News Articles

Health Equity, Social Determinants of Health, and the Role of Social Work

Wednesday, October 30, 2019

Recognizing the historical roots of health inequities and why social workers bring valuable perspectives to solving intractable healthcare challenges

By Linda Sprague Martinez, PhD and Noelle Dimitri, LICSW

The social determinants of health (SDOH) are the social circumstances in which people live, work, and play. A recent shift from acute care treatment to chronic disease management has brought a renewed recognition of the ways in which a person’s socio-environmental context affects their health and well-being. Some estimates credit these factors with twice the impact on health outcomes as quality healthcare has.

Not by chance, the social conditions within which people live, work, and play are gravely inequitable. Racialized social policies, for example, have given rise to a socially stratified society with separate and unequal conditions and opportunity. Within these circumstances, people have different access to educationsafe housingincomehealthcarefresh food, and other needs that influence their health outcomes. Social determinants like these are significant from a health equity lens because they help us understand the ways in which educational, racial, socioeconomic, and other social inequities contribute to health inequities.

Outcomes do not occur in a vacuum. As a profession, social work has long recognized the relationship between individuals and broader social systems — which we both shape and are shaped by. Now and since its inception, social workers play a critical role in advancing public health and eradicating these health inequities for future generations.

Social work’s value in addressing SDOH

The profession has roots in structural change efforts and the social determinants of health. Although the community health center movement — which radically changed the way we conceptualize healthcare in the U.S. — is often associated with Jack Geiger, MD, his advisor and co-conspirator in advancing the movement was Dr. John Hatch, who at the time was a social worker. Hatch’s work with Geiger lead to a healthcare delivery model aligned with the social work values of community development and asset-based intervention, including workforce development, food access, and healthy housing.

Achieving health equity requires fundamental change across multiple systems and at multiple levels.

Among today’s healthcare professionals, social workers are specifically trained to navigate the multiple dimensions that influence health — policy, community, healthcare settings, and family. In their day to day work, many social workers function as boundary spanners, facilitating communication among healthcare providers and the community partners that can offer critical social supports for a patient’s disease management.

Notably, social workers employ a person-in-environment approach to meet with people in nontraditional settings, creating access for the most marginalized segments of our population and for those who otherwise might not be able to reach care. As the boots on the ground, social workers have valuable insight and familiarity that can make all the difference in delivering effective care that addresses individuals’ unique needs. As Nobel-prize winning social worker Jane Addams once said, “social work’s special genius is its closeness to the people it serves.”

Achieving equity requires collaboration and systems change

At the end of the day, achieving health equity requires fundamental change across multiple systems and at multiple levels. As such efforts to advance health equity expand, medical communities must elevate the expertise and assets of social workers. Similarly, social workers focused on catalyzing change will benefit from equitable partnerships with health and public health practitioners.

Healthcare is a dynamic and evolving system, and we invite you to embark on this adventure with us. The Center for Innovation in Social Work & Health (CISWH) series will highlight success stories and provide an inside look at how integrated teams work and provide ideas that can be replicated to continue to address the social determinants of health to improve services for patients.

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This article is part of a series from the Boston University Center for Innovation in Social Work & Health (CISWH)  for Boston Medical Center’s HealthCity that highlights social workers working in healthcare and public health to address the nonmedical factors that impact health, known as social determinants of health. Know of a healthcare team that’s doing innovative work involving social workers? Contact us — we want to hear your story.