More Lessons from the Health Sector

First and foremost, the legal community – both public and private – needs to better understand and honour the unique perspective, role and access that healthcare providers traditionally have in a community. Governments

Integrating Healthcare and Legal Services to Optimise Health and Justice for Vulnerable Populations: The Global Opportunity

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and funders tend to prioritise health services over access to justice, and hospitals and health centres constitute a vital part of any community. And while health services may fail to efficiently meet the healthcare needs of vulnerable populations, health services vastly outnumber legal resources.

As a result, health organisations tend to have infrastructure, leadership, and capacity available at the local level to leverage alongside smaller-scale legal resources.

At a broader level, one could argue that the legal community ought to model all facets of best practices – from dissemination of information, to professional training, to the development of evidence-based practices – on the healthcare field, for the simple reason that the infrastructure, fi-nancing and implementation strategies for serving vast populations of vulnerable people in healthcare tend to be more advanced than in the legal community. Specific domains where the health sector offers important experience and frameworks include:

 how to measure impact and quality;

 how to anticipate and respond to trends using data; and

 how to strategically invest in legal interventions with a focus on prevention.

A recent report by the Australian Attorney General that described strategic frameworks for access to justice is replete with language tradi-tionally associated with the healthcare sector, including “triage”, “early intervention”, and “resilience”. For the legal community to successfully leverage the existing infrastructure of the healthcare system, it would do well to adopt the language of healthcare wherever possible. Other exam-ples of key strategies and tools:

3.1. The Team Concept

People do not generally have legal, social, economic, or health problems – they just have problems that have multiple impacts on their lives. The healthcare sector prioritises training members on how to work as a team, understanding their role, and working at the top of their profession. Alas, the legal profession is historically ill-equipped to partner with other pro-fessionals, especially in the public interest sector, and there are few incen-tives to promote inter-professional team work. But as the legal profession begins to contemplate the role of non-lawyers in expanding access to jus-tice, it will find that the healthcare setting has a ready team of “extenders”

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to train, and a system of triage and treatment in which to practice newly acquired advocacy skills.

3.2. Investing in Prevention – The Shift from Individual to Systemic Solutions

The health sector is decades ahead of the legal profession in terms of thinking about prevention. A helpful analogy likens surgery to litigation – both call for the intensive, yet inefficient allocation of resources focused on a single individual. Both surgery and litigation will always be neces-sary in some cases, but prevention can ensure that reliance on surgery or litigation is lessened by reallocating resources towards prevention activi-ties. In the health context, the classic example is cardiac health: a public health campaign to improve cardiac health by promoting tobacco cessa-tion, exercise, and weight loss has, as its ultimate goal, improved health and the reduction of cardiac surgery rates.

While it appears that the legal community is reaching consensus that the practice of individual representation for vulnerable populations is too intensive, inefficient, and costly, it has not yet coalesced around a set of prevention strategies. The public health field holds substantial experi-ence in documenting the impact of prevention as well as shifting profes-sional and community culture towards prevention.

Paediatrician and public health expert Megan Sandel of Boston University School of Medicine and the National Center for Medical-Legal Partnership describes the opportunity of preventive law as helping to move from individual legal interventions to broader systemic impact at the institutional and community level, where individual cases identified in the health setting act as diagnostic tools for failed policies – which are then more effectively addressed together by an integrated health and legal team. But it is an axiom of legal service provision that by the time a client realises that he has a legal problem, it is likely so far along that prevention is impossible. The healthcare setting, above virtually all other community settings, can provide the access, expertise, and atmosphere for preventive law practice. In order to provide early, preventive legal services, lawyers must practice civil law where clients frequently visit and where the idea of prevention already carries weight: healthcare sites. Indeed, legal services can only be accessed preventively in a setting where clients are seen rou-tinely and can be screened for legal problems.

Integrating Healthcare and Legal Services to Optimise Health and Justice for Vulnerable Populations: The Global Opportunity

Law of the Future Series No. 1 (2012) – page 79

3.3. Leadership and Innovation

The health sector routinely makes explicit investments in leadership and innovation, celebrating leaders who nurture bold innovations that chal-lenge the status quo. Health care leaders routinely look to other sectors – engineering and business – to invigorate standards and practices, which are evaluated using common metrics in the healthcare field. In contrast, the legal sector struggles to foster and scale innovations in access to jus-tice. Why? Both the health and legal sectors confront limits on their re-sources due in large part to the disproportionate need of vulnerable popu-lations. What is it about the healthcare field that supports a culture of in-novation and leadership?

One possible, albeit simplistic, answer lies in the financing and sus-tainability mechanisms for healthcare – a complex mingling of private and government funds that support the goods and services distributed at the local level. Pharmaceutical and other profit-driven healthcare-related enti-ties participate in the healthcare delivery system, and spark/support inno-vation for many reasons. In the legal sector, the only real commodity is information and advice provided by trained experts.