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It is widely accepted that health is to be approached as a universal right of all individuals. The implementation of this right depends on having a comprehensive social protection system that ensures equity in access to health care services (WHO, 2008). It is important to keep in mind that social welfare is often related to somatic health. Therefore, health is not a purpose in itself but a precondition of individual’s life quality and a premise for social and economic development at both individual and community level. According to its mission, social work has a crucial role in promoting individual, family and overall social welfare. One of its main objectives is to influence social policies. In fact, when actions are designed separately leaving aside social problems such as unemployment, poverty, high infractionality rate, different family dysfunctions, alcoholism, discrimination etc., any health related strategy will only partially fulfil its main goals: to ensure and improve population health.
The current issue of the Social Work Review presents to the reader articles and original studies in the field of patients’ rights and their implications in medical practice for a wide range of health professionals (doctors, medical assistants, social workers). Other articles focus on the roles performed by a social worker in the health care system, specific aspects and determinants of socio- medical care, health risk factors for vulnerable populations such as elderly, persons with disabilities, young mothers.
Health social work practice comprises both direct and indirect actions. Direct actions are social work interventions which envisage promoting, preserving or reinstating a good functioning state of individuals, families and groups which experience illness. Indirect actions refer to social work actions in different public health fields, starting with primary prevention through actions such as advocacy, development of community resources, providing information but also legislative reforms to promote integrated social and medical services (Poole, 1995; Mizrahi, 1995; WHO, 2008).
In their article, Denalee O’Malley, Csaba L. Dégi, Brittany L. Gilbert and Shari Munch make a critical analysis of social work practice in the context of insufficient cancer control and increased incidence of cancer mortality in Romania. The role of the social worker is considered to be important since he can significantly contribute to changing the health policy and life style strategies, thus leading to a more efficient national cancer control programme. The authors also bring forward relevant arguments about the necessity that the social worker is not only included in the multidisciplinary team but also trained in the oncology field.
The need for integrated socio-medical services is most of all important when addressing social problems which are oftentimes related to health. In the same time, in the context of lack of human medical resources and insufficient funds, hospital systems are frequently required to provide support for social work cases rather than medical. In the article “Integrated care – real or illusory solution for a higher quality in serving the population?” the authors Oana-Magda Vlăduţ and Liliana Dorina Seprodi conduct a critical review of the Romanian legislative framework with regard to integrated socio-medical services from both social and medical perspectives. The authors draw attention to the potential difficulties and pitfalls of this approach, which focuses on improving the quality of services, particularly through developing community actions.
Clinical social work is commonly used as interchangeable with direct social work practice in the field of health (Poole, 1995). A professional view on the activities performed by a social worker should not overlook the importance of having good knowledge and the ability to put into practice the necessary concepts and skills in clinical social work practice: empathy, active listening, directive and non-directive approach, transfer and contratransfer in the helping relationship, systemic approach of interactions in family relationships and between social workers and family members. The article of Maria Diaconescu focuses on these particular aspects an in addition it tackles the ethical dilemma of change versus social control.
At the beginning of the 20th century, Cabot stated that health care and social work are distinct branches of the same field- caring for people in need (Cabot, 1915, cited in Poole, 1995). Some of the ethical principles that both social workers and health professionals use in their work are respecting individual’s autonomy and the right of individuals to decide for themselves, preserving confidentiality and ensuring individual’s participation in the decision making process. From this perspective, it becomes clear not only that social work and health care are related but also that this could be a strong argument for the use of multidisciplinary teams in the case of illness. The interrelatedness of health and social work, together with the moral dilemmas emerging from the specific aspects of ensuring underage patients’ rights in health care are the main issues discussed in their article by Csanad Albert Lorincz and Maria Roth. Drawing on the results of the empirical study, they argue that underage patients’ rights should be analysed and put into practice using a multidisciplinary perspective.
The qualitative study of Orit Elgar Reger states once again that understanding different aspects of health care calls for a transcultural approach and not least transcultural competences from the part of professionals involved in providing health care services. The phenomenological research is motivated by studies that show that the competence of nurses to deliver culturally adequate nursing that matches the patients’ culture and origin increases the compliance to treatment and the outcomes of the treatment. The results of the phenomenological investigation presented in this article illustrate that health care professionals who are sensitive to patients’ cultural backgrounds have developed qualities such as openness, flexibility and creativity, which enrich the nurse-patient relation.
The relevance of cultural factors, ethical challenges and the need for multidisciplinary work in health care settings are the subjects undertaken by Andrada Pârvu, Einav Rosh and Livia Popescu. The conclusions presented by Andrada Pârvu in her case study synthetize the ethical challenges that a health professional may face when interacting with a Roma patient diagnosed with cancer. The challenges arise from the need to respect patient’s rights but also his cultural values. Based on these findings, the author asserts that although having a social worker in the multidisciplinary team in the case of terminally disease is considered to be beneficial and moreover it is legally stated, this issue is little implemented, thus depriving health care professionals and Roma patients of the support they need.
Einav Rosh and Livia Popescu discuss the specific aspects in transcultural nursing in the end of life, focusing on the factors that influence nurses’ practices and coping mechanisms in relation to culturally diverse patients and their families in Israel. The authors emphasize that their results can be extrapolated to any of members of the multidisciplinary team working in palliative care, including the social worker.
The determinants of health are extremely diverse. The income level, social status, education, social support network, gender, health care services and even genetic factors are considered to be important determinants of one’s health status (WHO, 2008, 2010). McDonell (2002) further argues that the socioeconomic context, social structure and cultural factors are also important health determinants. Accordingly, from a macro social perspective, economic and social developments are important factors in understanding the health status of a certain population. The study conducted by Titilayo Ayotunde, Omisakin O. Akintoye and Ogunfowokan A. Adenike brings to the attention of the reader the correlation between social, demographic and economic factors in what concerns early childbirth in Nigeria. The final conclusions reveal that the first childbirth experienced before the twentieth birthday represents a significant predictor for low level of education and consequently for poor household living conditions for Nigerian women.
Elderly persons and disabled persons are considered to be vulnerable categories because they face several health and social risks. In the current issue we have included articles which highlight the need for integrated services and measures aimed at offering a good quality of life for the elderly and the disabled persons. The articles of Sârbu and Nicoară are critical for professionals involved in providing services for the elderly. Sârbu argues for the importance of primary prevention in order to prevent suicide in the case of elderly and also for the need of informing the specialists working with the elderly. Paula Nicoară makes a review of the Romanian legislative framework in the field of socio-medical care provided to elderly in residential centres. Conţiu Şoitu opens an original discussion on possible explanations of the “small numbers paradox” with regard to nowadays’ incidence of disability in Romania.
In conclusion, the studies and articles included in the current issue present a few of the multiple possibilities for a social worker to participate in multidisciplinary interventions in the field of health care. Drawing on our articles, among the roles that a social worker can perform we highlight the following: the supportive role of a social worker in relation to individuals and families who face illness and the support provided to enhance their coping mechanisms; support in identifying community resources and in developing complementary community health care services; participating in health promoting programs and preventing discrimination with regard to health care access and the use of services. All the aforementioned roles are only possible if the health care multidisciplinary team includes the social worker as a valuable resource for enhancing the adequacy and quality of services provided to their patients. Equally important is the fact that social workers who are involved in health care need to have eclectic competences (Beckett, 2006) and to be trained and prepared for the specificities of social work in health care settings.
References
Beckett, C. (2006) Essential Theory for Social Work Practice. Sage Publications, 38-40.
McDowell, I. (2002) Social Determinants, in Breslow, L (ed.). Encyclopedia of Public Health, Volume 4, McMillan Reference USA, 1122-1123.
Mizrahi, T. (1995) Health care: Reform Initiatives , in Encyclopedia of Social Work, 19th Edition, Washington, DC: NASW Press, 1185-1198.
Poole, D.L. (1995) Health Care: Direct Practice, in Encyclopedia of Social Work, 19th Edition, Washington, DC: NASW Press, 1156-1167.
WHO, Commission on Social Determinants of Health (2008) Closing the gap in a generation. Health equity through action on the social determinants of health. Retrieved http://www.who.int/social_determinants/thecommission/finalreport/en/index.html
WHO. (2010) The world health care report – Health systems financing: the path to universal coverage. Retrieved http://www.who.int/whr/2010/en/index.html
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