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Article

Betty J. Ruth, Sarah Sisco, and Jamie Wyatt Marshall

Public health social work is a subdiscipline within social work that uses multifaceted transdisciplinary approaches to promote health equity and mitigate human health problems. Originating in the early 20th century, public health social work applies social work and public health theories, frameworks, research, and collaborative practice to address contemporary health issues. Epidemiologically informed and characterized by prevention, health promotion, and other integrative practices, public health social work is highly relevant to pervasive 21st-century challenges, such as health inequity, behavioral health integration, chronic disease, health reform implementation, and global health. With its strong focus on health impact and population health, public health social work is central to the profession’s viability and success in the post–Affordable Care Act (ACA) health environment.

Article

Toba Schwaber Kerson

Health is a need, a basic requirement for life. Needs can become rights when bodies of people, usually governments or organizations such as the World Health Organization sanction them. While many have declared health as a right, the greatest burden of illness continues to be carried by minority and medically underserved populations. Also, industrialization, urbanization, economic development, and food market globalization have brought with them the poor health habits that place people at risk for cardiovascular and other diseases. Improved health habits and universal health care coverage would help to address the health needs of all.

Article

Vivian Jackson and Wendy Jones

The revised NASW Standards and Indicators for Cultural Competence in Social Work Practice (2015) requires social workers to “provide and advocate for effective communication with clients of all cultural groups, including people of limited English proficiency or low literacy skills, people who are blind or have low vision, people who are deaf or hard of hearing, and people with disabilities” (p. 43). This article focuses on one component of this standard—literacy, specifically health literacy. It presents a summary overview of health literacy and its implications for social work practice. It also presents the history of the concept and provides various definitions and types of health literacy as described in the literature. The authors describe the association between health literacy levels of the population, the intricacies of health systems, and their impact on health outcomes. The negative impact for marginalized populations including persons with limited English proficiency and immigrants and refugees—a major focus of the social work profession—signals the need for action at multiple levels. The authors explore a multifaceted approach to health literacy at the clinical, organizational, and policy levels with reference to the role of the social work profession.

Article

Stephen H. Gorin and Terry Mizrahi

This entry presents an overview of national health-care reform in the United States, from its introduction into the public policy agenda at the turn of the 20th century through policy debates and legislative proposals more than a century later. Specifically, it concentrates on the programs and strategies to obtain universal coverage for health and mental-health services for all Americans at the national level, with limited success. It ends with a discussion of the Affordable Care Act (ACA). Special emphasis is laid on the roles of social workers and their professional organizations during this period.

Article

Rebecca S. Ashery

The passage of the Affordable Care Act (ACA) has injected new life into primary health care by establishing the primary care medical home (PCMH) as a cornerstone of health-care reform legislation. In addition to the PCMH, the ACA has a number of primary-care components that can open opportunities for social workers. Concerns remain for payment reform in the implementation of the PCMH. The implementation of the ACA is still a work in progress, with anticipated modifications and changes as issues arise.

Article

Wayne Lindstrom

Continuing a history of inequity, private insurers have placed restrictions and limitations on coverage for mental health conditions making access to treatment services increasingly more challenging. A state-by-state advocacy movement has led to the enactment of various state laws to require mental health parity. With the Clinton Administration’s attempt at health care reform, mental health parity became part of the health reform debate and led to the passage of the Mental Health Parity Act of 1996. The inadequacies of this law were partially corrected in the Mental Health Parity and Addiction Equity Act of 2008, which included mandated coverage for substance use conditions. The Obama Administration in 2011 included these provisions in the Patient Protection and Affordable Care Act, which does not require compliance monitoring nor does it provide a definition for “mental health,” which leaves insurers to define it and hence determine what coverage will actually be available.

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

Edward R. Canda and Sherry Warren

This entry provides an introduction to mindfulness as a therapeutic practice applied within social work, including in mental health and health settings. It describes and critiques mindfulness-based practices regarding definitions, history, current practices, best practices research, and ethical issues related to using evidence-based practices, acquiring competence, addressing social justice, and respecting diversity.

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

Barbara L. Jones and Casey Walsh

Despite rapid medical advances, children in this country still face significant barriers to adequate health care, including unequal access to insurance and health care. There is great need and opportunity in our nation at this time to advocate for the advancement and prioritization of pediatric health care. Children remain vulnerable to the challenges of poverty, violence, firearms, mental health, and health care access. Social workers play an important role in assisting children and families who face health care crises by providing supportive services, advocacy, culturally grounded assessment, trauma informed care, and evidence-based interventions to improve healthcare outcomes and quality of life. The Patient Protection and Affordable Care Act (ACA), signed into law in 2010, has increased access to pediatric health and behavioral health services. While the future of this law is uncertain at the time of this writing, social work is and will continue to be an important discipline to assist children and families in the areas of health promotion and adaptation to illness and injury.

Article

Larry W. Foster

Bioethics and biomedical ethics are defined. Common bioethical concepts, exemplary moral values, fundamental ethical principles, general ethical theories, and approaches to moral reasoning are reviewed. The scope of topics and issues, the nature of practice situations in bioethics, and social work roles on organizational bodies that monitor and respond to bioethical issues are summarized, as are trends in bioethics. Practice contexts, from beginning to end of life, are highlighted with biopsychosocial facts, ethical questions and issues, and implications for social work—a profession uniquely positioned in giving bioethics a social context.

Article

Jean K. Quam

Martha May Eliot (1891–1978) was an educator and public health official. She was the first woman president of the American Public Health Association. She became chief medical consultant for UNICEF in 1947. She was later assistant director general of WHO, and the U.S. representative to the executive board of UNICEF.

Article

Ruth Irelan Knee

Milton Wittman (1915–1994) was a social worker, writer, and leader in social work, public health, and mental health. He played a key role in the expansion of opportunities for social work education and for the involvement of social workers in the provision of mental health services.

Article

Marian A. Aguilar

This entry provides an abbreviated version of the status of women's health in the United States, highlighting health care utilization, health care expenditures, policy issues, barriers to health care, and the impact on populations at risk. The findings accentuate the importance of moving the women's health care agenda forward because of the persistence of health disparities not just among women of color but among women with disabilities, adolescents, women in violent relationships, women with AIDS, women who are incarcerated, women who are homeless, older low-income women, women on welfare, and lesbian women.

Article

Cecilia Ayón, Tanya Nieri, and Maria Gurrola

Latinx immigrants represent a large segment of the immigrant population in the United States. While immigrants tend to be healthier than native-born people, they experience a number of health disparities. Latinx immigrants experience many barriers to accessing health care, including immigration policy barriers related to undocumented or recent permanent resident status, lack of culturally and linguistically responsive services, challenges during the access verification process, discrimination by providers, and external resource constraints (e.g., cost). Many are uninsured or underinsured and experience limited access to care. Existing models to understand health are examined. A social determinants of health framework is used to understand immigrants’ health outcomes. Within this framework immigration is a social determinant of health. Substantial empirical evidence illustrates how the immigration policy context impacts on immigrants’ health through exposure to enforcement activity, threat of detainment and deportation, and actual deportation. Enforcement activity is racialized to effect all Latinxs regardless of status. Other domains including economic insecurity, education, and community and social support are other sources that may disadvantage immigrants and impact on their health. The search for economic opportunity is a primary motivation for Latinxs to migrate to the United States, yet many face economic challenges and live in poverty. Education has significant impact on immigrants across the development spectrum as they experience disparities in access. Social ties are critical to the wellbeing of Latinx, evidence suggests disparities in access to support by status. Immigrants contend with a number of challenges as they integrate into society. Social determinants of health, through multiple domains, affect immigrants’ health.

Article

Shirley Otis-Green

Health social work is a subspecialization of social work concerned with a person's adjustment to changes in one's health and the impact this has on that person's social network. Social workers in every setting must be ready to assist individuals and families adjusting to illness and coping with medical crises. This entry provides a brief overview and history of health social work and describes the settings and roles where this work is practiced. Significant challenges and opportunities in clinical care, research, education, and policy are discussed. Standards and guidelines for quality practice are then noted.

Article

Dolores Gonzalez Molina de la Caro (1910–1979) was a pioneer in mental health training, public welfare, public health, school health, and university counseling in Puerto Rico. She was director of the Bureau of Medical Social Work and Mental Health Program.

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

Valire Carr Copeland and Daniel Hyung Jik Lee

Social reform efforts of the settlement-house movement have provided, in part, the foundation for today’s Maternal and Child Health Bureau’s policies, programs, and services. Planning, implementing, and evaluating policies and programs that affect the health and well-being of mothers and children require a multidisciplinary approach. Social workers, whose skills encompass direct services, advocacy, planning and research, community development, and administration, have a critical role to play in improving the health outcomes of maternal and child populations.

Article

Charles L. Robbins

The distribution of illness and its impact are not random occurrences. Social workers can prevent illness through education and behavioral change as well as mitigate its impact once it does occur, and social workers should be knowledgeable about illness and the health status of the people with whom they work. As advocates for our clients, it is important that we pursue policies and programs that address the inadequacies and injustices in health care. To accomplish this, we must be prepared with the necessary knowledge.