On average, the United States spends more money per person on healthcare than any other comparable nation yet ranks 42nd in life expectancy and 169th in low birth weight according to Organization for Economic Cooperation and Development (OECD) data and a Peterson-Kaiser analysis on healthcare spending. These statistics suggest that public health is determined by more than raw spending on healthcare. Many factors affect the health of individuals, especially those living on the economic margin. Factors such as income and health insurance, safe and adequate housing, education and employment, legal status and personal and family stability draw a distinct line between the haves and have nots regarding wellness.  In an effort to alleviate the stress of poverty and its debilitating health effects, the Reno-based Northern Nevada Alliance for Health and Justice (NNAHJ) recently celebrated it’s two-year anniversary bringing medical and legal services together in one place, a medical-legal partnership.

In recent years, a growing understanding of the environmental factors that affect the health of low-income communities has given rise to a relatively new trend in social services thinking, medical-legal partnerships.  Rita Greggio is a medical-legal attorney for NNAHJ in Reno and said the concept started on the east coast and is rooted in the essential need for adequate housing.

“Parents were bringing their sick children to the hospital. These kids were suffering from asthma and all these kinds of respiratory problems, so the doctors would treat these kids and then send them home. A month or two later they would come back, and they’re still sick, so the doctor started wondering what’s going on. Why did these kids keep getting sick, and what they discovered was that the children lived in very bad housing. They lived in housing with mold, with infestations of mice. This was affecting the kids’ health. The doctors thought we can treat the kids but we can’t do anything about where they’re living, so maybe if we get some lawyers involved to make the landlords fix this really bad housing that’s making these kids sick, we can have an impact.”

Hear an audio interview with Rita Greggio.

Because the notion of having a lawyer on-hand when a person sees a medical doctor is new, cross training for medical professionals is a first step to helping people with debilitating legal and social problems. Countless health problems are rooted in federal, state, and local policies and laws that require the expertise of a poverty and administrative law attorney.

“A doctor doesn’t always know what someone’s legal issue is, but by having a lawyer in house, we can train doctors to look for those things,” Greggio said. “People naturally tell their doctors a lot, so if you’re my doctor, and I say, I’m not doing so well this week because I’m about to be evicted from my house. I may not know that I can get help for that, but if I tell my doctor that and my doctor turns around and says, you know what, we have lawyers here in the clinic, why don’t you talk to them about that problem, it’s gonna make it easier, it’s going to reduce the barrier for that individual to get the legal help because the individual may not know that they need a lawyer. They may not know how to get a lawyer, so by having someone they trust right there in the doctor’s office who they already have a relationship with says, ‘you know what, I think a lawyer could help you with that.’ It helps that person address that legal issue in a way that they might not (otherwise).”

An important aspect of program success is co-locating medical and legal assistance. Greggio said legal assistance can be intimidating for some averse to courts, lawyers and the legal justice system. Low-income individuals who lack transportation are far less likely to visit a second office for legal help, even if it’s free. A recent white paper revealed that co-location of medical and legal services is one of the most valuable aspects of the model.

“They’re not going to a new place where they’re meeting new people. They’re getting legal help, which can be very scary for people, but they’re doing it in a place they feel safe. They don’t have to travel anywhere else, so if I’m already pressed for time and I’m already sick and I’m already having to work more to make the rent, it’s going to be really hard if my doctor says, ‘go across town to go see this lawyer.’ We can provide all of that in one place, which makes it just that much easier for clients to do something that’s going to have such a benefit for their health.”

If a person charged with a criminal offense and cannot afford a lawyer, the US Constitution provides that one will be provided free of charge, but Rita Greggio points out that the constitutional guarantee of legal representation only applies in criminal matters, not civil cases.

“There are a lot of civil cases that are not criminal, so divorce, eviction cases, housing. There are a lot of areas of law that we call civil law, and unfortunately there is no law that says that you’re entitled to a free lawyer for your divorce or for your eviction case. Most states have some kind of funding, usually nonprofit agencies. They get grants, and we create what are called legal aid agencies. Legal aid agencies are basically nonprofits that are created to address those civil legal needs. Usually to qualify you have to be low income,” Greggio said.

The Northern Nevada Alliance for Health Justice has partnered with Washoe Legal Services. The effort is funded by grants that restrict legal assistance to issues that directly affect a person’s health, but Greggio said that casts a wide net, and to date, more than any other issue, the agency has helped people with legal problems related to housing.

“We’ve done a lot of housing cases because housing is just such an area that can have such an impact on someone’s health. And as you know, right now in northern Nevada we’re having a huge housing crisis,” Greggio said. “If we stop someone from getting wrongfully evicted, it helps them stay in their home and helps prevent them from losing their job, it helps them stay engaged with their health care, and people are just, they’re amazed that they can get that help from a lawyer at their doctor’s office for free, and they get the issue resolved.”

Sometimes an individual doesn’t need legal representation but has problems or questions, and sometimes, that’s all a person needs to get out from under oppressive stress that undermines their health.

“Sometimes someone says, ‘you know what, all I need is for you to answer some questions I have so that I can make this decision in my life,’ so not everything is going to court with someone. Even just giving someone the facts and their options can improve their well being. If you have some issue where you’re worried and you’re stressed and you don’t know what to do and you don’t know how to make a decision, you don’t see the light at the end of the tunnel, then you come in, you talk to someone. They give you the facts, and then you’re able to make that decision and move on. You don’t have all that stress and it has a positive impact on your health.”

The NNAHJ is currently funded through May 2020. There are two staff members including Rita Greggio who imagines a time in the future when there are medical-legal partnerships (MLPs) at every major medical facility in northern Nevada.

“Once we have sustainable funding, the dream would be to expand the model and maybe have an MLP not only at HOPES, but an MLP at the VA, an MLP at Renown, an MLP at other places around town,” Greggio said.

Greggio offered a satisfying example from the many cases they’ve handled over the past two years.

“There are plenty of attorneys that charge people to do social security work, and we had a client who had applied for Social Security disability, an individual who was very, very sick, who had brain tumors, and social security denied his disability. We were able to appeal that denial and we were able to get him something close to $15,000 in back pay. Now, if he had gone to a private attorney, about a third of that would have gone to the attorney, but by coming to the MLP, he didn’t have to pay anything. This was someone with an obvious need, a very severe disability, for whom that money really made a difference in his ability to care for himself and his family.”