HOSPITAL SOCIAL WORK: CONSUMERS’ CRITIQUE
This issue starts with the World Health Organization (WHO) definition of health and works its way through the connection of mind (emotions) and body and their interconnected impact on an individual’s health. When published, the profession of hospital based social work was in transformation. The conflict centered on the role of social workers; should social workers counsel patients or be a connector to community services? The issue covered standards and enforcement, the various functions of social workers and compared a municipal and a voluntary hospital’s social service departments.
COMMENTARY ABOUT THE ISSUES RELATED TO A NATIONAL HEALTH SERVICE
In a way of introduction, it is necessary to mention the social and political background when the CCAHS decided to veer a bit into an area fraught with emotional and political overtones: how America could (or should) organize the delivery of medical care to improve access and quality and somehow reduce the unaffordable and unsustainable increases in expenses.
Wellness was not an issue for the CCAHS. In fact, other than some fringes in society, wellness programs, services and practitioners were below the radar, considered off the map and were generally by almost all Americans considered as irrelevant at best and evil at worst. Prevention was translated into the health model as doing things doctors did or told a patient to do to find, track or identify a clinical condition which advanced to a state where it could be found, tracked or identified. Diagnostic procedures and laboratory tests ordered by a physician were the standard and considered the hallmark in addressing clinical conditions. When found or identified the process of treatment according to the medical (allopathic) model could commence.
An example is mammography. Although never consistently proven to be clinically safe or accurate or have overall positive and consistent positive outcomes, mammography was urged on all women who had breasts as a prevention technique for breast cancer. Sometimes it was mentioned as more successful at finding cancers of the breast when done in conjunction with self breast examinations by women and other diagnostic tests. Why women had increasing instances of breast cancer somehow was lost and real primary prevention took a back seat in critical decision making opportunities. The discussion of primary prevention of breast cancer in women was only started when the casual association of increases in smoking in women and rising rates of this cellular dysfunction were no longer plausibly deniable.
Wellness was not a topic of discussion among most people involved with illness, disease, and injury. It was assumed that wellness was something experienced for a short period after birth. Life it was assumed changed that wellness into illness and disease. Long life or aging brought about even more limitations none of which were considered prevented or ameliorated by medical intervention. As seen then, Americans deserved to enjoy life and the ways that enjoyment was obtained had little to do with illness, disease and injury. We later learned and now understand that what we do, what we eat, the quality of the water we drink and the air we breathe and the work we do are all factors that determine our wellness and health.
Each year, as Americans exercised the God given right to do as they pleased thousands of Americans were injured or killed by the use of weapons, vehicles, illicit and legal drugs, machinery or conditions found on the job. We later found that just about every major activity in our lives from work and play, movement and relaxation, our air, food and water and even the medical care Americans received all were factors, significant factors, in creating or destroying our wellness and health. But the focus to explain the loss of wellness and health was to state that genetics and the inevitability of death were controlling and that only agent for hope was the physician.
Health is that phase of life when life could be enjoyed with only a few inconvenient physical, mental or emotional limitations. The young enjoyed health which over a life time decreased naturally. There was little effort to understand this assumed natural progression from wellness to health to illness and disease. Because it was natural and accepted as unavoidable, there was little reason to believe that steps could be taken when young or at any point in life to do things that would prevent, minimize or deduce the pain, suffering or limitations caused by aging. Self-help and controlling one’s own health and destiny were viewed as cultism, extremism, dangerous and bogus.
So CCAHS did not comment on wellness or even health without consideration of the standing medical model. And as that model was starting to fail, yet, still accepted and understood as the ‘model’ CCAHS as with other entities sought to educate consumers about the organization, quality and expense of obtaining and receiving medical care. CCAHS developed its master plan to address the issues of access, quality and expense of medical care delivery. Its plan is even more relevant today.
One addition comment is also necessary and it too is still relevant: Americans have been told and have accepted that government is bad, incompetent and out to reduce citizens’ rights. Therefore, any master plan to organize medical care with any level of government participation becomes immediately suspect and open to the charge that it is nothing more than a ‘communist’ five year plan or as expressed more recently – nothing more than a way for government to determine who shall live and who shall die.
Anything called communist, communistic or socialistic has an immediate hoop to jump through to be considered, debated or implemented. The then current efforts to involve Americans in their government, health and society have all been discarded since the late 1970s. The free, unbridled medical delivery and insurance markets were left relatively un-tethered until the 2008 passage of the Patients’ Safety and Affordable Care Act (ACA) misnamed ‘Obamacare’. The ACA included relatively minor cosmetic changes in the present system of insuring and delivering medical care. It never challenged the underlying facts and assumptions which made America’s once number one health ratings plummet. While it has included new terminology and funding for new ideas, a close review shows that nothing there is really nothing new.
And so the CCAHS tread on the troubled waters by proposing a National Health Service in its next publications.