Social Work Takes On Health Disparities

February 4, 2013
by Maya Meinert
USC Provost Professor William Vega, left, speaks at All School Day with radiation oncologist Rosalyn Morrell and USC Dean's Professor Hortensia Amaro.

Even though Winston Wong now has a big job as medical director of community benefit at Kaiser Permanente, the nation’s largest non-profit health care provider, he still maintains a small family medicine practice.

“I want to always learn and remember what our patients face every day,” said Wong, who is tasked with developing partnerships with communities in advancing population management and evidence-based medicine, with an emphasis on safety net providers and elimination of health disparities, at Kaiser.

Wong served as keynote speaker at this year’s All School Day, “Does Wealth Mean Better Health?” The USC School of Social Work event began in 1992 after racial tensions sparked the Los Angeles riots, and each year since, the school has brought people together in an atmosphere of cooperation, respect and inclusion to raise awareness about diversity and matters of human conflict.

In his speech, Wong told the audience of social work students and faculty about one of his patients, a Chinese woman in her 50s who spoke only Cantonese and complained of back pain. Thinking he had adequately diagnosed her problem, he prescribed some painkillers and sent her on her way. Two months later, she returned with the same issue. That’s when he discovered the reason behind her back pain: She spends her days stooping in wastebaskets looking for recyclable bottles and cans.

“The roots of her pain were related to poverty,” Wong said. “Even though I try to be the greatest doctor in the world, it’s not enough.”

With the implementation of the Patient Protection and Affordable Care Act now starting, about 37 million Americans, or 10 percent of the U.S. population, will experience changes in how they deal with health care. Many of those people will now be able to receive health insurance.

“We’re living in a time now where you’re going to see the most significant changes in health care in a generation,” Wong said.

But that doesn’t mean that other factors, such as environment, race and ethnicity, genetics, socioeconomic status, and education, won’t continue to play into overall health and well-being. For example, Wong said there is a disproportionate prevalence of disease among communities of color. The rate of diabetes is highest among Latinos, African Americans and Native Americans, and the hospital admission rate for African Americans is more than three times the rate for Caucasians when it comes to heart disease. That suggests that something is wrong not only in prevalence of disease but that a certain group of people has to go to the hospital much more frequently for a treatable condition. This shows that there is a disproportionate number of people receiving suboptimal health care or who don’t have regular access to care.

“As we celebrate the onset of health care reform, it falls somewhat short of what we aspire to be,” Wong said.

The event panelists – William Vega, provost professor and executive director of the USC Edward R. Roybal Institute on Aging; Hortensia Amaro, dean’s professor of social work and preventative medicine and associate vice provost for community research initiatives; and Rosalyn Morrell, radiation oncologist at Advanced Radiation Center of Beverly Hills – built upon Wong’s sentiments.

“It’s not the issue of the sheer prevalence or frequency in disease but the unfairness in the way those diseases are distributed and how it affects families, social networks and communities, and ability of those people to be functioning members of society when they get sick,” said Vega, whose research has focused on health disparities in multicultural and aging populations. “The issue plays out over the life course. Gene-environment interaction is a continuous process, and it accumulates and culminates in aging people.”

Amaro said it’s imperative that those serving communities, including psychologists, public health professionals and social workers, look upstream at larger social factors that affect individual lives.

“Where we each live, where we each work, where we each play and where we each pray really defines the trajectories of our health in really fundamental ways,” she said. “We now know that beyond medical or clinical care is the need to create communities that are healthy and have the opportunity to allow families to develop their potential.”

Morrell, who treats patients from a variety of socioeconomic statuses, emphasized the need for increased cultural competency among all providers, especially medical doctors, to effectively treat the varied concerns patients have.

“We need to use plain language so patients understand so they’ll be more likely to get the right treatment,” she said. “And most cancer patients are treated at community-based centers. They need psychosocial support because when people get sick, sometimes they lose their jobs, which affects their marriages and families. They need social workers.”

Marilyn Flynn, dean of the School of Social Work, said the issue of health disparities is a universal problem, one that social workers are uniquely positioned to help alleviate.

“It is a main issue for us as social workers, and because we are now a mighty force across the country, our understanding of this problem and our ability to intervene is especially important,” she said.

Cherry Short, assistant dean of global and community initiatives and chair of the All School Day committee, agrees that social workers have much to contribute to the existing and burgeoning issues in the country’s health system.

“We know that if you have clean water to drink, fresh air to breathe, and a safe place to live and work, you’re more likely to experience good health,” she said. “As social workers, we need to make every effort to ensure that everyone, despite their race, economic status or educational level, has access to these things that make communities – and lives – thrive.”