By Medha D. Makhlouf
Numerous studies have documented that racism is a social determinant of health (SDoH) that negatively impacts Black, Indigenous, and people of color (BIPOC). As such, racism is one of “the conditions in which people are born, grow, live, work, and age” that are “mostly responsible for unfair and avoidable differences in health statuses.”
The U.S. health care system was not designed to respond to SDoH, much less to address racial health disparities. In fact, U.S. health care institutions have racist legacies that continue to influence the way they operate today. When health care providers fail to confront racism within and outside their walls, they perpetuate the racial health disparities that have plagued our nation since before its founding.
Medical-Legal Partnership (MLP) is a model of collaboration and joint advocacy between lawyers and health care providers who seek to improve social conditions that affect health and well-being. MLPs aim to address SDoH on three levels: direct representation in civil legal matters, institutional change, and systemic advocacy. They typically employ legal interventions to ensure that people’s basic needs are met, such as nutritious food, health care, income, safe and stable housing, and uninterrupted energy and water utilities. Improving access to such resources is an important way of engaging with the work of health equity.
While some MLPs incorporate a racial justice lens in their work, many do not. MLPs are generally more oriented toward addressing the effects of racism as a SDoH, rather than as the cause of poor health. But considering the cross-cutting nature of racism as a SDoH, MLPs can and should address it directly. As Director of the MLP Clinic at Penn State Dickinson Law, whose faculty has resolved to incorporate discussions of racism and inequality in the curriculum, I have begun researching Critical Race Theory (CRT) as a framework to understand how MLPs can build on their core activities to further address racism as a SDoH and make explicit the connections between racism and poor health. This post describes how MLPs can address racism as a SDoH in at least four ways that align with the goals of CRT.