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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

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

Racial disproportionality and disparities have been documented in the child welfare system in the United States since at least the 1960s, yet they persist as a national problem. This article provides an overview of the history of racial disproportionality and disparities in child welfare systems, the continuing presence of racial disproportionality and disparities, and the factors that contribute to racial disproportionality and disparities. The article concludes with strategies that have been developed over the years to address racial disproportionality and disparities, including calls for abolition of the child welfare system as a means of addressing these persistent problems.

Article

Rural social work, the history of which stretches back more than a century, has been revitalized since the mid-1970s. Definitions, typologies, and characteristics of rurality are provided, which serve as a framework for rural practice, policy, and research concerns. A primary focus is on differentiating rural social work from social work in urban areas. Theories relevant to rural practice, issues that disproportionately affect rural people, and considerations for preparation of rural practitioners are shared. Social workers interested in additional information are given basic references, as well as material specific to rural practice and allied professions in rural work.

Article

Michele Eggers-Barison and Lalit Khandare

Global health has been gradually gaining more traction in social work education. Global health addresses prevalent health vulnerabilities and collective responsibilities that transcend national borders. Global health is a multidimensional issue, which elicits an interdisciplinary multidimensional response. Various disciplines are in search of definitions, theoretical frameworks, and practice methodologies, including the development of competencies to meet global health needs. The need for social workers to critically engage in health inequities within social, cultural, economic, and political contexts globally is essential to bring effective change in the lives of those most marginalized and impacted by global health inequities. Social work is well positioned to address these needs through international social work practice and professional global standards to advocate for just policies and practice and to enhance equity and inclusiveness to promote social justice and human rights.

Article

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

Since their arrival 400 years ago, African Americans have endured 246 years of chattel slavery and 100 years of apartheid followed by decades of systematic racial discrimination and injustice. Nevertheless, Africans and their descendants have contributed significantly to the building of the United States and have greatly influenced every sector of society. To document this tenuous position, we summarize key demographic, economic, and social trends as well as the potential role of macro social work to improve outcomes. Present-day racism in the United States is persistent and frequently underestimated, so combatting anti-Blackness and White supremacy at structural and societal levels is essential.

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

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

Rhonda Wells-Wilbon, Rhea Porter, Taylor Geyton, and Anthony Estreet

Millions of Americans are affected by a mental illness or disorder each year. Given the prevalence, it is unfortunate that significant disparities exist within mental health care. Some of the most common reasons mental health disparities exist include stigma, previous negative experiences, limited mental health literacy, lack of culturally aware providers and services, language access, and lack of financial resources. Additionally, members of racial and ethnic, gender, and sexual orientation minority groups, who already encounter higher levels of bias, experience poorer mental health outcomes due to disparities than their counterparts. Grounded in the values and ethics of the profession, it is no surprise that social workers play a vital role in reducing mental health disparities.

Article

Hyejin Jung and King Davis

This entry presents an overview of disparities and inequalities. Disparity is defined as measurable differences between individuals, groups, races, regions, states, or nations. The frequency and severity of disparities distinguish groups by multiple identifiable characteristics. In the United States, minority populations have historically ranked higher in prevalence and incidence than others on most disparity indices. In many nations, at-risk groups are distinguished by historically high rates of disparities. Although the level of adverse conditions has declined in the United States and abroad, troublesome disparities exist in nations torn by war, disagreements, disputes, tribal differences, and dictatorial leaders. The major disparity indices include excess mortality rates from infectious diseases like COVID-19, poor health, poverty, unemployment, limited access to fresh and affordable food, absence of health care, absence of potable water, violence, and substandard housing. It is assumed that populations do not voluntarily choose these disparate conditions or cause them through personal deficits. The historical persistence of disparities and inequalities over decades is indicative of systemic or structural causation. This entry contributes to the historical, theoretical, and evidentiary base of macro social work practices that focus on changes in policies, leadership, planning, resource distribution, agency processes and functions, network development, organizations, lobbying, and communities.

Article

Sandra Wexler and Valire Carr Copeland

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 and inequities—differences in health status and healthcare utilization that are influenced by complex social, structural, economic, and cultural factors. It begins by exploring the “problem” with health disparities—what makes them problematic and for whom they are problematic. Factors contributing to health inequities, commonly referred to as social determinants, are then reviewed. Finally, the article considers early 21st-century policy and programmatic responses as well as future directions, including social workers’ role as macro practitioners.

Article

Eva M. Moya, Amy Joyce-Ponder, Jacquelin I. Cordero, Silvia M. Chávez-Baray, and Margie Rodriguez LeSage

The emergence of social work and macro practice is often associated with the eradication of poverty and prevention of homelessness through the efforts of 19th century settlement houses. Structural violence and social determinants of homelessness are often grounded in unequal social, political, and economic conditions. Health and mental health were affected by the lack of stable housing, causing and increasing the complexity of health and human service needs and services. Furthermore, due to inequities, some populations are inadvertently more likely to face chronic homelessness, which can be mitigated through the role community-engagement and macro practice interventions.

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

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.