MAKING THE INVISIBLE VISIBLE: Are Medical Social Workers Addressing the Social Determinants of Health?
Shelley L. Craig, PhD, RSW
Assistant Professor
Raluca BejanMSW student
Barbara Muskat, PhD, RSW
Social Work Director, The Hospital for Sick
Children
Purpose This study explores if health social
workers (HSWs) are addressing the vast range of social determinants of health (SDH) within their practice.
Social Determinants of Health It is increasingly recognized that the social
determinants of health and the associated health disparities cannot be addressed without intervention in the social circumstances of patients (Schrecker, Chapman, Labonte, & De Vogli, 2010).
This is a role that, historically, has been fulfilled by social workers in the health care system.
Health Social Work Health social workers (HSW) bring an ecological
perspective to health care, by incorporating a full range of psychological and emotional factors (Rachman, 1995) and attention to how individuals interaction with larger social systems influences their health (Claiborne & Vandenburgh, 2001).
HSW work collaboratively as part of institutional and community interprofessional teams to support recovery, to promote quality of life in the context of chronic illness and disability, and to advocate for societal change to address social disadvantages (Praglin, 2007).
The Changing Nature of Health Social Work
Social workers delivering services in health care face unique challenges and opportunities in a rapidly changing environment (Kim & Lee, 2009).
Almost 50% of all registered SWs in the province of Ontario are employed in medical settings
We talk about how we influence the SDH but how?
Social Determinants of Health (SDH)
SDH have been defined as the cumulative environmental factors shaping individuals’ health status
SDH are leveled along several axes of social stratification Socio-Economic Status (SES) Social Supports Diversity & Equity Health Care Services
Social Determinants of Health (SDH)
SES
Income & its Distribution
Unemployment & Employment Security
Education
Employment & Working Conditions
Early Life
Social Determinants of Health (SDH)
SOCIAL SUPPORTS
Housing
Social Safety Net
Food Security
Social Determinants of Health (SDH)
DIVERSITY & EQUITY
Gender
Racism
Aboriginal Status
Disability Status
Social Exclusion
Social Determinants of Health (SDH)
HEALTH CARE SERVICES
METHODS Survey of SW professionals (n= 54) employed at
major hospitals across Toronto
Measures: Basic demographic information (age, race, gender
identity, sexual orientation, educational degree) Job details (number of years in social work practice,
number of years in a health care setting, job title) Number and type of SDH addressed through public
health practice
Analyses: SPSS 19.0: descriptive statistics, correlations and
chi-square analyses
SW Participants’ Demographic Characteristics
Social Work Impact on SDH: Frequencies and Correlations
Discussion Social workers in health care are actively addressing the social determinants of health in their daily practice
Specifically, SWs are addressing SES (Income Distribution and Unemployment)and Social Supports (Housing and the Social Safety Net) Statistically significant correlations were observed with the
variables of each SDOH construct (eg those actively addressing Housing were also more likely to address the Food Security and Social Safety Net determinants)
SDH related to Diversity and Equity, such as Racism, Aboriginal Status, Gender and Social Exclusion, are not addressed as frequently in daily practice Statistically significant associations - SWs failing to address
one determinant might innately leave the subsequent other unaddressed
DiscussionThe focus on proximal/ tangible SDH may be related to:1) The short term nature of patient contact in health/hospital social work2) The needs of the health care setting and the reason social workers are hired3) The importance of addressing the most pressing needs first (food).4) The limitations faced by HSW practicing in health care systems to address complex determinants
This means that the presence of HSW is incredibly important for the most vulnerable populations YETSocial workers expressed guilt that they werent addressing the most complex determinants and seemed to brush over the provision of tangible benefits.
Conclusions Social work practice in health is now at crossroads
It needs to critically examine its ability to establish a social justice framework and apply a bio-psycho social perspective within these settings.
Future research should incorporate more comprehensive measures of SDH and investigate the ways in which client outcomes are influenced by SW interventions
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