Thinking upstream

Jenna Prochaska of Loyola’s Health Justice Project focuses on poverty law and health care access

Jenna Prochaska is a clinical teaching fellow at the Health Justice Project, a medical-legal partnership that serves low-income patients in Chicago and suburbs. Prochaska brings diverse public interest legal experience to her fellowship, with a focus on poverty law and health care access.

Here, Prochaska discusses her fellowship and the policy work that she and her students have engaged in and how she influences her students to work upstream to become agents of change.

“We can’t always solve all the problems, but we do look for opportunities to help bring about some broader policy change.”

Describe your fellowship with the Health Justice Project.

Our clinic is structured as a medical-legal partnership, so the bulk of my work is supervising interdisciplinary teams of law students, social work students, and medical students who provide direct representation to patients of Erie Family Health Centers. This model of practice provides students with an opportunity to learn from each other and think holistically about the issues facing their clients. All of our clients are living in poverty. As a result, they come to us facing interrelated issues. Just solving one piece of a client’s problem isn’t sustainable.

The holistic model of our advocacy also relates to our policy work because we encourage Health Justice Project students to think “upstream” about their cases and the issues facing their clients as well and to ask: Is this an isolated issue, or is it connected in some way to a broader problem that we are seeing come up in multiple cases or that relates to a policy or system that needs to change? We can’t always solve all the problems, but we do look for opportunities to help bring about some broader policy change.

Tell me about your work related to substandard housing conditions.

We often get referrals from our healthcare provider partners about substandard housing that is exacerbating a client’s asthma or anther underlying health condition. There have historically been fewer protections for tenants in these circumstances who live in Cook County but outside of Chicago. Last year, I worked with some Health Justice Project students to support advocacy efforts to expand the rights of tenants living with substandard housing conditions throughout Cook County by passing the Countywide Residential Tenant Landlord Ordinance (RTLO). This effort was led by a coalition of advocates, including the Lawyers Committee for Better Housing and Housing Action Illinois.

Health Justice Project students contributed by gathering research and client experiences to demonstrate the connection between substandard housing and health. We engaged closely with community advocates working on the effort, drafted written testimony for the County Board, and published a letter to the editor in the Chicago Sun-Times about the need for these additional protections for our client communities. That ordinance passed in January 2021, and all the provisions were in effect as of June 2021. Since then, we’ve done outreach and trainings on the new protections to our client communities. That’s one example of how working on individual client cases that come through the medical-legal partnership can translate into thinking about how to support upstream solutions.

What other upstream work do you handle with the Health Justice Project?

A related area of upstream advocacy the Health Justice Project has historically been involved with is related to lead exposure in rental housing for young children. We have conducted Freedom of Information Act research on this issue and are collaborating with partners at the Shriver Center on Poverty Law and Legal Aid Chicago to continue that work. We are also a part of a coalition of public health and housing advocates led by the Metropolitan Housing Organization called Proactively Addressing Substandard Housing (PASH). This group is working to hold the City of Chicago accountable for how it ensures that lead in rental housing is identified and addressed before children are exposed and harmed. 

Another area of upstream work relates to local ordinances called Crime-Free Housing and Nuisance Property Ordinances. These are city ordinances that impose penalties on rental property owners based on calls for police service. We have seen how their enforcement can lead to unnecessary evictions, as landlords can be threatened with fines or the revocation of their rental license. They are particularly harmful to people who need to call the police more often, and can pose unique risks of harm to survivors of domestic violence and people with disabilities. They are also often disproportionately enforced in Black and Latinx communities, so can limit housing opportunities and perpetuate longstanding patterns of segregation based on race. With support from undergraduate students at Loyola’s Center for Urban Research and Learning, we are gathering data about the scope of these ordinances in Illinois—where they are enforced and what harms they’re causing. The goal is to provide backup support to legal services advocates who see issues related to these ordinances come up in their cases, and ideally advocate for broader statewide policy solutions to the problems they continue to cause. –Stephanie Mitchell King (January 2022)