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Article

Larry E. Davis, John M. Wallace Jr., and Trina R. Williams Shanks

African Americans have been a part of the nation's history for nearly four hundred years. Although their history includes the forced imposition of chattel slavery, the strict enforcement of legal segregation, and a tenuous acceptance as equal citizens, African Americans have been, and continue to be, major contributors, creators, investors, and builders of America. In this article we summarize briefly the history of African Americans, we examine racial disparities in key indicators of social, mental, and physical well-being, and we highlight persistent strengths that can be built upon and areas that provide hope for the future. The challenge for social work is to simultaneously celebrate the historical successes and ongoing contributions of African Americans to this country while also recognizing the vestiges of structural racism and fighting for greater civil rights and social and economic justice.

Article

Paula S. Nurius and Charles P. Hoy-Ellis

Evolving understandings of stress have literally transformed how we think about health as contextualized within complex and multilevel transactions between individuals and their environment. We present core concepts of stress through the lens of life-course and life-span perspectives, emphasizing appraisal-based and biobehavioral models of stress response systems. We describe theories of allostatic load, embodiment, epigenetics, weathering processes, and accelerated aging that operationalize mechanisms through which stress affects health and contributes to health disparities. In addition to social determinant and life-span developmental perspectives on stress and health, we emphasize the value of health-promotive factors that can serve to buffer stress effects. Social work has important roles in targeting health-erosive stress from “neurons to neighborhoods”.

Article

Daniel S. Gardner and Caroline Rosenthal Gelman

Minority and immigrant elders constitute a greater proportion of the population than ever before and are the fastest growing segment of the older population. Within these racial and ethnic groups there is considerable variation with regard to age, gender, country of origin, language, religion, education, income, duration of U.S. residency, immigration status, living arrangements, social capital, and access to resources. The authors summarize research on older adults regarding racial and ethnic disparities, barriers to health and social service utilization, and dynamics of family caregiving. Implications are offered for social-work practice, policy, and research.

Article

Valire Carr Copeland and Sandra Wexler

Despite technological advances and changes in healthcare delivery, some groups in the United States continue to have better health-related outcomes than others. This article discusses health disparities—differences in health status and healthcare utilization that are influenced by complex social structural, economic, and cultural factors. Illustrations are offered of health disparities found among diverse populations in this country. The “problem” with health disparities is then explored. From an ethical standpoint, health disparities can be seen as unjust. From a cost perspective, health disparities exact not just a financial toll that is borne by society, but individual, group, and community consequences, as well. From a human rights vantage, health disparities can further disadvantage people who are already vulnerable and marginalized—health disparities can cost people their lives. Factors contributing to health disparities, commonly referred to as social determinants, are reviewed. Finally, future directions, including social workers’ role as advocates, are considered.

Article

Grace Christ

The ability of medical technology to prolong life over the past century has forced an examination of the experience and care of the dying. Many diseases that once were expected to follow a sloping illness trajectory with predictable deterioration and ultimately death are now more commonly experienced as chronic illnesses. They require more medical and other resources and challenge the family's ability to cope for much longer periods. The knowledge, value, and skill base of social work, and its broad range of practice sites make it uniquely suited to contribute to the movement to improve the care of the dying. The Social Work Hospice and Palliative Care Network were formed in 2007 to advance and give voice to social work's expertise in this area and to promote its development in practice, education, research, and policy.

Article

Henrika McCoy and Emalee Pearson

Racial disparities in the juvenile justice system, more commonly known as disproportionate minority contact (DMC), are the overrepresentation, disparity, and disproportionate numbers of youth of color entering and moving deeper into the juvenile justice system. There has been some legislative attention to the issue since the implementation of the Juvenile Justice and Delinquency Prevention Act of 1974 (JJDPA) and most recently with attempts in 2017 to reauthorize the Act. Originally focused solely on confinement, it became clear by 1988 there was disproportionality at all decision points in the juvenile justice system, and the focus changed to contact. DMC most commonly is known to impact Black and Hispanic youth, but a closer look reveals how other youth of color are also impacted. Numerous factors have been previously identified that create DMC, but increasingly factors such as zero-tolerance in schools and proactive policing in communities are continuing to negatively impact reduction efforts. Emerging issues indicate the need to consider society’s demographic changes, the criminalization of spaces often occupied by youth of color, and gender differences when creating and implementing strategies to reduce DMC.

Article

Rowena Fong, Ruth G. McRoy, and Alan Dettlaff

Racial disproportionality and disparities are problems affecting children and families of color in the child welfare, juvenile justice, education, mental-health, and health-care systems. The term “disproportionality” refers to the ratio between the percentage of persons in a particular racial or ethnic group at a particular decision point or experiencing an event (maltreatment, incarceration, school dropouts) compared to the percentage of the same racial or ethnic group in the overall population. This ratio could suggest underrepresentation, proportional representation, or overrepresentation of a population experiencing a particular phenomenon. The term “disparity” refers to “unequal treatment or outcomes for different groups in the same circumstance or at the same decision point.” A close examination of disproportionality and disparities brings attention to differences in outcomes, often by racial group, and by social service systems. It is necessary to examine the reasons for these differences in outcomes and to be sure that culturally competent practices are upheld.

Article

Peter A. Newman

AIDS (acquired immunodeficiency syndrome) is the most deadly epidemic of modern times. Since HIV (human immunodeficiency virus), the virus that causes AIDS, was first identified in the United States in 1981, nearly 1 million Americans have been diagnosed with AIDS and 530,756 have died. Forty million people are living with HIV worldwide. Although AIDS is still a fatal disease, new drug therapies have greatly slowed the course of disease progression and enhanced quality of life for persons living with HIV. Nevertheless, monumental disparities persist within the United States and between the developed and developing worlds in this two-tiered epidemic.

Article

Mary E. Rogge

The concept of environmental justice gained currency in the public arena during the latter part of the 20th century. It embodies social work's person-in-environment perspective and dedication to people who are vulnerable, oppressed, and poor. The pursuit of environmental justice engages citizens in local to international struggles for economic resources, health, and well-being, and in struggles for political voice and the realization of civil and human rights.

Article

Social work and criminal justice have a shared history in the United States dating back to the 19th century when their combined focus was rehabilitation. But with an increase in crime, this focus shifted to punishment and incapacitation, and a schism resulted between social work and criminal justice. Given current mass incarceration and disparities in criminal justice, social work has returned in force to this important practice. The latest Bureau of Justice Statistics research reports that 1% of all adult males living in the United States were serving a prison sentence of a year or longer (Carson & Anderson, 2016) and rates of diversion, arrest, sentencing (including the death penalty), incarceration, etc., vary considerably by race/ethnicity (Nellis, 2016). This entry explores race and ethnicity, current population demographics, and criminal justice statistics/data analysis, plus theories and social work-specific strategies to address racial and ethnic disparities in the criminal justice system.

Article

M. Aryana Bryan, Valerie Hruschak, Cory Dennis, Daniel Rosen, and Gerald Cochran

Opioid-related deaths by overdoses quadrupled in the United States from the years 1999 to 2015. This rise in mortality predominately occurred in the wake of historic changes in pain management practices and aggressive marketing of opioid medications such as oxycontin. Prescription opioid misuse and subsequent addiction spilled over to heroin and fentanyl for many. This drug epidemic differed from others in its impact among non-Hispanic whites, leading to drastic changes in how the United States views addiction and chooses to respond. This article offers an overview of opioid use disorder (OUD), its treatment and its relationship with pain. It also discusses special populations affected and provides insight into future directions for research and social work practice surrounding opioid management in the United States. Because of the profession’s emphasis on the person and social environment as well as its focus on vulnerable and oppressed populations, social work plays a critical role in addressing the crisis.

Article

Michele Rountree and Courtney McElhaney Peebles

Communities of color are disproportionately burdened by the prevalence of HIV/AIDS. Research has shown that race and ethnicity in the United States are population characteristics that correlate with other fundamental determinants of health outcomes. This entry will chronicle the history of the epidemic, report the disparate impact of the disease affecting communities of color, and acknowledge the social determinants of health that contribute to the vulnerability of risk. A call to address the imbalance of health inequities, with a complement of individual-level interventions and new approaches that address the interpersonal, network, community, and societal influences of disease transmission, is discussed.

Article

Katharine Briar-Lawson and Toni Naccarato

Over the decades, family services have been one of the overarching features of social work practice, education, and research. Efficacy studies help to reinforce the focus on serving individuals in the contexts of their families and to address intergenerational family systems. Families provide the bulk of services to their members but require tailored resources, effective services, and supports. The growing diversity in families compels more cross-cultural competence, responsive policies, and evidence-based practices. Family service practitioners must increasingly address the social exclusion of many families while integrating economic and employment supports with counseling, skill training, and other interventions.

Article

Wendy Auslander and Elizabeth Budd

The purpose of this article is to provide an overview of: diabetes and its significance, the differences in types of diabetes, and landmark clinical trials that have resulted in changes in philosophy and treatment of diabetes. Second, a review of the various types of evidence-based and promising behavioral interventions in the literature that have targeted children and adults are presented. Social workers and other helping professionals are uniquely positioned to work collaboratively to improve psychosocial functioning, disease management, and prevent or delay complications through behavioral interventions for children and adults with diabetes.

Article

Since the start of the human immunodeficiency virus (HIV) pandemic, numerous biomedical advances have caused the social-work response to shift from management of a crisis to prevention of an incurable, but treatable chronic disease. About 1.3 million people in the United States and more than 33 million people worldwide are estimated to be living with HIV. Rates of incidence in impoverished, marginalized communities are highest, with the rates continuing to increase among young African American gay and bisexual men. Other communities at high risk are people who are incarcerated, engage in sex work or other kinds of exchange sex, and participate in risky injection-drug use. Minority groups are often impacted because of reduced access to quality medical care and HIV testing. Social workers in HIV prevention work are challenged to educate clients and communities on the sexual risk continuum, provide more interventions that are culturally tailored for disadvantaged at-risk groups, and implement evidence-based HIV prevention and testing programs worldwide. The National HIV/AIDS Strategy now provides structure to funding opportunities for HIV prevention programs, and there is disparate access to effective treatments worldwide for those living with HIV.

Article

Lonnie R. Snowden

This entry describes the extent of the mental health problem in the United States, trends in treatment rates, and evidence that public recognition of mental illness and related interventions is increasing both in the United States and internationally. Emphasis is given to the structure of the mental health system's major sectors, to the key roles that social workers play, and to the challenges they face, outlined at the conclusion of several sections, in providing effective and quality care against the complex backdrop of this system.

Article

Colleen Galambos

This entry provides an overview of the state of health care in the United States. Service delivery problems such as access and affordability issues are examined, and health care disparities and the populations affected are identified. A discussion of two primary government-sponsored health care programs—Title XVIII (Medicare) and Title XIX (Medicaid), and the Patient Protection and Affordable Health Care Act—are reviewed along with various health care programs and major existing service delivery systems. Ethical conflicts in providing health care, and new directions and challenges are discussed, along with future roles for social workers.

Article

King Davis and Hyejin Jung

This entry defines the term disparity as measurable differences between groups on a number of indices. The term disparity originated in France in the 16th century and has been used as a barometer of progress in social justice and equality in the United States. When disparity is examined across the U.S. population over a longitudinal period, it is clear that disparities continue to exist and that they distinguish groups by race, income, class, and gender. African American and Native American populations have historically ranked higher in prevalence and incidence than other populations on most indices of disparity. However, the level of adverse health and social conditions has declined for all population groups in the United States. The disparity indices include mortality rates, poor health, disease, absence of health insurance, accidents, and poverty. Max Weber’s theory of community formation is used in this entry to explain the continued presence and distribution of disparities. Other theoretical frameworks are utilized to buttress the major hypothesis by Weber that social ills tend to result from structural faults rather than individual choice. Social workers are seen as being in a position to challenge the structural origins of disparities as part of their professional commitment to social justice.