RESUMEN
Medical-Legal Partnerships (MLPs) have been widely acclaimed for promoting health equity and achieving meaningful outcomes. Yet, little to no research has analyzed if this critical work has been done with communities - through meaningful engagement and building power - or if it has been done for communities without their involvement.
Asunto(s)
Equidad en Salud , Justicia Social , HumanosRESUMEN
Micronesian communities in Hawai'i have a long history of mobilizing to address challenges they encounter as the most recent and fastest growing Pacific Islander immigrant population in the state. In particular, community leaders navigate a slew of obstacles specific to systemic racism and health care access. These hurdles have become exacerbated by the COVID-19 pandemic, prompting a range of Micronesian-led responses to the health crisis including strategic adaptations to existing networks and roles to address essential public health functions. These community responses have filled many critical gaps left by the state's delayed response to addressing the disparate impact of COVID-19 on Micronesian communities. This article highlights and encourages engagement with diverse models of collaboration and elevation of Micronesian leadership that has resulted in more productive cooperation with government leaders, agencies, and policymakers. This work offers insight into pathways forward toward healthier Micronesian families and communities.
Asunto(s)
COVID-19 , Pandemias , Hawaii , Humanos , Nativos de Hawái y Otras Islas del Pacífico , Pandemias/prevención & control , SARS-CoV-2RESUMEN
The Medical-Legal Partnership for Children in Hawai'i (MLPC) has worked to address the social determinants of health for low-income patient-families since 2009. Focused on identifying health-harming legal needs, doctors and lawyers work together to assist families with family law, housing, public benefits, education, employment, civil rights, and other concerns. Providing free, direct legal service in the medical setting allows the medical-legal partnership (MLP) team to identify community-wide concerns such as language access violations, racial discrimination, and unfair policies. These individual concerns then inform systemic advocacy and community engagement efforts. The MLPC Hawai'i team has grown through its experiences working with public housing residents, Micronesian migrant communities, and low-income families, ultimately evolving the national MLP framework to become a patient-centered "medical-legal home." This evolution is possible through the utilization of "rebellious lawyering" concepts of working with, not just on behalf of, community clients. This article will introduce the concept of a medical-legal partnership, provide examples of lessons learned from working alongside vulnerable and resilient communities, and explore the idea of the patient-centered medical-legal home as an innovative program to improve the social determinants of health and reduce health disparities.
Asunto(s)
Medicina Legal/organización & administración , Atención Dirigida al Paciente/organización & administración , Medicina Legal/tendencias , Hawaii , Humanos , Atención Dirigida al Paciente/métodos , Atención Dirigida al Paciente/tendencias , Determinantes Sociales de la Salud , Poblaciones Vulnerables/estadística & datos numéricosRESUMEN
Under the Compacts of Free Association (COFA), people from the Freely Associated States--the Republic of Palau (ROP), the Republic of the Marshall Islands (RMI), and the Federated States of Micronesia (FSM)--have been migrating to the United States in increasing numbers. In 1996, Congress passed broad welfare reform (Personal Responsibility and Work Opportunity Reconciliation Act) which limited certain federal benefits previously available to COFA migrants, including Medicaid benefits. Prior to July 2010, the State of Hawai'i had continued to include COFA migrants under its state-funded Medicaid program. In the face of budget constraints, the State removed these people from its Medicaid rolls. A challenge on the legal basis of the denial of equal protection of the laws, ie, the Fourteenth Amendment to the US Constitution, was successful in reinstating health care to the COFA migrants in December 2010. From the health worker's perspective, regardless of various social justice arguments that may have been marshaled in favor of delivering health care to the people, it was an appeal to the judicial system that succeeded. From the attorney's perspective, the legal victories are potentially limited to the four walls of the courtroom without community involvement and related social justice movements. Together, the authors propose that in order to better address the issue of health care access for Micronesian peoples, we must work together, as health and legal advocates, to define a more robust vision of both systems that includes reconciliation and community engagement.