As a lawyer who practices in both the health care and wellness worlds, I have the advantage of witnessing strategies to try to improve health outcomes in both worlds. One issue that is dominating the health care policy literature is implementing strategies to address Social Determinants of Health (“SDOH”). SDOH includes issues like:
- family relationships,
- housing
- education levels
- income and employment concerns,
- cultural values
- legal status (such as immigration, criminal or credit history status)
These issues can have an enormous impact on an individual’s health and wellbeing. For example, someone who is in an abusive relationship will not achieve full wellbeing, no matter how many wellness activities you throw at them. The same is true for individuals who live in poor housing conditions, are worried about deportation, face financial burdens or feel discriminated against.
“The WHO Commission on Social Determinants of Health concluded in 2008 that the social conditions in which people are born, live, and work are the single most important determinant of one’s health status.” See https://journals.sagepub.com/doi/pdf/10.1177/00333549101250S402. As stated by Dr. David Satcher, former U.S. Surgeon General, lifestyle choices are important, “but factors in the social environment are what determine access to health services and influence lifestyle choices in the first place.” Id.
Addressing SDOH in turn addresses health inequities that exist based on race/ethnicity and gender. Id. Thus, recent efforts to promote diversity, equity and inclusion (DEI) should go hand-in-hand with efforts to tackle SDOH.
As noted above, SDOH as it relates to health status is top-of-mind in health policy research and programs. The wellness sector needs to join in those efforts, including workplace wellness. The recent “Five Essentials for Workplace Mental Health and Well-Being” spearheaded by the U.S. Surgeon General lists normalizing and supporting mental health, as well as operationalizing Diversity, Equity, Inclusion and Accessibility norms, policies and programs. To do that effectively, employers must prioritize examining the SDOH that affect their workers. Examining SDOH could naturally be incorporated into workplace wellness programming, such as through strategic, thoughtful questions that can expose SDOH. But wellness professionals should not stop at exposing SDOH. There also needs to be a system in place to address those SDOH once exposed.
The Need for Wellness-Legal Partnerships
The system I propose to tackle SDOH once exposed through workplace wellness programming is a “Wellness-Legal Partnership” or “WLP.” These partnerships would be modeled after “Medical-Legal Partnerships (MLPs), which started in Boston in 1993 to allow doctors to utilize legal resources in health care settings to ensure vulnerable patients’ legal needs are identified and met. See Anne M. Ryan, et al., Pilot Study of Impact of Medical-Legal Partnership Services on Patients’ Perceived Stress and Wellbeing, J. of Health Care for the Poor and Underserved, 23 (2012): 1536-1546. MLPs have three core components:
1) direct legal services for patients who are referred to lawyers;
2) transformation of health and legal institutions to address legal needs early; and
3) policy change to remove legal barriers to health.
Research on MLPs demonstrates that including attorneys on health care teams increases access to resources for patients, improves awareness by the health care organization and society at large of public health issues and social services, and reduces stress for the provider, the patient and the patient’s family. See Dana Weintraub, et al., Pilot Study of Medical-Legal Partnership to Address Social and Legal Needs of Patients, J. of Health Care for the Poor and Underserved, 21 (2010) 157-168 (noting that a study of 20 cancer patients who had received legal assistance through an MLP showed positive results, such as 75% of patients said legal assistance reduced stress, 50% reported receipt of legal assistance had a positive effect on their family or loved ones, 45% said legal assistance positively affected their financial situation, and 30% reported that legal assistance helped them maintain their treatment regimen).
Reducing stress in the workplace is a goal mentioned frequently by workplace wellness professionals and aligns with the Surgeon General’s Five Essentials for Workplace Mental Health and Well-Being. If MLPs are known to reduce stress in health care system patients, then WLPs can similarly reduce stress for employees in the workplace.
How would WLPs Work?
WLPs could work as part of an Employee Assistance Program (EAP) or a separate partnership agreement between the employer and legal resource. ERISA already contemplates “prepaid legal services” as part of an employee welfare benefit plan offering. 29 CFR § 2510.3-1. Thus far, few employers incorporate legal services into their welfare benefit plan offerings. But, if evidence shows on the health industry side of things that legal services can address SDOH and reduce stress, then more employers may be willing to include legal services as part of their workplace wellness program offerings.
The legal resource of an WLP may be a wellness law firm, a wellness law clinic through a law school, or wellness association with legal resources. For an example of a legal benefit sponsored by an employee association, see https://www.dol.gov/agencies/ebsa/about-ebsa/our-activities/resource-center/advisory-opinions/1994-25a. As wellness professionals identify SDOH through corporate wellness assessments, the wellness professional could refer the wellness program participant to wellness law specialists. These wellness law specialists would make connections with other legal specialists in housing law, immigration law, family law, and criminal law. The legal specialists would assist the wellness program participant with the more “upstream” drivers of health and wellbeing, clearing the way for the participant to more fully engage in wellness activities that promote healthier behaviors. WLPs could also work alongside wellness professionals in creating effective assessments and evaluating the work environment to remove barriers to achieving wellness.
There is much potential in WLPs, and I intend to write much more about it in the coming months and years. But it is time for wellness to start looking beyond individual behaviors and lifestyle choices and toward helping dismantle the injustices that perpetuate wellness inequity.
If you would like to learn more about how the Center for Health and Wellness Law, LLC can help advance WLPs or your wellness program equity, please contact us.