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| Abby Burns, MSW/MPH Student (Dec '18) |
"The major health problems to be solved today are those
which require social work intervention" (Watkins, 1985, p. 17).
Social work and public health are complementary perspectives
for analyzing and addressing disparities in mental and physical health
outcomes. Being a dual-degree professional in these two fields enables us to
integrate their perspectives in flexible and dynamic ways. Possessing both an
MSW and an MPH also comes with the responsibility to support the value of each
perspective in our future careers. In a public health-oriented setting, an
MSW/MPH professional can emphasize the importance of cultural sensitivity and
tailoring interventions to match the needs and strengths of a specific group.
In a setting that is dominated by social workers, an MSW/MPH professional can
advocate for the use of evidence-based interventions and can push for the incorporation
of rigorous process and outcome evaluations into an organization’s activities.
Social work’s focus on vulnerable populations can benefit
from the prevention-oriented perspective of public health, and vice versa. In public
health social work, prevention can take the form of preventing either the
causes or sequelae of vulnerability. Take, for example, the vulnerable
population of people with cognitive disabilities. Public health social workers
can develop and evaluate programs to serve pregnant women with alcohol use
disorders, which would constitute primary prevention of in utero alcohol
exposure, the leading cause of cognitive disabilities of known etiology (Paley &
O'Connor, 2011). Public health social workers could also create and
implement transitional housing or educational programs for emerging adults with
cognitive disabilities. Such programs would constitute secondary
prevention of the social and health consequences that occur when these emerging
adults are unable to integrate into their communities.
The overlap between social work and public health is evidenced by the
many similarities in each discipline’s code of professional ethics—the “Code of
Ethics of the National Association of Social Workers” and the “Principles of
Ethical Practice of Public Health,” respectively (National Association of Social Workers
Delegate Assembly, 2008; Public Health Leadership Society, 2002). Both documents identify meeting the basic human needs of every
community member as a fundamental goal. They both include advocating for the
representation and allocation of resources for disadvantaged and
disenfranchised groups. Both documents also discuss the importance of
confidentiality and trust, and describe the balance that must be struck between
individual autonomy and the exercise of power for the good of a community.
The public health document mentions the importance of prevention, which is
not mentioned in the ethical code for social workers. Primordial prevention is
a framework for improving population health by addressing the economic,
environmental, social, and cultural conditions which act as risk or protective
factors for a variety diseases. Primordial prevention creates living conditions
that are conducive to healthier communities, thereby addressing the common root
causes of diseases. These conditions are already the targets of social work
interventions, even if the stated goals of those interventions do not
explicitly mention primordial prevention. One example would be a program that
aims to increase high school graduation rates by mentoring students who are
considering dropping out. This would constitute primordial prevention because
having a high school diploma is associated with a lower risk for many different
health problems.
Social work organizations often struggle to secure funding for programs that
address these root causes of poor health. Dually-trained professionals in
public health and social work can use their understanding of disease causation
and epidemiology to strengthen the case for these programs. Their public health
training enables them to incorporate data, in forms such as community needs assessment
and correlational analysis, into grant applications or presentations to
policymakers on the local, state, or federal level. Using their social work
training in communication skills and stakeholder engagement, they can tailor
this evidence base to the values and characteristics of the intended audience.
In this way, they can secure funding and obtain buy-in for their prevention
efforts.
Their interdisciplinary training further equips MSW/MPH professionals to
understand the intersectionality of the social determinants of health. A study
of birth outcomes among middle class women living in Chicago illustrates this
intersectionality. Researchers found that women who lived in racially mixed
census tracts tended to have superior birth outcomes compared to women who
lived in predominantly African American tracts. The researchers cited superior
socioeconomic contexts in less racially segregated neighborhoods as a possible
explanation for this finding. However, the direction of this effect was
reversed for African American women, such that these women had poorer birth
outcomes if they lived in a racially mixed versus a predominantly African
American neighborhood. The researchers concluded: “The positive effect of a
better socioeconomic context may be countered for minority women by adverse
effects of racism or racial stigma” (Pickett, Collins, Masi, & Wilkinson,
2005, p. 2229).
The unique
challenges that face older adults who are LGBTQ provide another example of
intersectionality among the social determinants of health. Maddux (2011) found
that two thirds of LGBTQ adults over the age of 65 live alone. Many are
estranged from their families, so they do not have the option to rely on a
family to provide care and assistance later in life. They are likely to hold
off longer than non-LGBTQ adults in seeking help, often until a medical crisis
occurs. When accessing home health care services or entering a residential care
facility, they often re-enter the closet to avoid discrimination and abuse.
Sometimes, LGBTQ older adults are forced to cycle through several home health
workers or care facilities before they find professionals who will treat them
with dignity and respect (Maddux, 2011). MSW/MPH professionals are ideally
trained to grapple with this issue by working within community-based
organizations and programs. In Boston, the LGBT Aging Project conducts
trainings and workshops for health care professionals, case managers, and
others who wish to improve their competence and sensitivity in working with LGBTQ
patients (Fenway Health, 2017). Other community organizations
provide safe spaces for LGBTQ older adults to gather and socialize. These
organizations help their clients to create networks of social support, which
increase the likelihood that they will be adequately cared for when the time
comes that they can no longer live independently. Public health social workers
could contribute to both types of programs, and thus work to eliminate the
health care disparities that LGBTQ older adults experience.
Dually-trained practitioners in social
work and public health are uniquely equipped with the knowledge and skills to
understand and intervene in the intersections between health and social
conditions, like those described above. They are powerfully positioned to not
only comprehend the causes and sequelae of a health problem, but also to implement
prevention or treatment programs through direct practice. These programs could
be delivered to individuals, couples, families, groups, organizations, or even
entire communities, and could be administered within private, public, or
non-profit settings. Regardless of their client level or work place, public
health social workers bring an invaluable perspective to addressing the most
pressing health problems that face our society.
References
Fenway Health.
(2017). LGBT Aging Project. Retrieved
from http://fenwayhealth.org/the-fenway-institute/lgbt-aging-project/
Maddux, S.
(Writer). (2011). Gen Silent [Film]. San Francisco, California: Kanopy
Streaming.
National
Association of Social Workers Delegate Assembly. (2008). Code of Ethics of the
National Association of Social Workers. Retrieved from https://www.socialworkers.org/pubs/code/default.asp
Paley, B., &
O'Connor, M. J. (2011). Behavioral interventions for children and adolescents
with fetal alcohol spectrum disorders. Alcohol
Research & Health, 34(1), 64-75.
Pickett, K. E.,
Collins, J. J. W., Masi, C. M., & Wilkinson, R. G. (2005). The effects of
racial density and income incongruity on pregnancy outcomes. Social Science & Medicine, 60,
2229-2238. doi:10.1016/j.socscimed.2004.10.023
Public Health
Leadership Society. (2002). Principles of the Ethical Practice of Public
Health. Retrieved from https://www.apha.org/~/media/files/pdf/membergroups/ethics_brochure.ashx
Watkins,
E. L. (1985). The conceptual base for public health social work. In A.
Gitterman, R. B. Black, & E. Stein (Eds.), Public health social work in maternal and child health: A forward plan
(pp. 17-34). Washington, DC: Division of Maternal and Child Health.
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