Tackling Housing Instability Through Medical-Legal Partnerships

/ Blog Post

Headshot of Morgan-Colonna
Photo of Morgan Colonna

By Morgan Colonna, 2021 Equal Justice Works Fellow hosted by Central Virginia Legal Aid Society.

Historically, housing policies in the United States have contributed to social inequality and residential segregation in our country. This is certainly true in Richmond, Virginia, which has a long history of racial segregation in housing.

When the Fair Housing Act made racially restrictive covenants in real estate illegal, Richmond found other ways to break up and isolate the city’s black community. Construction of I-95—the nation’s longest north-south interstate highway—through the heart of the Black community, and the concentrated construction of five public housing communities within one mile of each other in the East End of Richmond, are two examples of ways in which Richmond’s urban renewal policy led to clustering low-income persons, who were mostly Black, in the center of Richmond.

Today, low-income families in Richmond’s East End still face substandard housing, higher rates of poverty, and fewer resources for health promotion than other neighborhoods in the city.

Studies show there is an inextricable link between housing and health. Additionally, studies show, disparities exist in health across socioeconomic groups as low-income families are more likely to experience unhealthy and unsafe housing conditions and are also the least likely to be able to address them. Researchers have specifically identified housing stability, quality, safety, affordability, and the physical and social characteristics of neighborhoods as factors that directly impact a person’s health.

A person who lacks safe, stable housing is also less likely to have a usual source of medical care and more likely to postpone needed treatment or go without prescribed medications. Housing issues have been linked to increased mortality, trauma, depression, anxiety, physical health morbidity, increased hospitalizations, food insecurity, risk of teen pregnancy, drug and alcohol use, suicide, and health care expenditures, as well as disruptions to employment, social networks, education, and receipt of social service benefits.

Medical-legal partnerships (MLPs) provide one approach to addressing some of the most complex needs affecting health, including housing issues, by adding lawyers to a person’s health care team to address social issues rooted in legal problems. At VCU Health in Richmond, Virginia, I am a part of the health care team within my designated clinics, serving low-income patients within the hospital and in a community health clinic in Richmond’s East End. Doctors, nurses, and social workers screen their patients for potential legal issues and refer the patient to me in the same way they would refer a patient to any subspecialty. From there, I step in to help patients resolve legal issues which have a direct impact on their health.

Within the housing realm, improving substandard conditions, preventing eviction, and protecting against utility shut-offs helps to ensure a patient stays housed in a healthy physical environment. Ensuring a patient has a stable, decent, affordable home also helps avoid costly emergency room visits related to homelessness, and consistent utilities help patients follow medical treatment plans.

Ensuring a patient has a stable, decent, affordable home also helps avoid costly emergency room visits related to homelessness, and consistent utilities help patients follow medical treatment plans.

I recently referred a patient who depends upon daily insulin and breathing treatments. Her landlord disconnected her utilities and was threatening to evict her due to non-payment of rent. Once I received her case, I was able to work with the state’s rent relief program to obtain rental assistance for the patient and prevent the eviction. I also worked with city officials and the landlord to reconnect the utilities within the same day. In addition to preventing an eviction, we restored this patient’s access to necessary medical treatments and medications within her home.

This is just one example of how the MLP works to identify and address social issues that directly impact health. Although this partnership does not erase Richmond’s history, the MLP is making strides in addressing some of the structural problems at the root of many health inequities that still exist because of Richmond’s history of segregation and housing discrimination.

Visit here to read more stories about the work of our Fellows and how they are keeping thousands of Richmond residents safely in their homes during the pandemic.

The Housing Justice Program is funded by The JPB Foundation and Equal Justice Works.

Learn more about becoming an Equal Justice Works Fellow