannon is an Associate Professor and Director of the Health Justice Alliance Law Clinic at Georgetown University Law Center.
