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Social work and health inequalities

What can social workers do about health inequalities? This question is foremost in the minds of members of the Social Work and Health Inequalities Network (SWHIN).

SWHIN aims to “promote research, discussion and action by social work researchers, educators, practitioners and managers, to combat the causes and consequences of unjust and damaging socially created inequalities in health”. It is an international network with about 300 members across the globe.

Yesterday I met with Paul Bywaters, Julie Fish and Kate Karban to think about how SWHIN can take forward its new connections with the Institute of Health Equity (IHE). The IHE is undertaking work to reduce health inequalities in the wake of Michael Marmot’s review Fair Society, Healthy Lives, that was published in 2010. In brief, the Marmot Review recommended policy action was required in six areas to reduce health inequalities:

1. Give every child the best start in life

2. Enable all children, young people and adults to maximise their capabilities and have control over their lives

3. Create fair employment and good work for all

4. Ensure healthy standard of living for all

5. Create and develop healthy and sustainable places and communities

6. Strengthen the role and impact of ill-health prevention.

Inequality is a political issue. It requires political action to address inequalities within a society, but governments are often unwilling to do so. This is evidenced by the storm which was created on the publication of Richard Wilkinson and Kate Pickett’s excellent book The Spirit Level in 2009. They provided robust evidence that health is affected more by how equal a society is than how wealthy it is. Life expectancy and mental health problems, for example, are more common in countries with higher levels of inequality, irrespective of their wealth. The publication of The Spirit Level prompted spirited defences from right wing think-tanks. (Wilkinson and Pickett tackle the arguments made by the Policy Exchange’s Beware False Prophets and the Democracy Institute’s The Spirit Level Delusion in a new chapter in the 2010 edition of their book – read them for yourself and make up your own mind about what the evidence says). 

Tackling inequality requires political action to reduce income differentials between those at the top and those at the bottom of the occupational hierarchy. It is also about understanding how social class mediates power in society so that those at the bottom end up with poorer life chances than those at the top. Social workers typically work with the poorest in society and therefore have an important role in tackling health inequalities. Two practical examples of how practitioners do this came to mind in our discussions yesterday.

Firstly, there is lots of evidence that children in care have poorer educational and health outcomes than other children. Social workers, foster carers and other social care workers work daily to provide children who are looked after with the best possible care to enable them to make the best possible start in life. The renewed focus on supporting looked after children when they leave care also helps them to maximise their capabilities and have control over their lives. Although it may not be articulated as such, much of children’s social care is about reducing health inequalities for these young people both now and in their futures.

Secondly, there is also evidence that people with severe mental health problems die sooner than other members of the general population. Mental health practitioners, including social workers, are increasingly working to promote healthy living and the well-being of people with mental health problems. Rethink have just launched a new physical health check toolkit to help with this.

Social work has a vital contribution to make to the reduction of health inequalities. SWHIN is working hard to evaluate the social work contribution to tackling the social determinants of health inequalities and to influence policy. Whilst not neglecting the fact that political action is required to ensure that all public policy address inequality, social workers can recognise their important role in bringing about change in the lives of people who have the poorest life opportunities.

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