Inequities in Health Care: How Social Workers Can Step Up to the Plate

By Elizabeth Drucker

If you talk to any social worker who has been in the field for a while, many will say that health inequities can seem insurmountable. One masters-level clinician working in a community mental health center describes a case where an African-American woman was regularly denied vital pain medication she needed because the doctors dismissed her pain. Unfortunately, this is not an isolated incident. Fortunately, it is an issue that both the Centers for Disease Control and Prevention (CDC) and the NASW are trying to moderate.

With their National Center for Chronic Disease Prevention and Health Promotion, the CDC strives to equalize variables that negatively impact health care. More specifically, the organization has designed the Racial and Ethnic Approaches to Community Health (REACH) Program to target disparities occurring in these populations: Black or African-American, Hispanic or Latino, Asian, American Indian, Native Hawaiian, Pacific Islander, and Alaska Native persons.

A sharp increase in disease among patients of these marginalized groups adds urgency to the situation. For example, according to the CDC, in 2015–2016 Hispanic and non-Hispanic Black adults had a higher prevalence of obesity than non-Hispanic white adults.

Social workers’ mission is aligned with that of the CDC. And there are many actions they can take to help level the playing field. In the latest revision of the Code of Ethics (2021), the NASW added a section on Cultural Competence. It states that “social workers must take action against oppression, racism, discrimination, and inequities, and acknowledge personal privilege.”

Social workers must always focus on being inclusive. By not making an effort to narrow the health disparities gap, more individual suffering, along with additional structural barriers in the health care system as a whole, will occur. Social workers are trained to advocate for their clients and must never forget this key focus of practice. For example, the NASW is concerned with how social workers will provide culturally competent care to those seeking “electronic social work services.” So-called telehealth services have become a way of life since the advent of the pandemic. But not everyone has access to a computer and quiet space to have sessions with a therapist.

The NASW Code of Ethics says that social workers “should be aware of cultural and socioeconomic differences among clients’ use of and access to technology and seek to prevent such potential barriers.”

Along the lines of advocacy, social workers can help clients work the system better, including educating clients on how to advocate for themselves using the resources that are available. This might include understanding chronic illnesses better and how they manifest holistically in a person’s life. Or providing stress management strategies that will help them cope with chronic illnesses such as diabetes. Social workers can be present with their clients, helping them feel heard and empowered.

Social workers should also monitor the client’s discussions with other members of the health care team. What biases do doctors and nurses seem to have? How can social workers contribute slices of information about the client’s daily experience? Social workers spend more time with patients and know them more as people than diagnoses. Getting to know the person behind a health condition prevents erroneous conclusions that may be based solely on race or ethnicity.

In the end, it is important that social workers stay true to their purpose of education and advocacy. Social inequities are not new, but the pandemic has intensified their effects. There’s a lot wrong with the health care system, but social workers have the potential to make some important changes just by going to work every day. They should look to the NASW’s Code of Ethics and be purposefully present in their interactions with both clients and other members of the health care team. As trained professionals, social workers have much to contribute that will reduce health disparities and hopefully improve the system one patient at a time.

Keep in mind that social workers also play an important role in policy. This could mean serving on a committee or as a local representative, reaching out to local representatives or finding some other way to be heard. This advocacy thread runs through every social worker’s vision of practice.

Social workers can also attend national conferences and give presentations to share their challenges and triumphs with other professionals.

Health inequities are an entrenched, pervasive problem, one that can’t be solved in one day. However, social workers are in position to make a big difference, one client, one day at a time.

— Elizabeth Drucker is a freelance writer and mental health advocate from Illinois.