Close the Health Gap
Six in 10 American adults have a chronic disease and four in 10 have at least two such diseases. (Centers for Disease Control and Prevention, 2021). Furthermore, health problems that were once thought of as issues for middle-aged and older adults, such as obesity and diabetes, are today reaching crisis proportions among children and teenagers. Over 18 percent of children and youth are obese (Centers for Disease Control and Prevention, 2019).
All of these risk factors, for the oldest to the youngest among us, are contributing to declines in life expectancy — the first downward life expectancy in U.S. history and a phenomenon not seen in most other economically developed nations — as well as greater suffering, poorer quality of life and astronomical healthcare costs.
NASW supports the enactment of a national health care policy that ensures access to a full, coordinated continuum of physical, mental health and social care services for all people. A single-payer system that ensures universal access to these services is the best means to achieve this goal, and the Affordable Care Act (ACA) moves the nation in the right direction. The Affordable Care Act be preserved and expanded.
Telehealth expansion by both public and commercial health plans has been instrumental in connecting millions of Americans with health, behavioral health and social care services during the COVID-19 pandemic. NASW strongly supports making this expansion permanent, including the removal of geographic and other site restrictions and restrictions on the use of audio-only devices.
It has been well-documented that social factors or needs, not medical care, account for up to 80 percent of health outcomes. Addressing these social needs is therefore a public health imperative. According to the National Academies of Science, Engineering and Medicine’s 2019 study, Integrating Social Care into Healthcare Delivery, social workers are “specialists” in identifying and addressing non-medical, social needs. Indeed, the demand for healthcare social workers is projected to grow significantly through 2026 (U.S. Bureau of Labor Statistics, 2018). To realize the promise of social care in improving health, the federal government should institute innovative funding mechanisms to reimburse social workers for these services.
Regulatory barriers to social work services must also be removed. Despite participating in Medicare since 1989, clinical social workers are still not permitted to be directly reimbursed by Medicare to provide care to skilled nursing facility residents, or to individuals receiving Health Behavior and Assessment Intervention (HBAI) services. Eliminating these barriers should be a priority.
As the COVID-19 pandemic has laid bare, wide racial and ethnic disparities in both health and health care persist. Even when income, health insurance, and access to care are accounted for, disparities remain. Low performance on a range of health indicators — such as infant mortality, life expectancy, prevalence of chronic disease, and insurance coverage — reveal differences between racial and ethnic minority populations and their white counterparts. Eliminating racial disparities in health care is vital to pushing the entire health care system toward higher quality and better cost containment. Research demonstrates that achieving health equity requires approaches that address the social determinants of health—the social, economic, and environmental factors that influence health. Racial disparities in health can be reduced through strategies that help bridge health care and community health, increase focus on prevention and primary care, and support testing and spreading of new delivery and payment arrangements. In addition, initiatives to foster increased workforce diversity, maintain accurate, complete race and ethnicity data to monitor disparities in care, and setting measurable goals for improving quality of care are needed for achieving better health for all racial, and ethnic and gender-identity groups. Because social workers are among the most diverse mental and behavioral health and healthcare professions, well-educated to address the needs of all populations, investment in social work is a critical investment in reducing health disparities.
NASW calls on national leaders to:
- Prioritize health equity and eliminating health disparities including developing a White House-led strategy focusing on the social determinants of health and enacting the Health Equity and Accountability Act and similar legislation.
- Protect and expand the Affordable Care Act (ACA) and ensure that all Americans have access to health insurance coverage.
- Ensure that all health insurance plans cover the Essential Health Benefits.
- Protect and expand Medicaid and enable continuous enrollment for Medicaid and the Children’s Health Insurance Program (CHIP).
- Revise guidance to states on Medicaid waivers regarding block grants, per-capita caps, work requirements, eligibility restrictions, and cost sharing, among others.
- Create financing structures to promote and reimburse for social needs care provided by private and public health insurers and require delivery sites to screen for social care needs.
- Strengthen and enforce ACA Section 1557 Non-discrimination provisions.
- Make permanent the expansion of telehealth, including removing site and geographic restrictions, enabling the use of audio-only devices and payment parity with in-person payment rates.
- Protect Roe v. Wade and ensure access to reproductive health services.
Ensure Healthy Development for All Youth
According to UNICEF (2020), the United States ranks near the bottom of dozens of advanced nations on the mental and physical well-being of its children. Of the 41 nations ranked for child poverty, the United States was fourth from the bottom. Children of color remain the poorest group in the nation. Congress and the administration must take action to prioritize and meet the needs of children and adolescents, especially youth of color, who are now the greater proportion of the total population of children.
More than six million young people a year receive treatment for severe mental, emotional, or behavioral problems (Perou, R., Bitsko, R.H., Blumberg, S. J., Pastor, P., Ghandour, R.M., Gfroerer, J.C., et al., 2013). Strong evidence shows how to prevent many mental and behavioral health problems before they emerge. By unleashing the power of prevention through widespread use of proven approaches, we can help all youth grow up to become healthy and productive adults.
Youth suicide is a major public health problem. For youths between the ages of 10 and 24, suicide is the second leading cause of death, and rates have increased over 10 percent from 2007 to 2017 (Cutin & Heron, 2019). In addition to fatalities, thousands of young people annually receive medical treatment for self-inflicted injuries. Children of color, boys, foster youth and LGBTQ youth are also at an increased risk for suicidal behaviors.
Health services play a crucial role in the lives of children, allowing children to grow and develop to their fullest potential. The Children’s Health Insurance Program has enabled states to provide insurance coverage to 8.4 million children, including the Maternal, Infant, and Early Childhood Home Visiting Program. Children’s health coverage is sliding perilously backwards. This trend must be reversed.
Unaddressed social, emotional, and behavioral needs of children interfere with their academic achievement. Providing supports and services to address these needs improves educational outcomes which translates into improved life outcomes including economic security, which is a key determinant of well-being. Social workers in school settings help communities address systemic issues such as school dropout, adolescent pregnancy, child abuse, homelessness, and juvenile crime, as well as emotional and behavioral problems such as substance use and suicide.
Between 1990 and 2014, the high school dropout rate decreased from 12.1 to 6.5 percent (U.S. Department of Education, 2016). The decrease can be credited, in part, to an increased focus on attendance and dropout prevention. Despite these gains, vast disparities in America’s schools still persist, with dropout rates reaching over 50 percent in communities of color and low-income communities. The COVID-19 pandemic has only widened this gap.
School social workers have the skills necessary to identify, prevent, and intervene with at-risk students. Research findings reinforce the need for more school social workers; more preschool and science, technology, engineering, and mathematics education; and less suspension and expulsion. Widespread implementation of these measures can help increase graduation rates for these students. Expansion of social work services to students in their fourth and fifth years of high school is also a promising approach to improving the transition to college.
NASW calls on national leaders to:
- Sufficiently fund the Supplemental Nutrition Assistance Program (SNAP), daycare vouchers, school lunches and other anti-poverty programs.
- Provide universal access to high-quality pre-kindergarten programs for all 3- and 4-year-old children during the school day.
- Provide universal school meals.
- Bridge the digital divide so all students have reliable and affordable access to internet-based learning.
- Increase the number of social workers in preK-12 educational settings.
- Increase resources to support community-based programs including Temporary Assistance for Needy Families (TANF), Maternal and Child Health Services, Maternal, Infant and Early Childhood Program, Head Start, Early Head Start, and the Affordable Care Act.
- Increase funding for childcare and the Maternal Infant and Early Childhood Home Visiting Program.
- Pass the Family and Medical Insurance Leave (FAMILY) Act (H.R. 1185/S. 463) to create a national paid family and medical leave insurance program.
- Pass the Counseling Not Criminalization in Schools Act (S.4360/H.R. 7848 in the 116th Congress) that would divert resources from school-based law enforcement and toward evidenced-based and trauma informed services.