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While the primary role of physicians is to treat disease, the causes of disease can be complex and influenced by factors beyond their control. Issues such as financial instability, poor housing conditions, food security and neighborhood violence can affect medication compliance, education level, quality of diet, or frequency of exercise. Additionally, medications such as inhalers and steroids may temporarily relieve a child’s asthma exacerbation, but as long as the child continues to return to his cockroach infested house, struggles to eat a well-balanced diet, or is unable to exercise outside due to fear of violence, he will continue to struggle with asthma control.

Therefore, it is essential for primary care physicians to be “upstreamists“, or those who are willing to travel against the current to arrive at the root cause of the problem. As there is increasing pressure for the “fifteen minute appointment”, providers often do not have time to address many of the social issues that exacerbate chronic medical conditions. That’s how the concept of the Medical Legal Partnership (MLP) came to be. First founded in 1993 by Barry Zuckerman, a pediatrician at Boston Medical Center, in conjunction with an attorney from Greater Boston Legal Services, the goals of an MLP are to create a team of healthcare providers and lawyers to address legal barriers to improving health.

Increasingly, federally qualified health centers and hospitals around the US are partnering with local legal aid services to provide their patients with additional assistance on all of their legal issues. When individuals are having trouble with a service provider, a letter signed by a lawyer can encourage the offending service to do the right thing. For example, landlords of public housing are required to provide standard living conditions, but often cannot held accountable by their tenants. In these situations, a referral to the MLP can provide patients with advice regarding which county department to call or even help drafting paperwork to file for court hearings. This can educate patients on the rights that they are entitled to by the law as well as help start applications for public benefits, such as food stamps or health insurance.

The MLP model is designed to help patients like this child who will continue to struggle to control her asthma for as long as she lives in an area with allergens and poor air quality.


In many low income communities such as Worcester, Massachusetts, nearly one in ten children suffer from asthma. Uncontrolled asthma as a child leads to poor health and development in addition to a large number of missed school days. It is essential to help these children control their asthma through a combination of clinical care, disease education, and stable housing conditions. We need to see all of these issues as closely intertwined, and interventions at multiple levels are required to truly improve a child’s health outcomes. The MLP model will help provide thorough, comprehensive care while also improving long-term patient satisfaction and health.

Feature Image Source: Agreement signing by TMS

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