Humans in Public Health: Making the Case for Public Health

Liz Tobin-Tyler is a lawyer who combines law and public health to study reproductive justice, maternal and childhood health and domestic violence.

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Megan Hall

Before we begin today’s episode, a quick warning- our conversation will include some brief mentions of domestic violence. Please listen with care. 

Liz Tobin-Tyler is a lawyer who combines law and public health to study things like reproductive justice, maternal and childhood health, and domestic violence. 

But at first, she wasn’t even on track for a career in law, OR public health 

Liz Tobin-Tyler:  00:48  

I was headed for the PhD in English.

Megan Hall: 0:49

But, she was also volunteering at a domestic violence shelter for women and children. 

Liz Tobin-Tyler:  00:56  

So when I was studying English as a master student, I took a course called the representation of women in law and literature. 

Liz Tobin Tyler: 01:02

And so during that time I looked at Toni Morrison's novel, Beloved, which was about an enslaved mother who ultimately decides to kill her child rather than have her child go back into slavery. And so I looked at that in comparison to three legal cases at the time.

Megan Hall: 01:19 

The court cases all involved mothers who were in difficult situations with their children. 

Liz Tobin-Tyler: 1:23  

It really opened my eyes to thinking about the law, and the way that law uses language to construct reality.

Liz Tobin-Tyler: 01:30  

I think my English background, my humanities background, made me also think about how law can become a narrative. If you think about legal cases, what you have are stories about people's lives. And obviously, there's generally some sort of conflict that needs to be resolved. But the way a court uses language to do that, tells a story as well.

Megan Hall:  01:54 

And after you took that course, you just decided to be a lawyer?

Liz Tobin-Tyler:  01:57  

I actually did. I actually applied to law school as I finished that master's degree and moved to Boston and went to law school. So yeah, that it really did have a big impact on me.

Megan Hall:  02:09  

First you were looking at literature, and then you combine it with law, and then you're combining it with public health? So how are you mixing all these things together? 

Liz Tobin-Tyler:  02:17 

Yeah so I found this really great opportunity at Boston Medical Center while I was in law school, to work in what was the first medical legal partnership in the country. And the idea of that was to bring lawyers and social workers and physicians and others working in the healthcare context, together to really do interprofessional interdisciplinary problem-solving around issues that were affecting low income families.

Megan Hall:  02:41  

And would you work with specific patients? Or were these sort of overall policy decisions you were making at the hospital?

Liz Tobin-Tyler: 02:48  

We worked directly with patients. So the way a medical legal partnership works is that clinicians work in collaboration with the legal team. And they essentially will ask questions of the patients and their families when they come in about their housing, about violence in the home, about you know, accessing basic needs, a whole range of issues, social determinants of health, but with an eye towards, are there legal, unmet legal needs here? Because many people and this is true of all, I think all people but particularly for lower income people, they often don't know they have a legal issue, right? They know they have a problem. But they may not understand because they don't know the law, understandably, that there's a legal remedy that might be available to them. So part of the idea is really, ask people about their lives, hear their story, their narrative and say well here are the different ways these professionals can be supportive.

Liz Tobin-Tyler: 03:43

Often clinicians would sort of diagnose the medical problem, you know, prescribe the medication and move on. And what we discovered was when we all worked together and really heard the patient's story or the family's story, there were multiple ways that we could support that family through legal advocacy, through obviously, helping them access what they needed in the community, through medical care.

Megan Hall: 04:06 

Is there anyone who really sticks in your mind as an example of someone who benefited from this partnership? 

Liz Tobin-Tyler:  04:12 

You know, without using a name obviously, I worked with a mom who was faced with just what I saw as an untenable situation, which is that she had a child who was lead poisoned. What often will happen when a child is lead poisoned, is a landlord will evict the family because they don't want to conform to the law. And so, you know, not only is the child lead poisoned, but then the family is facing homelessness, and so it was often the case that they didn’t want to push the landlord on their rights, which included lead safety. And so sometimes, you know, with this mom and others that we saw, she felt like she was choosing between having housing at all, and maybe that housing had lead in it and, and choosing to try to find other housing, and frankly, sometimes the other housing that people had available to them was just as bad, for the price right? For what they could afford.

Megan Hall: 05:07

So what ended up happening to them?

Liz Tobin-Tyler:  05:10 

Yeah. So the, again, I think the beauty of working in collaboration with multiple partners is that we were able to find her alternative housing, you know, again, with the lawyer and social worker, and clinicians kind of working together, so she was able to move into safe housing. So yeah, there are happy endings to some of these stories. They're not always simple. But when the law lends itself to remedies, it can be really, really powerful.

Megan Hall:  05:36 

Do we need a lawyer in every hospital? 

Liz Tobin-Tyler:  05:38  

Absolutely. We actually have, there are about 450, medical legal partnerships now. And I'm proud to say I worked at the first one in Boston, but it's a model that has really expanded across the country. 

Megan Hall: 05:52

These days, Liz spends most of her time on research looking at how legislation and the Supreme Court are shaping public health - specifically women’s health.  Of course, includes the Dobbs Supreme Court decision, the one which overturned the constitutional right to abortion. 

Megan Hall:  06:07  

Do you remember where you were when you heard about the Dobbs decision?

Liz Tobin-Tyler: 06:11  

I do. And I was in the car, actually, you know, I wasn't surprised, actually, when the decision came down, because there had been the leaked opinion. And I had read the leaked opinion. And the, the final decision was very much the same. So that was the gut wrenching moment for me.

Liz Tobin-Tyler:  06:31  

I think, especially, you know, a year and a half past the decision, it's still a daily struggle for me to sort of maintain a sense of despair about the decision and what it means. And we're seeing the implications, play out across the country.

Megan Hall: 06:46

But Liz’s research also includes cases you might not think about when you consider women’s health. She looked at a different Supreme Court decision from 2022 that created a new test to decide if gun control laws are constitutional. 

Liz Tobin-Tyler: 06:59

The court said that for the government to impose a particular regulation, restricting firearms access under the Second Amendment, it had to demonstrate historically, or a history and tradition of the government having done that at the time that the Second Amendment was written. And that obviously makes it very difficult to restrict firearms for lots of reasons. Because, you know, what were the laws on the books at that time? It was a very different time, obviously, in terms of how we think about firearms, types of firearms, where people carry firearms, all of those things. But in particular, it struck a chord with me, because I became concerned that this was going to make it easier for people to have firearms, who are domestic abusers.

Megan Hall: 07:49

And gun control for domestic abusers is an issue that disproportionately affects women:

Liz Tobin-Tyler: 07:54

And we know that if a woman lives with somebody, an intimate partner, and there's a firearm in the home, they're five times more likely to be murdered with that firearm.

Megan Hall: 08:03

There is a federal law that restricts gun ownership for people who have been accused of domestic abuse. It’s called the Violence Against Women Act - but that law didn’t exist when the Second Amendment was written. It was passed in 1994.  

Liz Tobin-Tyler: 08:16 

So I saw all the writing on the wall here, and of course,there was a case brought in Texas, by a man who was a known domestic abuser, there was a restraining order against him. He had been violent with his partner, and under the restraining order that was issued against him, he was supposed to turn over his firearms. He did not do that. 

Megan Hall: 08:37

The man’s lawyers brought this case to the Supreme Court. The argument was, that under the new test…

Liz Tobin-Tyler: 08:43

There is no history and tradition of regulating firearms by people who are under a restraining order. And so it seems to me that this provision, which was in the federal Violence Against Women Act, saying that firearms may be taken away from somebody who is subject to a restraining order, it's not clear that that law is constitutional, 

Megan Hall:  09:08

because back in the day, we didn't really protect women's rights.

Liz Tobin-Tyler:  09:11

Exactly. Exactly. 

Megan Hall: 09:13

The Supreme Court is still deciding whether or not gun control for domestic abusers is allowed under this new test. Liz actually wrote about what the case could mean in a new article, published in JAMA Health Forum.

Liz Tobin-Tyler:  09:25 

The oral arguments were heard in November. I listened to all of them. And the court, I think, in that case, seems to be recognizing that this is problematic, which I think is a good thing. 

Liz Tobin-Tyler:  09:38 

You know, Justice Jackson, who I'm a huge fan of, asked some very important questions about how the court could continue to use this history and tradition analysis in a case like this, where clearly, you know, there were no protections for people who are experiencing domestic violence. In fact, it was legal at the time that the Second Amendment was written, husbands were essentially permitted to abuse their wives for punishment. Certainly Black women who were enslaved at the time had no protections. So she raised a lot of those questions about, you know, if this is the history and tradition, and we're going to use that as our test as a way to determine, you know, what we do now with regard to in this case, firearm regulation, isn't that problematic? 

Liz Tobin-Tyler:  10:24

And the Dobbs case was actually decided under a same analysis, which was a historical analysis of how laws regulated abortion going all the way back to the founding of the country. And Justice Alito, who wrote that case, looked specifically at laws and in the mid-19th century, that were passed, because prior to that, there weren't really laws that regulated abortion. 

Liz Tobin-Tyler: 10:48 

And so it speaks to this problem of how do we analyze history? If we're going to analyze history, through certain perspectives, you know, whose perspective are we using? Are we using enslaved people's perspectives? Are we using women's perspectives at that time? Are we using sort of white male perspectives of how history went down? And why?

Megan Hall:  11:09 

And it's interesting that it all sort of comes back to narratives, right, like what is the narrative that the Court is using to think about the laws for our country?

Liz Tobin-Tyler:  11:16

Absolutely. And I wrote a piece that was published in Health Affairs about exactly that question. Because the court spent in Dobbs, you know less than a page, talking about the implications of allowing states to ban abortion, for women's lives. I mean, women were almost erased from that decision in terms of what the implications of that decision would have for women's lives, particularly low income women of color, who are going to have and do have after Dobbs, less access to reproductive health care. It was as though they didn't exist. And I think that does speak very much to law as  narrative, whose narrative? whose story? 

Megan Hall: 11:56

And although the Dobbs decision is a big setback for reproductive justice, Liz hopes that it can be a turning point.

Liz Tobin-Tyler:  12:03 

There's a wonderful colleague I have, her name's Kim Mutcherson, who's a legal scholar, and I was at a conference on the Dobbs decision, and she said, you know, reproductive justice, could be the Phoenix that rises from the ashes of Dobbs. What I loved about Kim's quote is that I think she was saying, this is a terrible moment in time, and there are ashes from Dobbs. But how do we take this and begin to change the narrative about what it is that we need to support all people to make, you know, the decisions they need to make for themselves and their families about reproductive health care and abortion, but also how do we construct the society in a way that addresses those social determinants of health that really has an equity lens and provides those things for all people.

Megan Hall:  12:54  

Great. I think that's a good place to end. Liz, thank you so much. This was really interesting. I learned a lot. 

Liz Tobin-Tyler:  12:59  

Thank you so much. I enjoyed it.