Legal Skills Through a Health Justice Lens: First-Year Northeastern Law Students Work Toward Health, Equity, and Justice for Two Oppressed Groups
We have a really special post today - George Consortium member Jason Potter describes his innovative work as a professor and the work of his students here at Northeastern University School of Law. These first year law students studied legal skills through a lens of health justice and turned health justice theory into practice by partnering with non-profit organizations and creating tangible guidance on issues of safe consumption facilities and barriers to health care for transgender individuals. The students will present their work at two upcoming community presentations - if you are local to Boston, please join us!
Law Office 7’s presentation of their research to the community, entitled, Establishing a Safe Consumption Facility in Massachusetts: An Interdisciplinary Review of Legal Barriers and Avenues to Harm Reduction, will take place on Thursday, Mar. 29, 2018, from 2:00-3:00 p.m. in 160 Dockser Hall (Forsythe Street entrance).
Law Office 8’s presentation of their research to the community, entitled Winning Gender-Affirming Care for Transgender Medicaid Recipients in New York, will take place on Thursday, Apr. 5, 2018, from 2:00-3:00 p.m. in 160 Dockser Hall (Forsythe Street entrance).
By Jason Potter, Associate Teaching Professor, Northeastern University School of Law
Poor health in any population affects everyone. Poor heath negatively affects, inter alia, the economy, wages, property values, education, healthcare costs, and crime rates. Despite legislative innovations mandating access to care, from EMTALA to the Patient Protection and Affordable Care Act, improvements in the health of impoverished and minority populations remain incremental. Institutional racism, stigma, and bias—in the healthcare industry, in education, in employment, in social structures, and in legal systems—negatively impact the health of low-income, minority, immigrant, disabled, and non-conforming communities. As one scholar noted, the principles of “[h]ealth, equity, and justice” are the “keystones of a . . . thriving society,” and uniform application of these principles to all populations is a moral imperative. Today, these principles remain unfulfilled.
Social justice has been described as “a communitarian approach to ensuring the essential conditions for human well-being, including redistribution of social and economic goods and recognition of all people as equal participants in social and political life.” Social justice and health are inexorably linked. According to Amartya Sen, “[i]n any discussion of social equity and justice, illness and health must factor as a major concern.” Sen further noted that “health equity cannot be but a central feature of the justice of social arrangements in general.” A “health justice” movement that treats law as a tool for achieving health, equity, and justice is well underway in the legal academy, and in legal education.
At Northeastern University School of Law, I teach in an innovative experiential program called “Legal Skills in a Social Context” (LSSC). In the LSSC Program, teams of first-year students (known as “law offices”) examine the complex interplay among law and diversity, values, and institutional oppression alongside learning traditional lawyering skills such as legal writing and research. Each law office partners with a nonprofit or government organization to complete a year-long social justice project. Given my interest in social determinants and the centrality of health to core social justice principles that also frame LSSC discourse, approaching the course through the lens of health justice and social determinants seemed both inevitable and novel. As it turns out, my students are likely the only first-year law students in the United States learning foundational legal writing in a health justice context.
Over the 2017-2018 academic year, my “law offices” served two oppressed and underserved groups of people. First, LSSC students in “Law Offices 7” confronted the enormous challenges facing people who use drugs (PWUD). There are significant “downstream” health consequences when drug enforcement laws are a primary means of addressing the harms of drug use. PWUD face “consequences associated with disclosure, including loss of employment, loss of housing, loss of child custody, loss of benefits, discrimination by medical professionals, and even arrest, prosecution, and incarceration.” Yet the view that addiction amounts to a moral failing, despite scientific evidence showing it is a chronic medical illness, remains the dominant one in the United States, particularly with respect to those who inject drugs. The resulting stigma and discrimination create an immense barrier to recovery and health for PWUD. Second, “Law Office 8” examined the unique healthcare needs of transgender individuals—needs that are problematized by discrimination in nearly every system, including the medical system. Of the 27,715 respondents to the 2015 National Transgender Discrimination Survey (conducted by the National Gay and Lesbian Task Force), 25% of respondents reported having difficulty with insurance related to their transition, and of the 87% of respondents who had sought care in the past year, 33% of them had at least one negative experience with a provider. Nearly a quarter of respondents reported that they needed care but didn’t seek it due to concerns about provider mistreatment. In their own unique ways, transgender individuals and PWUD both face significant barriers to health as a result of oppression.
Law Office 7’s project, on behalf of AIDS Action Committee of Massachusetts, addressed, among other things, the nearly impervious set of federal and state drug laws that could thwart the establishment of an effective point of healthcare engagement for PWUD—the first Safe Consumption Facility (SCF) in the Commonwealth. In its traditional sense, an SCF is an environment, equipped with medical staff and equipment such as naloxone and clean needles, created for the purpose of reducing harm to clients as they consume pre-obtained drugs. The team used the traditional SCF model as the main vehicle for analysis, but also considered different SCF models (such as clinical and mobile medical unit models), and examined how these models interact with the Controlled Substance Act (CSA), federal regulations, the Massachusetts CSA, state regulations, zoning restrictions, and other requirements. Finally, the team explored potential ways forward in Massachusetts and provided general legislative recommendations. Law Office 7’s presentation of their research to the community, entitled, Establishing a Safe Consumption Facility in Massachusetts: An Interdisciplinary Review of Legal Barriers and Avenues to Harm Reduction, will take place on Thursday, Mar. 29, 2018, from 2:00-3:00 p.m. in 160 Dockser Hall (Forsythe Street entrance).
Law Office 8’s project, on behalf of the Legal Aid Society of New York, involved the challenges facing transgender New York residents in accessing medically-necessary, gender-affirming health care despite laws that guarantee Medicaid coverage for such care. The team created a guide with the aim of assisting a wide audience of attorneys, advocates, and individuals attempting to navigate the complex Medicaid and fair hearing process in New York. The comprehensive guide introduced transgender cultural competency, explored the process of accessing Medicaid benefits for gender-affirming care, furnished detailed steps for Medicaid recipients facing care denials and the internal insurance grievance process, discussed preparation and expectations for the fair hearing process (setting forth advocacy tips and practitioner insights), and described potential next steps in the event of an unfavorable fair hearing decision. The team’s goal in creating the guide was to provide insight and instruction on navigating the entire process of receiving Medicaid benefits for gender-affirming care, from beginning to end. Law Office 8’s presentation of their research to the community, entitled Winning Gender-Affirming Care for Transgender Medicaid Recipients in New York, will take place on Thursday, Apr. 5, 2018, from 2:00-3:00 p.m. in 160 Dockser Hall (Forsythe Street entrance).
The principles of health, equity and social justice are not satisfied “when they do not apply equally to all members of society.” Explicit, implicit, and structural biases continue to shape the healthcare experiences of transgender individuals and PWUD, which negatively affects health outcomes in these communities. At the mercy of systems that are neither designed to consider their unique healthcare needs nor the social determinants of health, many transgender individuals and PWUD are incapable of realizing their full capabilities as human beings. This year, NUSL’s LSSC Students in Law Offices 7 and 8 didn’t just study health justice. They turned health justice theory into practice.