Social Work Practice for Promoting Health and Wellbeing

Critical Issues

Liz Beddoe, Jane Maidment, Liz Beddoe, Jane Maidment

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781136283956
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

Promoting health and wellbeing is an essential part of all effective social work – not just for practice in healthcare settings. In fact, the IFSW holds that 'social workers in all settings are engaged in health work' and physical and mental resilience can make a major difference to all service users' lives.

Drawing on international literature and research, the authors collected here encourage thinking about the social, political, cultural, emotional, spiritual, economic and spatial aspects of health and wellbeing, and how they impact on the unique strengths and challenges of working with particular populations and communities. Divided into three parts, the first section outlines the major theoretical paradigms and critical debates around social work and ideas of wellbeing, globalisation, risk and vulnerability, and the natural environment. The second part goes on to explore how diverse understandings of culture, identity, spirituality and health require different strategies for meeting health and wellbeing needs. The final part presents a variety of examples of social work research in relation to health and wellbeing with specific populations, including mental health.

Exploring how structural inequality, oppression and stigma can impact upon people, and drawing upon a social model of health, this book is an important read for all practitioners and researchers interested in social work, public health and social inclusion.

1 Social Work Practice for Promoting Health and Wellbeing

Liz Beddoe and Jane Maidment

DOI: 10.4324/9780203112816-1

Introduction: social work and health

Health is intrinsically part of being human – we experience our lives with our bodies and minds. The quality of our lives is inextricably bound up with our health and wellbeing which, in turn, incorporates physical, psychological, emotional, cultural, social and spiritual dimensions. Since the inception of the World Health Organisation (WHO), health has been conceptualised as broadly encompassing these dimensions and thus as much more than the absence of disease (WHO, 1948).

Social work involvement in healthcare, through government, not-for-profits and private sector services is a significant field of practice for our profession. Large numbers of social workers in New Zealand and Australia (as well as the United States, Canada and South Africa) are engaged in a broad range of health-related settings. Health spans not only clinical/medical settings but also community-based mental health and healthcare environments, drug and alcohol services, aged care services, end-of-life care and health and development services for children and families. Social workers are confronted with health-related issues across all fields of practice, including the criminal justice system, working with young people, migrant and refugee services, grief and loss issues, disability services, reproductive health and the health of older adults. Social workers’ understanding of health and wellbeing fits comfortably with those wider descriptions offered by such seminal definitions as those offered by the influential Ottawa Charter for Health Promotion. This charter outlined an agenda which positioned health as a valuable resource, and recognised the contributions needed beyond the health sector in the promotion of health and wellbeing:

Health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social wellbeing, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being. (WHO, 1986)

In 2008 the profession approved the IFSW Policy Statement on Health, which declares health to be an international social work issue. This important document states that health ‘is an issue of fundamental human rights and social justice and binds social work to apply these principles in policy, education, research and practice’ (2008, p. 1). Globally, recent research has identified the complexity of the interaction between socioeconomic status and social participation and the overall health and wellbeing of people, families and communities (Rose and Hatzenbuehler, 2009). The mission of social work to work towards improving the lives of all people through a reduction of inequalities brings health into the heart of social work. Bywaters, McLeod and Napier have significantly argued that ‘Social work in all settings is concerned with the impact on people’s lives of the social forces which determine health chances and health experience…. all social work has health impacts’ (2009, p. 11). Bywaters and Napier emphatically suggest that:

Social work is health work…. [s]ocial workers in all settings engage every day with children, men and women struggling to realize their basic rights to health. It is not only social workers in health settings such as hospitals or clinics who must be concerned with health issues. (Bywaters and Napier, 2009, p. 453)

Social workers are constantly challenged to integrate ‘health thinking’ into their work; Pockett and Beddoe (in press) have suggested that one approach is to include such thinking throughout the social work assessment process and the documentation of practice. For example, a social worker working in child welfare may acknowledge that inequitable access to healthcare for rural children with serious illness may lead to severe family hardship. Support and financial assistance needs are perceived as both a family problem requiring response but also as an indicator of a larger health inequity. Giles (2009) suggests that social workers develop a ‘health equality imagination’. Practitioners can foreground the cumulative impact of health inequalities in the daily lives of children and families often obscured by a focus on neglect or abuse.

Generally, the engagement of social work in health has been focussed around hospital and home-based intervention related to illness and disability, but there is great potential for social work to reconceptualise health’s significance in all social services work. Current trends towards strengthening primary health care underscore the need for social workers to have a broad understanding of health and wellbeing incorporating physical, social, emotional, cultural, spiritual, environmental and economic dimensions. This focus supports an understanding of the unique strengths and challenges of working with particular populations and communities. If the centrality of health in people’s lives provides a strong rationale for seeing health as a central dimension of social work, then a second and equally important element is that ‘health is primarily a product of social determinants such as food, water, income, housing, a safe environment and education’ (Bywaters and Napier, 2009, p. 453).

The purpose and scope of this book

We are New Zealand social work educators and researchers who have practised in health settings with lifelong interests in health and wellbeing. Our aim was to deliver an internationally relevant book to support the dissemination of new research and thinking about health, wellbeing, and the social, political, cultural, emotional, spiritual and spatial aspects of health . Social Work Practice for Promoting Health and Wellbeing addresses this broad commitment to educating social workers about health, beyond the traditional text-book approach which has been to focus on sickness and medical treatment. We wanted to avoid chapters which referred to particular illnesses and to shift attention to a broad conceptualisation of health as a social good while acknowledging the focus of social work practitioners and researchers on issues of everyday lived experience of individuals, families and communities struggling with illness, trauma, disabling environments, poverty and environmental determinants. We were also moved to action by the growing awareness of health issues in the international social work arena, namely the International Federation of Social Workers (IFSW) Global Agenda for Social Work and the IFSW Policy Statement on Health (IFSW, 2008). These two key documents underpinned a starting point for us that awareness of health is central to human wellbeing and this has been underscored in many of the contributions to this book.

At the heart of our book is a framework drawing on notions of resilience, connectedness and relationship using progressive ideas and contemporary theory. We have encouraged our contributing authors to strike a balance between issues of structural inequality, oppression and stigma and the impact of these on the wellbeing of citizens while drawing upon a holistic, multifaceted and intrinsically social model of health. As such we asked authors to consider the emotional and interpersonal impact of health changes in peoples’ lives within cultural, political and economic contexts. We asked each author to address two or three of the following themes: theory for health practice; critical perspectives on health including stigma, risk and vulnerability; culture, spirituality and diversity; issues of space and place; sustainability and resilience for individuals, families and communities; and collaborative practices.

Organisation of Social work practice for promoting health and wellbeing

The book is organised into three sections. The first, ‘Current themes and critical issues’ explores the major theoretical paradigms and critical debates in health. We asked authors to ensure their material was grounded in current debates and evidence-based where this was appropriate. These chapters intend to provoke debate, and refer to the most contemporary understandings of health and wellbeing while acknowledging milestone knowledge development.

There are myriad ways of understanding and defining health and wellbeing. Jane Maidment’s chapter discusses concepts of health and wellbeing within Western and other cultural contexts. She examines the relationship between spirituality, religion, health and wellbeing and the relevance of these for social work in health. The characteristics of salutogenesis and its relevance in this model for promoting public health are considered. Paul Bywaters explores key global health issues and their implications for social work and outlines some possibilities for practice informed by an analysis of globalisation. He provides examples from practice across the globe. Turning to the profession itself, Linda Haultain explores the perennial challenges and emerging themes social workers face in contemporary health care environments and revisits the core functions and roles of the profession based on research carried out in a large New Zealand teaching hospital. Haultain advocates for professional strategies that will help strengthen and sustain the profession’s role in a health environment. Liz Beddoe examines how the social construction of risk permeates contemporary social care and health discourses including the creation of vulnerable populations in contemporary health and social policy. Risk and vulnerability constructs are critically interrogated with regard to their dual impact on the social work profession and service users.

Using the very current experience of civil defence emergencies and natural disasters as a focus, Carole Adamson employs an ecological lens to construct a relational understanding of resilience for social work practice. Ecological and constructivist approaches to social work are offered for exploration and critique and readers are challenged to develop perspectives on stress and resilience that incorporate and resonate with social work knowledge and principles. Viviene E. Cree revisits the idea of stigma as part of a transformative agenda for change in social work and health. She argues that stigma remains a crucial core concept in aiding social workers to understand the impact of illness on identity and inclusion. The chapter draws on her experience as a practitioner and researcher studying the impact of HIV (parental and own) on Scottish children and families. Finally in this section, Uschi Bay starts with the consideration that people and nature are never separate; thus the wellbeing of both the natural environment and people needs to be fostered through understanding the need for respectful interdependence. Bay contends that the natural environment can be a source of ‘distress and dis-ease’ and promotes a rethinking of wellbeing that recognises the interdependence of people and nature in social work practice.

The second section, ‘Diverse communities: culture, identity, spirituality and health’, was designed to explore diverse forms of knowledge that inform our many understandings of health and wellbeing. This section intends to promote critical thinking and awareness of varied worldviews through inviting readers to consider alternative ways of knowing, doing and being that may often be marginalised by dominant discourses and structural inequalities. In doing this, authors were asked to describe diverse understandings of culture, identity, spirituality and health and related strategies for meeting health and wellbeing needs. A key role of social workers is to challenge the discriminatory environments endemic in the health arena in many countries.

Given the generally unequal health status of minority and indigenous peoples globally we believed it was essential for this book to carry non-Western voices and experiences of health and wellbeing. Lorraine Muller is an Indigenous Australian researcher whose chapter describes a journey to the restoration of Indigenous knowledge to assist in the healing and reclaiming of wellbeing. Muller discusses the process of colonisation and its negative effects on the wellbeing of Indigenous people. She describes decolonisation as a framework for research that is relevant to both the colonised and coloniser communities, for both are afflicted by the ideology of colonisation. Taking an historical perspective, Jim Anglem explores racism as an insidious and debilitating phenomenon affecting the health of the Māori population of New Zealand, producing health inequalities suffered by many Indigenous peoples.

Yvonne Crichton-Hill, Tanya McCall and Genevieve Togiaso are Pacific researchers who here explore concerns over the comparatively poor health status of Pacific peoples in New Zealand. The range of conceptual models presented will contribute to an understanding of how health interventions with Pacific communities might best be delivered.

Other minority groups can experience health inequalities and the adverse effects of stigma and social exclusion. Joy Phillips argues for a more just and inclusive society that recognises difference and diversity including the lived experience of GLBT people in sickness, health and wellbeing. Significant health and wellbeing disparities impact on GLBT people and raise issues of access and equity in health care. Phillips notes that older lesbians and gay men are often silenced by policy and practice which actively exclude and marginalise their needs and voices as they encounter the challenges of ageing. Helen Meekosha and Karen Soldatic explore the often troubled relationship social work has had with disabled people who were historically pigeonholed by their deficiencies. They note that practical intervention was often more traditionally focused on the family and/or carers of the disabled person. Meekosha and Soldatic argue for considerable improvement of the position of disability studies in the social work education curriculum so that social workers can play a critical role in facilitating the highest levels of health and wellbeing for disabled people.

The third section aims to capture examples of current research relating to health and wellbeing in specific populations where social work may make a difference. Our aim was to provide some key findings from research, but also have authors document any unique methodological issues encountered in conducting that research with a participant group. As such, each chapter addresses the dual objectives of documenting current research on specific issues, while strengthening research knowledge and culture for social work practitioners. The research studies that inform these chapters have many themes in common and, of particular note, is the recurring importance of these concepts in social work: collaborative practice and research, critical thinking about trauma and change, resilience and salutogenesis.

Andrew Thompson and Carole Adamson discuss the importance of collaborative practice in family-centred care in child health. The chapter draws on Thompson’s research on families’ experiences of family meetings and focuses our attention on the ethical and methodological challenges related to such practice-focused research, including concern about potential re-traumatisation for service-users and the intricacies of gaining consent from families and medical professionals for recording often painful, but crucial, meetings. Resolution of these challenges was achieved by attention to ethical and collaborative processes. Phil Crane considers ‘space and place’ in an examination of the contribution of public spaces to the wellbeing of young people. Using a case study he explores how participatory action research can be used as a process tool for contextually responsive, collaborative, iterative and multi-method, community-level practice. Crane argues that the addition of a spatial frame to practice can open up unexpected alliances and opportunities for enhancing the wellbeing of young people.

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Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright Page
• Contents
• List of Figures
• List of Tables
• Notes on Contributors
• 1 Social Work Practice for Promoting Health and Wellbeing
• Part I Current themes and critical issues in health and wellbeing
• 2 Exploring Interpretations of Health and Wellbeing for Social Work
• 3 Globalisation, Social Work and Health
• 4 Facing the Challenges Together A future vision for health social work
• 5 Risk and Vulnerability Discourses in Health
• 6 Stress, Resilience and Responding to Civil Defence Emergencies and Natural Disasters An ecological approach
• 7 Stigma in Health and Social Work Towards a new paradigm
• 8 The Natural Environment and Wellbeing
• Part II Diverse communities Culture, identity, spirituality and health
• 9 Indigenous Australian Social-Health Theory Decolonisation, healing – reclaiming wellbeing
• 10 Whai Ora – Māori Health
• 11 Pacific Health
• 12 Gay, Lesbian, Bisexual, Transgender, Transsexual People and Discourses of Health and Wellbeing
• 13 Disability-Inclusive Social Work Practice
• Part III Messages from research
• 14 Collaborative Practice and Family Meetings in Children's Health
• 15 Improving Public Spaces for Young People The contribution of participatory research
• 16 Ageing in Resiliency Learning from the experiences and perceptions of migrant older adults
• 17 Refugee Resettlement Considerations of health and wellbeing
• 18 Mental Health, Social Work and Professionalism
• 19 Partnering in the Field of Chronic Care Service Provision
• 20 Crafting Social Connectedness A community development model
• 21 Pregnancy in an Age of Medical Technology Decisions, loss and research with a vulnerable population
• Index