Public Health Legal Services: A New Vision

Abstract

In recent years, the medical profession has begun to collaborate more and more with lawyers in order to accomplish important health objectives for patients. That collaboration invites a revisioning of legal services delivery models and of public health constructs, leading to a concept we develop in this article, and call "public health legal services." The phrase encompasses those legal services provided by non-government attorneys to low-income persons the outcomes of which when evaluated in the aggregate using traditional public health measures advance the public's health. This conception of public health legal services has emerged most prominently from innovative developments in Los Angeles (the HIV Legal Checkup model), Boston (Medical-Legal Partnership for Children) and New York (LegalHealth). It departs from the commonplace understanding about public health law as concerned with the exercise of the state's public health power. It extends that understanding to include the exercise of individual rights by private lawyers that also advances the public's health. Just as it was once discovered that communities need access to health information, clean water, inoculation, and regulation of hazardous activities and products as part of a comprehensive scheme for promoting and achieving health, so too the emerging vision suggests that community health promotion also requires affordable access to effective legal information and assistance. The idea of public health legal services offers a rich and powerful incentive for public and private agencies to increase free and subsidized legal services. At the same time, the legal services necessary from a public health perspective may not be the ones currently emphasized by providers. The vision of public health legal services in many ways favors prevention over crisis management, and therefore calls upon traditional legal services providers to rethink their customary resource allocation models. The vision may call for painful short-term choices between the new model and the always urgent demand for litigation and crisis-driven work. This Article engages that tension in an effort to understand, if not resolve, its dimensions.