Medicine and law: new opportunities to close the disparity gap.

Socioeconomic disparities in health persist despite significant advances in medicine, universal coverage, and quality of care.1,2 Although the relationship between poverty and poor health is complex, access to basic needs such as adequate housing and nutrition, appropriate education, and personal safety is well documented to improve health trajectories.3 The article by Beck et al4 in this issue of Pediatrics represents a special example of how a multidisciplinary approach to social determinants of health initiated from a primary care setting can address poor housing conditions and reduce risk for asthma for individual patients and for a population. The government has enacted laws and regulations to address the negative health impact of hunger, insufficient income, unsafe housing, and disability. When families do not receive the benefits or protections of these laws, health is undermined. The consequences can be treated medically, but their upstream causes are social and are more effectively addressed by using legal strategies.5,6 The authors of a recent report estimate that 50% to 85% of health clinics for low income people have users, between 10 and 17 million people, who experience unmet legal needs, many of which impact their health.7 Many at-risk individuals may not know that their problems have legal solutions. Medical-legal partnerships, developed at Boston Medical Center in 1993 for children, help parents navigate the complex government and legal systems that often hold solutions to many social determinants of poor health. The health care team’s role is to identify unmet legal needs that cause or exacerbate child health problems. Once these problems are identified, lawyers bring critical skills to complement the expertise of the health care team. Medical-legal partnerships now include adult health services and are practiced in over 220 hospitals and health centers, from primary care to specialty services.6,8,9,10,11