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Only in this way can a new generation of social workers learn to apply social work skills in an attack on the roots of social problems. This move is long overdue and should have our serious, considered attention. Despite these appeals, however, public health and prevention were not widely reintegrated into social work education or practice.

Most of social work remained centered on casework. Intense debates surrounded the value of casework; disconnected from social change efforts, some viewed it as ineffectual or destructive. Systems-level social work proliferated through opportunities made possible by the War on Poverty, the Great Society, and the establishment of Medicaid and Medicare. Meanwhile, social work education broadened to include a stronger focus on social problems. The movement to community health—although not wholly advantageous to medical social work—offered public health social work new opportunities.

Despite substantive advances in social work education, training, and practice, the idealism and funding that fueled the Great Society waned as the Vietnam War ground on; gradually, fiscal cutbacks undercut progress in many aspects of social welfare. Although social work practice in public health continued, s disinvestment gutted many innovative health and social programs, and community-oriented social work jobs decreased. As the conservative climate strengthened, the larger profession redirected its attention to advancing social work survival through licensure, third-party reimbursement, and private practice.

By the s, escalating health costs unleashed market-driven cost containment efforts throughout the health arena. Lacking the needed data to prove their financial value, many hospital social work departments were decentralized or eliminated; the roles of hospital-based social workers shifted from counseling to discharge planning and case management, and some traditional social work tasks moved to allied professionals. The report acknowledged broad disarray in the public health field, including funding and workforce issues; lack of coordination with primary care, mental health, and social services; and mounting challenges such as AIDS.

She urged the profession to more clearly articulate its value and function in public health. Yet, many questioned whether the broader field, now heavily focused on therapeutic work with individuals and families, could refocus on public health. Bracht, tracing the arc of support for social work in public health and prevention, concluded, The structural, educational, philosophical and incentive bases of practice are so ingrained at the individual treatment level as to inhibit either quick or major changes. Social workers were close witnesses to the changing social, environmental, and economic determinants of health as mental illness, violence, suicide, trauma, chronic disease, and substance abuse increased.

An ever-expanding array of studies highlighted health disparities, particularly racial inequalities, and articulated the need for upstream social work interventions. Social work responded early and forcefully to the HIV epidemic, engaging broadly in outreach, advocating for destigmatization, and crafting culturally responsive preventive interventions.

Collaborations between the fields expanded to include community-based efforts in substance abuse and HIV prevention, chronic disease management, child abuse prevention, and toxic waste activism. Finally, recent health reform efforts issued a clarion call to the profession to once again widen its lens for greater impact. Although the future of health reform remains uncertain, the expanded integrated health social work model that emerged in response emphasizes care coordination, prevention, community engagement, and interprofessional teamwork; these are all areas of deep practice expertise that began a century ago and are still deeply needed.

Public health social work serves as an important base for a new era of health social work in two critical ways. The rebuilding of this bridge is now evident across a wide range of professional activities: membership in the Public Health Social Work Section of the American Public Health Association has doubled, a new Social Work in Public Health journal was launched in , and prevention has been integrated into educational and practice standards. The American Academy of Social Work and Social Welfare has established a dozen Grand Challenges for the field, the majority of which require public health approaches.

Some 43 MSW—MPH programs produce graduates who practice in all core public health services, from community mobilization and health promotion to program evaluation and surveillance. Harry Hopkins may have believed that these two fields were inseparable and in firm possession of common ground, but a century later it appears necessary to remind ourselves of the past and to assess the continuing validity of his assertion.


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Clearly, social work and public health have much in common: shared Progressive Era roots, a joint commitment to social justice, and a history of collaboration. Today, however, there is a growing understanding of how the unmet social needs of humanity detract from health and produce inequitable health outcomes. Clearly, efforts to advance health equity will be undermined if these two domains are not consciously reconnected. Social work, with its depth of involvement across all of social welfare, is vital to these efforts.

The challenges facing the two fields—health inequities, racism, climate change, violence, mental illness, persistent infectious and chronic diseases, and economic inequality—are profound, pressing, and intractable. Even this brief historical review reminds us that changing society at the level of social determinants is never easy and is nearly always controversial, even today. Moreover, those not directly involved in health are already engaged in addressing the social determinants of health through long-established efforts in housing, education, child welfare, and the promotion of racial and other forms of social justice.

It is time to recognize its historic significance, value its current capabilities and contributions, and provide leadership to expand its place in the broader public health enterprise. PMID: Affiliation Betty J. Sickness is rarely an isolated fact, but is related to conditions under which people live.

Handbook of Health Social Work, 3rd Edition

The profession stands today at the brink of a vast opportunity to make good its greatest usefulness to society. We urge social work educators, practitioners and researchers to engage in a dialogue to find ways to focus the profession away from pathology and towards prevention, [and] population [health] practice. The structural, educational, philosophical and incentive bases of practice are so ingrained at the individual treatment level as to inhibit either quick or major changes. Hopkins HL. The place of social work in public health. Google Scholar. Waitzkin H. John D.

Spotlight on Social Work: The Evolution of Social Work at Texas Children’s

Stoeckle and the upstream vision of social determinants in public health. Am J Public Health. Social workers: continuing to address the social determinants of health. Public health social work. In: Franklin C , ed. Encyclopedia of Social Work. Accessed June 6, Browne T.

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Social work roles and health-care settings. In: Gehlert S , Browne T , eds.

Handbook of Health Social Work. Hoboken, NJ : Wiley ; : 20 — Gibelman M. The search for identity: defining social work—past, present, future. Soc Work. Gehlert S. Conceptual underpinnings of social work in health care. Hoboken, NJ : Wiley ; : 3 — Social Work Archives. Auburn Hospital, Cambridge, MA. Bracht NF. New York : Haworth Press ; Folks H.

Points of contact between the health officer and the social worker.


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    Healthcare Social Workers

    Hoboken, NJ : Wiley ; : 64 — Siefert K. An exemplar of primary prevention in social work: The Sheppard-Towner Act of Soc Work Health Care. Bloom M. Primary prevention: revolution in the helping professions?

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