Breaking free from siloes: intersectionality as a collective action frame to address toxic exposures and reproductive health

ABSTRACT

There has been increasing interest in collaborative approaches between the environmental justice (EJ) and reproductive justice (RJ) movements to address the higher burden of toxic exposures and associated reproductive health outcomes in vulnerable communities. This study examined the collective action frames (CAFs) of advocates at the EJ/RJ nexus. CAFs highlight how advocates identify problems and solutions, and motivate action. The use of intersectionality was identified as a main CAF used in three key ways: breaking free from identity-based, issue-based, and movement-based siloes. First, interviewees described breaking free from identity-based siloes by identifying risks of toxic exposures that result from intersecting social locations (e.g. gender, race/ethnicity, income, immigration status) and by equally prioritizing multiple aspects of their identities as they engage in advocacy. Second, they described breaking free from issue-based siloes by developing multi-issue agendas that address a complex web of interrelated problems impacting health. Third, they described breaking free from movement-based siloes by developing cross-movement collaborations to address issues of mutual concern. Among multiple reasons given for cross-movement collaborations, advocates perceived them as valuable in order to disrupt social, political, and economic power imbalances that shape environmental reproductive health inequities, as well as other health and social inequities. Based on these findings, we suggest that intersectionality is a master frame, and thus may be useful to advocates in other social movements addressing intersectional issues. Understanding an intersectionality frame can help to inform advocacy approaches to promote health and health equity, particularly those focused on policies and structural drivers of health.     

Accentuation of Individual Differences in Social Competence During the Transition to Adolescence

Using a sample of individuals (277 males, 315 females) studied since birth in the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, the present study investigated how early pubertal maturation and school transition alter youth trajectories of social competence during the transition to adolescence. Social competence showed strong continuity, with the most socially competent children remaining so in adolescence. Early pubertal maturation and school transitions accentuate individual differences, increasing social competence among more competent youth, but further diminishing social competence among less competent individuals. In essence, facing challenges that require social competence may further separate competent individuals from less competent peers. Thus, the psychosocially rich become richer, while the psychosocially poor become poorer.     

Building shalom: Integrating social work,peacebuilding and Catholic Social Teaching for transformational change

ABSTRACT

This article argues for greater integration between peacebuilding and social work, based on shared values, complementary practices, and congruence among key underlying theories in both fields. The article also describes how principles of Catholic Social Teaching align with and enhance both social work and peacebuilding. The implications of the ecological model for the three commonly accepted domains of social work practice—micro, mezzo, and macro—find equivalent expression in dimensions of conflict transformation, as well as in Catholic Relief Services’ approach to building social cohesion by working iteratively at individual, intragroup, and intergroup levels. Three case studies illustrate this approach.     

A Survey of Australian Human Services Agency Software Usage

Human Services agencies use a wide range of software systems to manage caseloads, maintain records, deliver services to clients, and for interagency communication. Some systems are generic, such as Word or Excel, while some are specialized to the organization, such as specialized databases for tracking case notes. Some software systems are shared across organizations. We surveyed nearly 40 Australian Human Services agencies to ascertain the range of software currently in use by agencies and their opinions on it, with a view to identifying promising new Human Services applications. We interviewed representatives from a selection of smaller agencies. This resulted in detailed feedback on key issues to consider when developing and deploying new Human Services software.     

Understanding social factors and inequalities in health: 20th century progress and 21st century prospects

The development of social epidemiology and medical sociology over the last half of the 20th century, in which Leo Reeder played a central role, transformed scientific and popular understanding of the nature and causes of physical health and illness. Viewed in the early 1950s as shaped almost entirely by biological processes and medical care, physical health and illness are now understood to be as much or more a function of social, psychological, and behavioral factors. Utilizing a stress and adaptation conceptual framework, social epidemiology has identified a broad range of psychosocial risk factors for health, most notably: (1) social relationships and support; (2) acute or event-based stress; (3) chronic stress in work and life; and (4) psychological dispositions such as anger/hostility, lack of self-efficacy/control, and negative affect/hopelessness/pessimism, with new risk factors continuing to be identified. However, proliferation of risk factors must be balanced by conceptual integration and causal understanding of the relationships among them, their causes, and consequences. One source of such integration and understanding has been the rediscovery of large and persistent socioeconomic and racial-ethnic disparities in health. Socioeconomic position and race/ethnicity shape individuals' exposure to and experience of virtually all known psychosocial, and well as many environmental and biomedical, risk factors, and these risk factors help to explain the size and persistence of social disparities in health. Improving the socioeconomic position of a broad range of disadvantaged socioeconomic and racial-ethnic strata constitutes a major avenue for reducing exposure to and experience of deleterious risk factors for health, and hence for improving the health of these groups and the overall population. This in turn requires better understanding of the macrosocial forces that influence the socioeconomic position of individuals.     

Physical and mental health inequalities between native and immigrant Swedes

To study health inequalities between native and immigrant Swedes, we investigated differences in self‐rated health (SRH), mental wellbeing (MW), common symptoms (CS), and persistent illness (PI), and if socioeconomic status (SES), negative status inconsistency, or social support could account for such differences. A secondary analysis was conducted on questionnaire data from a random adult population sample of 4,023 individuals and register data from Statistics Sweden. χ² tests and binary logistic regressions were used to identify health differences and study these after accounting for explanatory variables. Compared with natives, immigrants more commonly reported negative status inconsistency, poorer SES, and poorer social support as well as poor SRH, very poor MW, and high level of CS but not PI. Significant differences were accounted for by work‐related factors and social support. We encourage future research to address how pre‐ and peri‐migration factors relate to immigrants’ post‐migration SES, social support, and health status.

Policy Implications

• Given the relationship between work‐related factors (employment status, hours worked per week, and income) and all health outcomes in this study, labour market interventions that facilitate the integration of immigrants into the labour market, and into occupations that better correspond with their capacity, will arguably have public health benefits.
• Feelings of loneliness was, in our study, important in accounting for immigrants’ poorer self‐rated health compared with natives’. Therefore, we endorse interventions that facilitate immigrants’ social networking and integration and thereby reduce feelings of loneliness.
• Common physical and mental symptoms may be important indicators of health and we, thus, suggest these to be taken into account when developing ill‐health prevention programmes.

     

The Impact of Women’s Work on Gendered Health Inequities

ABSTRACT

How does the work that American women perform, both in the formal economy (paid labor) and in the caring economy (caring for children and households) negatively affect their health? The World Health Organization’s social determinants of health model is used to illuminate the causes of gendered health inequities. The social determinants of gendered health inequities that are correlated with women’s work include globalization, cultural norms, an imbalance of power between men and women, the feminization of work, the gendered pay gap, unequal responsibilities in the caring economy, the lack of recognition of the value of caring work, stress, and poverty.     

Aging,Health, and Social Policy:

Seven major turning points in the evolution of U.S. aging policy are identified and reviewed: (1) the Social Security Act (2) the Great Society (3) the federalization of Old Age Assistance (4) the enactment of comprehensive social services (5) Social Security improvements (6) New Federalism, and (7) medical cost-containment policies under Medicare and Medicaid. In the 1980s, significant and growing problems of uninsurance and underinsurance for health care have re-emerged. Simultaneously, state Medicaid programs are characterized by their increasing variation and inequities, while there has been a decline in access for the poor. The future of aging policy will be decided in the context of four socio-demographic realities: (1) population aging (2) trends in mortality and morbidity (3) the relationship between income and health, and (4) aging as a woman's issue. The article concludes with a call for a recommitment to the public interest and to public solutions which affirm that health care is an inalienable right.     

Measuring Sexual Orientation: A Review and Critique of U.S. Data Collection Efforts and Implications for Health Policy

The U.S. Department of Health and Human Services’ (HHS) Healthy People 2020 goals sought to improve health outcomes among sexual minorities; HHS acknowledged that a dearth of sexual orientation items in federal and state health surveys obscured a broad understanding of sexual minority–related health disparities. The HHS 2011 data progression plan aimed to advance sexual orientation data collection efforts at the national level. Sexual orientation is a complex, multidimensional construct often composed of sexual identity, sexual attraction, and sexual behavior, thus posing challenges to its quantitative and practical measurement and analysis. In this review, we (a) present existing sexual orientation constructs; (b) evaluate current HHS sexual orientation data collection efforts; (c) review post-2011 data progression plan research on sexual minority health disparities, drawing on HHS survey data; (d) highlight the importance of and (e) identify obstacles to multidimensional sexual orientation measurement and analysis; and (f) discuss methods for multidimensional sexual orientation analysis and propose a matrix for addressing discordance/branchedness within these analyses. Multidimensional sexual orientation data collection and analysis would elucidate sexual minority–related health disparities, guide related health policies, and enhance population-based estimates of sexual minority individuals to steer health care practices.     

Meeting the Challenge of Preparing Social Workers for Integrated Health Practice: Evidence From Two MSW Cohorts

ABSTRACT

Changes in health care policy have led to an expansion of integrated care models that rely on collaboration among interprofessional health teams. Recent federal funding has encouraged the development of innovative training models to prepare social workers for integrated health practice. This article presents evidence from the first two MSW cohorts of the Integrated Mental and Behavioral Health Training Program funded by the Health Resources and Services Administration. Twelve students completing the program in 2014 (n = 5) and 2015 (n = 7) participated in evaluation activities at the time of program completion and at 1-year postgraduation. Findings highlight key components of the training program instrumental in student attainment of program goals and competencies. Implications for MSW education and training for practice in integrated care environments are discussed.     

Stressful neighborhoods and depression: a prospective study of the impact of neighborhood disorder

Quantitative and qualitative research suggests that urban disadvantaged environments may be highly stressful to their inhabitants. Social disorganization may be deleterious to both physical and mental health. The relationships among perceptions of one's neighborhood, measures of social support and social integration, and level of subsequent depressive symptoms was examined with a community sample of 818 individuals screened for an HIV prevention intervention, most of whom were current or former drug users. After adjusting for baseline levels of depressive symptoms, perceptions of neighborhood characteristics (vandalism, litter or trash, vacant housing, teenagers hanging out, burglary, drug selling, and robbery) predicted depressive symptoms at a 9-month follow-up interview. Measures of social support and social integration, entered as interactions with neighborhood perceptions, did not buffer the effect of neighborhood perceptions. However, CES-D scores at follow-up for frequent church attendees were lower. The data support theories of social disorganization and social stress and suggest the need for structural intervention.     

Social Workers’ Roles in Supporting the Sexual and Relational Health of Children with Disabilities

The purpose of this study was to understand social workers’ roles in meeting the sexual and relational health needs of children (aged 3–11) with disabilities. We conducted semi-structured interviews with 12 social workers from a range of practice settings. A phenomenological lens privileged the perspectives of social workers in their definitions of disability and sought to convey the meaning they assigned to their experiences of working with children in practice concerning matters related to sexual and relational health. Social workers enacted a broad definition of disability and often came to work with youth in contexts labeled as sexually problematic. In the provision of sexual health services, social workers embodied commonly adhered to roles including as practitioners, enablers, advocates, brokers, and managers. Services are needed that promote positive sexuality and relational health among children with disabilities. It is important that social workers be proactive advocates for the full inclusion of people with disabilities as equal sexual citizens.     

Experiential Exercises for the Development of Computer Literacy Among Social Work Undergraduates

Summary

This paper describes exercises and assignments used to promote computer literacy among social work undergraduates. These exercises were used as course assignments in an elective course for seniors, “Information Technology and Human Services.” Exercises met four criteria: (1) they assume no previous computer experience or knowledge, (2) they are directly related to human services practice, (3) they promote mutual support, (4) they are experiential. Exercises include use of word processing, database, spreadsheet, electronic mail, privacy invasion, shopping for a computer system, and impact of information technology on the larger society.

The potential placement of computer literacy exercises in the social work curriculum is discussed. It is suggested that a single experiential course best meets the need for promoting computer literacy among social work students.     

Service learning, social justice, and campus health

Healthy campuses are critical so that students can learn and actively participate in shaping and maintaining a strong educational environment. This Viewpoint describes the commonalities between service learning, social justice, campus health, and the goals of Healthy Campus 2010, which was developed from the larger Healthy People 2010 objectives proposed by the US Department of Health and Human Services. The values, methods, and intended results of service learning are closely related to effective health promotion and disease prevention. Service learning focuses on personal and civic responsibility, thus providing students with opportunities for enhancing individual and community health. Service learning also espouses social justice and provides a vehicle for students to learn about, reflect on, and address health disparities. The author cites research concerning the effect of service learning on students in institutions of higher education and their social justice-related behaviors.     

‘Health in all Placements’ as a Curriculum Strategy in Social Work Education

The convergence of health and social perspectives that aim to improve the quality of life of individuals, groups and communities through advancing the social determinants of health provides an important context for social work education. The adaptation of global initiatives such as Health in All Policies (HiAP) to a `health in all placements' approach in social work education is suggested as a curriculum initiative to support learning about health inequalities and enable students to locate their practice in the social, political, environmental and economic context of health and wellbeing. The integration of this approach with principles of social justice, social inclusion and the theoretical framework of transformative learning in field education is also discussed. It is argued that the approach supports the inclusion of global and local perspectives in social work curricula and pedagogical imperatives in higher education.     

Gendered Dimensions of the HIV Pandemic: A Cross‐National Investigation of Women's International Nongovernmental Organizations,Contraceptive Use,and HIV Prevalence in Less‐Developed Nations

The human immunodeficiency virus (HIV) pandemic has a profound impact on women as a result of social and biological vulnerabilities to the infection. In this article, we explore the influence of democracy, women's international nongovernmental organizations (INGOs), and contraceptive use on female HIV rates, using indirect‐effect modeling techniques to properly test the interrelationships among key variables. Structural equation models reveal that democracy and women's INGOs work to reduce female HIV rates indirectly, by promoting the use of contraceptives among women in less‐developed nations. Despite these promising findings, the analyses also reveal that INGOs are negatively associated with sociohealth dimensions of female empowerment, which thus serves to promote HIV rates. The results suggest that interventions undertaken by INGOs may not be as successful as government programs in addressing inequalities in health and social resources for women in poor nations.     

Four elephants in the room: A reflective analysis of the wailing rage displayed by Baltimore youth after Freddie Gray’s death

Eliminating health disparities is our ethical and generational responsibility to protect and promote the health of all Americans. However, we cannot effectively eliminate health disparities in the United States unless we acknowledge and confront the three social culprits that threaten the elimination of health disparities: poverty, racism, and inequities. When addressing communal health, a multigenerational intentionality approach is needed to combat determinants of health. Retrospectively, we used the 2015 wailing rage demonstrated by youth in Baltimore City after the death of Freddie Gray Jr. to introduce our Multigenerational Intentionality to Communal Health conceptual framework. The conceptual framework directs any determinants of health process (i.e. planning, policy, programming, practice, etc.), to decisively utilize the looking backward-thinking forward method to explore the intersectionality of how generational determinants of health (e.g. poverty, racism, disparities and inequities) threaten communal health.     

ON INTERGENERATIONAL IMMOBILITY: EVIDENCE THAT ADULT CREDIT HEALTH REFLECTS THE CHILDHOOD ENVIRONMENT

We examine the persistence of inequality through credit health, linking administrative records from several sources. We document that childhood circumstances are strongly predictive of financial fragility in adulthood, with credit scores among those from disadvantaged backgrounds nearly 100 points lower and 20 percentage points more likely to qualify as subprime. We find evidence this relationship reflects differences in human capital and debt management; still, neither appears to fully explain the relationship. Our results reveal another dimension along which childhood circumstances persist into adulthood and could mean the many settings that evaluate individuals based on their credit health help reinforce inequities.(JEL D12, E24, I32)     

Social Integration and Mental Well-Being Among Jail Inmates

Although social integration has consistently been linked to mental well-being among the general population, this relationship has not been explored for persons confined in total institutions. Jails, in particular, represent unique conditions that have the potential to alter the traditional relationship between social ties and mental health. Although previously unexamined, social ties maintained by jail inmates outside and inside of the institution are commonly presumed to weaken some of the adverse effects of a stressful environment and positively influence mental health. The current study explores the impact of social integration on mental well-being among 198 male and female inmates incarcerated in a large county jail. The impact of marital status, parental status, and social support (both inside and outside of the jail) on various dimensions of mental health was examined. The results indicate that rather than promoting mental well-being, social relationships inside and outside of the institution are associated with higher levels of distress. Specifically, married inmates report higher levels of depression and anxiety, and inmates with close social relationships inside of the jail report higher levels of hostility, although gender differences in these patterns are evident. The results of this study suggest that social integration may play a different role for persons incarcerated in total institutions than among the general population due to the unique conditions of social stigmatization and separation from support networks.     

SAMHSA urges treatment programs to test for HIV

Last month, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) called on public health and substance use disorder (SUD) treatment providers to help make sure patients who are negative for human immunodeficiency virus (HIV) stay that way, and that those who are HIV‐positive are tested, receive antiretroviral treatment and stay “adherent” to the treatment. The directive came in the form of a “Dear Colleague Letter” from SAMHSA Director Elinore F. McCance‐Katz, M.D., Ph.D., assistant secretary for mental health and substance use for the Department of Health and Human Services.