Bachman Responds

We appreciate the opportunity to address Feinstein and Thompson’s question: “Where does clinical social work fit into this era of population health?” They wondered why our AJPH special issue (Social Work and Public Health: Charting the Course for Innovation) did not further explore the role clinical social workers play in promoting population health.

A critique of Rose’s preventive medicine strategy is that broad-based population prevention efforts may perpetuate existing health inequities.¹ If we apply prevention strategies equally across the population, then the current gradient of health status will be preserved. To date, the profession of social work, largely populated by clinical social workers, has not been able to apply its social justice framework to reverse this trend.

As we pointed out, more than half of the 650 000 social workers in the United States are practicing in health settings; it is reasonable to assume that the majority of them are clinical social workers. We also argued, however, that although social work’s unique skill set and social justice mission position the profession for leadership in the emerging health landscape, social work has struggled to find its identity and define its role across the spectrum of clinical and population health activities. This dilemma may derive in part from the false dichotomy between clinical and macro social work. Our special issue offered specific recommendations on how to increase the impact of social work, including clinical social work, by integrating more systems-level, prevention, and upstream interventions to effectively mitigate health inequities.

We have charted a path forward for both clinical and macro social work in partnership with our public health colleagues. Social workers have unique skills and knowledge that can change the status quo and promote innovative action and systems-level change. These activities must include large-scale population health efforts. The strategy must also, however, target vulnerable individuals and groups that suffer from health inequities brought on by inequitable distributions of the goods and resources that make up the social determinants of health. To maximize the effectiveness of these efforts, a unified vision for the profession is required. Moreover, social work must step into a leadership role, recommitting itself to reducing inequities through prevention, advocacy, education, policy initiatives, and community health–oriented work. A new era for social work and public health must be rooted in a vision of comprehensive and lifelong systems that promote individual and population health, grounded in a social justice perspective.