Social Work in Health Setting

 An Introduction

A community's health problems are viewed as the result of interactions between specific causal agents and individuals, which are mediated by environmental circumstances. In other words, the causes of ill health are the social system's malfunctioning in terms of population explosion, unemployment, poverty, ignorance, old age, unsanitary living conditions, bad housing, poor nutrition, incompatible dietary habits, poor quality of sanitary facilities, lack of safe drinking water, and so on. As a result, it is considered that illness is merely a sign of social instability. Curing illness or restoring good health has been proposed as a result of the application of medicine in medical science. Many social scientists believe that health is misinterpreted in terms of therapy, which is not a prerequisite for good health. Prof. Imrana Qadeer believes that the ruling classes' consciousness, culture, and power influence the concept of health and approaches to controlling health problems. 

As a result, it is apparent that social forces or variables are extremely important for the health of the population. The recognition of social aspects in health has a long history in the profession of social work. The first project was established in England about 1880, when a group of volunteers working for an asylum began visiting discharged patients at their homes. Sir Charles Loch's advice in 1895 in England regarding lady almoners' visits to the patient's home in order to prevent drug abuse offered by the charitable hospital cleared the door once more for the introduction of medical social work. Home visits for released patients (from hospitals) were started in the United States in 1900 to give home level care by nurses. It revealed the significance of social influences in health. 

Dr. Charles Emerson recognized the importance of social components in disease in 1902. He believed that medical students should act as volunteers for charities or agencies and investigate the socioeconomic and emotional situations of patients. Indeed, when Dr. Richard C. Cabot created the Department of Medical Social Work at the Massachusetts General Hospital in Boston in 1905, the true relevance of social determinants in health was formally acknowledged in the social work profession. Following that, trained social workers were sent to various hospitals in the United States in order to improve the quality of health care, understand the social elements associated with sickness and treatment, and employ community resources in complete patient care. The first social worker in health care was established in India in 1946 at J.J. Hospital in Mumbai, and subsequently in 1950 at Lady Irwin Hospital in Delhi. The current chapter will attempt to comprehend several concerns required to carry out social work in the health care industry.

The Definition of Health and Health Care

Health In our society, most of the time, 'Health' is overlooked and underappreciated, unless it is substantially destroyed. It has always been understood as "lack of sickness" in a restricted sense. The definitions of 'Health' in several dictionaries are superior to the old understanding. "Health is the condition of being sound in body, mind, or spirit, especially independence from physical disease or pain," according to the Webster dictionary. "Health is the soundness of body or mind; that condition in which its duties are adequately and efficiently executed," according to the Oxford English Dictionary. With the advent of science, the concept of health has developed over time from a personal concern to a global communal aim. 

These evolving conceptions include the bio-medical concept, the ecological concept, the psycho-social concept, the holistic concept, and so on. In biomedical terms, one is deemed healthy if he or she is disease-free. According to it, the human body is considered as a machine, and disease is the result of the machine's powerlessness. This machine is being repaired by the doctor, and his last recommendation is medication. Health, according to ecologists, is a dynamic equilibrium between humans and their environment, whereas disease is a maladjustment between these two components. According to the psycho-social notion, health is determined by the people's social, economic, political, cultural, and psychological elements. 

The holistic notion is a synthesis of the three previously described principles. It implies that all societal sectors, including industry, agriculture, animal husbandry, housing, education, public works, communication, and others, have an impact on health. The World Health Organization's (WHO) definition of 'Health' is universally accepted and comprehensive in scope. WHO (1948) defines health as "a state of total physical, mental, and social well-being, not only the absence of disease or disability." The physical component refers to the body, the mental component to the mind, and the social component to the broader socio-cultural milieu. 

As a result, it is clear that influences from all of these realms play a direct and important part in shaping and defining an individual's health. Despite the fact that the WHO definition has a positive implication, it has been questioned by many academics or researchers. For example, Prof. Imrana Qadeer (Social Action, JulySeptember, 1985) contends that this definition tends to focus on the ideal rather than the actual, because it assumes the notion of an absolute, i.e., an individual's "complete well-being," rather than examining the individual's relationship with his social environment. It also ignores the notion that health and well-being have a spectrum and cannot be quantified in absolute terms (or quality). Many people believe that the definition of WHO is meaningless because no one in this world is physically, psychologically, or socially flawless. We are all sick if we adopt this definition. Despite the aforementioned restrictions, WHO's view of health is conventional, positive, and attempts to embody the objectives of the general public. According to Prof. Qadeer, a comprehensive notion of health should include a social dimension that reflects the exploitation of one class by another, the struggle of the exploited against this exploitation, and their conscious, collective endeavour to rebuild society.

Medical Care

Medical Care The World Health Organization has declared that health is a fundamental human right. It is necessary to have access to health care in order to reach this goal. The term 'health' refers to a broader idea, whereas 'health care' is a subset of health. A variety of elements influence 'health,' including basic sanitation, safe drinking water, housing conditions, appropriate food, healthy lifestyles, environmental risks, communicable diseases, medical care, and so on. However, the word 'Health Care' refers to services offered by any institution (whether a government organisation, a commercial institution, or a non-governmental organisation) to alleviate pain and suffering caused by a range of ailments. Health care is not the same as medical care, which refers to personal services supplied directly by physicians or rendered as a result of physician instructions. To summarise, medical care is a subset of health care, and health care is a subset of health. Primary, secondary, and tertiary health care are the three levels of care. Individuals come into contact with the national health care system in primary care. With the assistance of multi-purpose workers, village health guides, and trained dais, Sub-Centres (SCs) and Primary Health Centres (PHCs) serve as service providers. 

More complex problems are dealt with at the secondary level. This is accomplished through the use of Community Health Centres (CHCs) and district hospitals. Tertiary level care refers to highly specialised services delivered by regional or apex institutions such as Medical College Hospitals, All India Institutes, and so on. 

Following independence, serious attempts were made to upgrade the health care facility. As a result, there has been a gradual evolution in the methods of providing health care. Initially, Comprehensive Health Care was implemented in response to the Bhore Committee's (1946) recommendations. "It proposed integrated preventive, curative, and promotional health services from 'womb to tomb' for every individual living in a specific geographical area." As a result, SCs and PHCs were established. The second method to health care, known as 'Basic Health Services,' was developed in 1965. "It was conceived of as a network of coordinated, peripheral, and intermediate health units capable of fulfilling duties critical to an area's health." The third strategy was promoted as 'Primary Health Care,' which was stated at the Alma-Ata Conference in the USSR in 1978 in order to achieve the objective of 'Health for All by 2000 AD.' "Primary Health Care is necessary health care that is made universally available and acceptable to individuals via their full participation and at a cost that the community and country can afford." Dr. Gouri Pada Dutta believes that the year 2000 has passed, but the Declaration has yet to be realised. In fact, it appears to be moving in the opposite direction. The shift in attitudes in rich countries is concerning; by turning health into a commodity, international firms are attempting to turn underdeveloped countries into easy victims in the marketplace. However, there is a bright spot in this otherwise bleak situation. The National Health Assembly in Kolkata in 2000 and the People's Health Assembly in Bangladesh in 2001 both clearly contradicted the World Bank's and its allies' ominous attempt. By raising the slogan 'Health for All Now,' as many as 94 countries agreed to make the Alma Ata Declaration a success.

Personification of the Patient

According to the Oxford English Dictionary, a 'Patient' is a person who receives medical treatment from a doctor (either in a clinic/hospital or at home/community). The term "person" refers to a human being who is an individual with distinguishing characteristics. Thus, the term 'Patient as a Person' refers to considering a patient, despite having a sick role, to be a normal person who is expected to perform many familial and social functions. These functions may include participating in family decision-making, carrying out responsibility for family economy and child care, listening to and expressing sympathy for other family members' psycho-social problems, giving/receiving respect to/from others, showing solidarity for community welfare, and so on. This phrase is significant in the field of medical and psychiatric social work for four sorts of people: doctors, family members, community members, and social workers. When a patient is admitted to the hospital, many things that are normal in the lives of the hospital staff frequently cause an emotional crisis in the patient's life. Patient is unable to acclimatise to the hospital environment due to the odour of drugs, improper responses from personnel, lack of doctor's visits, unsanitary conditions of the ward, substandard food, dread produced by the sufferings of many other patients and death, and so on. As a result, the doctor should treat the patient as a person, placing less emphasis on the sick role. Patients, on the other hand, have certain expectations from a variety of persons. They want family members and neighbours, in particular, to understand their psycho-social problems, provide emotional support, and not isolate them as patients. A social worker must also understand the concept of 'Patient as a Person.' A social worker who practises it strives to lessen the burden of a condition on the patient. In this regard, the social worker, without emphasising the patient's sick role, engages him/her in various activities, shows respect, is aware of his/her many other concerns (apart from the disease), and provides referral services to address them.

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