How can social work affect health care reform

Although health care reform is a serious challenge for health care social workers, it also creates many opportunities. Most often, social workers define this type of challenge from a reactive perspective. Rather than think of the impact of health care reform on the social work profession, perhaps health care social workers should ask this question: "How can the profession of social work actually affect health care reform?" Prior to coming to the Catholic University of America in 2002, I was one of the five associate directors at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University in Baltimore. In this role, I was responsible for community programs and research that attempted to understand the significant disparities that existed in mortality among all of the most prevalent cancer diagnoses in Baltimore city. I, along with the members of my team, was shocked to learn in the year 2000 that the leading cause of death for African American men under the age 30 was homicide, whereas for African American men over the age of 30, it was prostate cancer. Yes, prostate cancer. Based on mortality statistics for 1997 through 1999, African American men died of prostate cancer at a rate three times higher than that for any other population in Baltimore city. When you read these types of statistics (and there are many other examples in other chronic illnesses), health care reform--in terms of access to care and the provision of health care services--is essential. Today, we need to examine health care reform from a number of perspectives. Let me raise three questions that need to be explored: 1. Has the time arrived for social workers in health care to fully embrace the concept of illness prevention and control and actively involve themselves in primary and secondary prevention efforts? By preventing the onset of a disease such as cancer, or through the design of an early detection programs, can social work interventions actually save lives among the most vulnerable populations? The answers to these two questions are yes and yes. 2. Must social workers adopt evidence-based interventions under the realm of tertiary prevention to minimize the effects of a range of chronic illnesses? The answer is yes. 3. Can social workers design interventions and programs that significantly reduce health care spending? Again, the answer is yes, and this requires further examination. Much research exists that has demonstrated a significant association between cancer, psychological distress, and unsatisfactory quality of life, not only at the time of diagnosis, but throughout treatment and recovery (Worden, 1989; Zabora et al., 1997). It is clear that cancer patients are at risk for the development of psychological symptoms and problems, perhaps to an even greater extent than patients with other medical illnesses (Mishel, 1999). Some of the potential risk factors hypothesized to be involved in the development of cancer patients' distress are social isolation, pessimistic attitudes, loss of control, loss of hope, socioeconomic factors, pain, side effects of cancer treatments, and poor problem-solving skills (Zabora, 2009). Undetected and untreated psychological distress may be transformed into somatic complaints such as fatigue, pain, or sleep disorders. Health care providers may assess these somatic complaints and respond with medications, lab tests, scans, or procedures (Allison et al., 1995; Zabora, 1998). Somatic complaints may well continue until the true source of a complaint is identified and treated. Brief psychosocial interventions that address significantly elevated levels of anxiety or depression at the initiation of treatment may be far less costly than a series of non-medically appropriate procedures and scans or an avoidable hospitalization if physical complaints increase in severity. Given that one-third of all cancer patients (and there is evidence to indicate comparable rates among patients with cardiovascular disease and diabetes) experience significant distress that may interfere with the delivery of effective cancer therapies (Zabora, Loscalzo, & Weber, 2003), it is highly unlikely that significant progress in health care reform can be achieved unless the need for the integration of mental health care is simultaneously addressed. …