Social Workers: Continuing to Address the Social Determinants of Health

We appreciate the focus of the “Voices From the Past” published this month from Stoeckle et al. on “Social Work in a Medical Clinic.”¹ Although Waitzkin’s² response discussed the origins of Stoeckle’s upstream conception of public health and mentioned early social work advocates such as Ida Cannon, we note that some 50 years later, social workers continue to play an essential role in medical care. The excerpt is particularly timely given the Patient Protection and Affordable Care Act’s refocused attention on the physical and social determinants of health. In integrated primary care settings across the country, social workers provide screening, brief interventions, and care management.³ As envisioned by Stoeckle and Cannon, health professionals are increasingly working in teams to provide patient-centered, holistic care.⁴

In addition to its emerging role in integrated care, social work is and has been deeply involved in the provision of behavioral health. As the largest provider of mental health services in the country, social work is critical to meeting the needs of the estimated two million previously uninsured adults who will receive behavioral health services, many through integrated care settings.⁵ Integrated care, defined as “the systematic coordination of general and behavioral healthcare,”⁴ encourages providers to more closely collaborate to meet patient needs.

Understanding the social context of health is the specialty of social work training. Through a person-in-environment perspective, graduate students are trained to recognize biopsychosocial factors that impact health. Because health is influenced by a largely common set of risk and protective factors, prevention and treatment necessitates an approach that considers both social and physical determinants. Stoeckle et al.¹ understood that it is the social environment that often prompts patients to seek care and enables them to follow recommendations. In short, social workers bridge the clinic and the community. As care managers and behavioral health specialists,³ they link patients to resources, offer emotional support, and provide empirically supported behavioral interventions.

In 2014, the Health Resources Service Administration awarded $26 million to 62 social work programs to prepare graduate students to work in integrated settings.⁶ Another $54 million was awarded to community health centers to hire mental health professionals.⁷ No doubt these changes would please Stoeckle and Cannon. Their vision is being realized in the transformation in the US health care system. It is gratifying that social work will play a pivotal role in our collective effort to improve the social determinants of population health.