Social Work’s Commitment and Leadership to Address Social Determinants of Health and Integrate Social Care into Health Care
Social Work Commitment and Leadership to Address Social Determinants of Health and Integrate Social Care into Health Care- Considering social work as a vital profession for advancing social care integration into health care delivery.
Social Work Commitment and Leadership to Address Social Determinants of Health and Integrate Social Care into Health Care
Health care reforms are raising important issues such as how to better integrate social and clinical care,
and what kind of human resources as well as technological infrastructure would be needed to make that happen effectively.
NASEM 2019 Consensus Study Report on Integrating Social Care in the Delivery of Health Care:
Moving Upstream to Improve the Nation’s Health challenges health and human sector leaders to systematically,
consider ways of integrating social care into health care delivery in response to these questions..
In order to sustainably integrate social care and health care,
leaders in the health and human sectors must take a variety of administrative, educational, technological,
and workforce steps across administrative, educational, technological, and workforce arenas.
Keywords: Social work, Social determinants of health, Social care, Integrated care, Workforce
Points for Practitioners
- Social determinants of health and health outcomes for individuals and populations are linked, as shown by several studies.
- Access to, delivery, and results of health care are influenced by the social determinants of health.
- Health outcomes may be improved and health inequities reduced by addressing social needs.
- In tackling social issues, social workers have had a prominent position for more than a century.
- It will be necessary for health care managers establish innovative, responsive, and integrated systems of care if they want to expand health care to include social care.
Introduction
Historically, social work has addressed the social and contextual factors of health, improved access to health care,
and decreased health disparities as an integral part of the healthcare system.
Social workers have been
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Zerden, Cadet, Galambos & Jones 310
The pioneering efforts of Mary Stuart and Ida Cannon in the establishment of medical social work,
as well as the turn-of-the-century Settlement House Movement,
have all been examples of leaders in addressing social issues.
Studies have shown that social workers have made significant contributions to medical care
by assessing patients to understand their health and social issues,
then sharing that information with patients and other agencies so that the best interventions can be devised for each individual’s
unique situation (American Association of Hospital Social Workers, 1928; Gehlert, 2012; Ruth & Marshall, 2017).
Social Work
While social work has played an important role for over 100 years in promoting health and enhancing the quality of health care, t
This role has not always been recognized.
SDOH has been a constant emphasis of social work since its inception.
As defined by the World Health Organization (2017), SDOH are the “conditions in which people are born; grow; work; live; and age;
and the wider set of forces and systems shaping the conditions of daily life.”
SDOH are inextricably linked to individual and population health outcomes, affecting access to,
delivery and outcomes of health care (Braverman & Gottlieb, 2014).
There is mounting evidence that social and environmental determinants of health (SDOH)
have a stronger influence on health than medical care alone (Braverman & Gottlieb, 2014;
Schroeder, 2007). ZIP codes in the United States, for example,
are typically stronger indicators of an individual’s health than their genetics are (Graham, 2016; RWJF, n.d.).
People and Population
Many people and populations, particularly those with multiple and chronic needs but lacking adequate resources to address them,
or those who are further marginalized by social risk factors such as race/ethnicity,
socio-economic status, and geographic location,
may see improved health outcomes and decreased health disparities if social needs are addressed.
SDOH has been a constant emphasis of social work since its inception.
As defined by the World Health Organization (2017), SDOH are the
“conditions in which people are born; grow; work; live, and age; and the wider set of forces and systems shaping the conditions of daily life.”
SDOH are inextricably linked to individual and population health outcomes,
affecting access to, delivery and outcomes of health care (Braverman & Gottlieb, 2014).
There is mounting evidence that social and environmental determinants of health (SDOH)
have a stronger influence on health than medical care alone (Braverman & Gottlieb, 2014; Schroeder, 2007).
Zip Codes
ZIP codes in the United States, for example, are typically stronger indicators of an individual’s health
than their genetics are (Graham, 2016; RWJF, n.d.). Many people and populations,
particularly those with multiple and/or chronic needs, but lacking adequate resources to address them,
or those who are further marginalized by social risk factors such as race/ethnicity,
socio-economic status, and geographic location,
may see improved health outcomes and decreased health disparities if social needs are addressed.
Answers to these issues are beginning to emerge.
The National Academies of Science, Engineering, and Medicine (NASEM) was requested in 2018
by a coalition of social work groups to commission a consensus research report on
how to completely integrate social work and social care into the health care delivery system.
NASEM's Expert
It was the purpose of NASEM’s expert committee to study how social care services may be integrated
into the delivery of health care in order to improve health outcomes for everybody.
The report, Integrating Social Care into the Delivery of Health Care:
Moving Upstream to Improve the Nation’s Health (2019), identified and appraised existing
and new options, and proposed strategies to expand and optimize social care in health care delivery,
based on the results of the study.
The administration’s difficulties and potential for a more lasting and successful transformation of health care are explored in detail in the following article,
which summarizes important findings from the 2019 NASEM study.
Using the social work profession’s abilities and knowledge,
this article describes how the social work profession has championed advocacy for the integration of social care across sectors and continues to do so.
Overview of the 2019 NASEM Report
The National Association for the Research of Ethnic Minority Health (NASEM) commissioned
with a consensus study report in 2018 to analyze and suggest ways to integrate social care with health care.
Initiated by a coalition of social work leaders concerned about the poor state of health in the United States,
the lack of attention paid to SDOH in the health care system,
and the roles played by social workers and other providers,
this study gathered social work associations, faculty, and leadership in social work schools and programmed.
In order to address these issues, the NASEM report looked at:
(1) emerging models for the integration of social care into health care practices;
(2) current and emerging workforce and organizational collaborations that provide social care; and
(3) existing models for developing systems of care that improve health and reduce health inequities.
The Consensus Report’s language and 5A framework were established,
by an interprofessional panel of experts from many parts of the health and social services sectors.
It took the NASEM team until 2019 to complete its report,
which marked the culmination of all of their efforts in educating the public,
on the ever-changing intricacies of health care delivery and financing.
Here are the report’s core suggestions for establishing and maintaining,
an integrated system of social and health care, broken down into parts.
Tasks and Challenges: Necessary Components to Create and Sustain Integrated Social and Health Care
Systems-level change is required for all five of the recommendations,
to integrate social care into health care delivery and maintain this integrated framework.
Without a prepared staff, these recommendations cannot be accomplished or improved
First, design health care delivery systems that include the integration of social services into health care;
Second, build a workforce to integrate social services into health care;
Third, create an interoperable digital infrastructure; and
Fourth, finance the integration of health care and social services.
These five recommendations are: (NASEM, 2019).
Components support social and health care integration via five main actions (the 5A’s): awareness, adjustment, assistance, alignment, and advocacy.
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Overview of the 5A’s Framework
Table 1 provides an outline of the report’s organizational structure, which included the five A’s.
Patients benefit from all of the five basic activities, but the adjustment and support activities,
concentrate on enhancing care delivery at the micro or individual level.
An important aspect of advocacy and alignment is addressing issues at the community level rather than the individual household level.
Adaptation, help, alignment and advocacy are all influenced by the fifth activity category:
understanding of the social requirements, dangers and assets of people or groups.
In this way, awareness activities are intertwined with the other three.
Awareness of the social risks and assets of patients and populations across care settings
(i.e., hospitals, nursing homes, ambulatory care facilities, outpatient clinics, other public and nonprofit human services organizations)
provides the heath care team with a picture of patient requirements.
Awareness exercises might take place during admission or routine evaluation methods in certain circumstances.
Discussion: Moving Forward and Obtaining Sustained Change
In order to execute the NASEM report’s recommendations, this part makes use of the social work,
profession’s experience in the difficult task of integrating social care into the delivery of health care.
Systems-level adjustments will be required across and within the many components of workforce development,
health information infrastructure, finance models, and evaluation and research,
even if they are addressed in distinct sub-sections. Administrators of health and human services must,
in fact, constantly review the best ways to manage these components as policy and practice contexts quickly change.
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