Child Health Inequality: Framing a Social Work Response

By Hernandez, Virginia Rondero; Montana, Salvador et al. | Health and Social Work, November 2010 | Go to article overview

Child Health Inequality: Framing a Social Work Response


Hernandez, Virginia Rondero, Montana, Salvador, Clarke, Kris, Health and Social Work


Social epidemiology, a branch of public health research methodology, has helped to shape the definition of health inequality. Its major concepts include the following: maintaining a population perspective, the social context of behavior, contextual multilevel analysis, a developmental and life course perspective, and general susceptibility to disease (Berkman & Kawachi, 2000). The population perspective infers that health is affected by individual characteristics and the characteristics of one's population group (Berkman & Kawachi, 2000; Warnecke et al., 2008). Health behaviors (and health beliefs) are also affected by one's social context of behavior, in that these behaviors are "socially patterned and often clustered with one another" (Berkman & Kawachi, 2000, p. 7). Contextual multilevel analysis is used to assess the multiple factors and effects of population group characteristics; social context; and pathways of proximal, intermediate, and distal determinants of health. Proximal determinants include population characteristics such as, income, class, race; intermediate determinants relate to social context, including neighborhood and social relationships; and distal determinants reflect societal influences such as the social condition of a population (Li, McMurray, & Stanley, 2008;Warnecke et al., 2008). A developmental and life course perspective provides "a lens" through which social factors--such as early life influences that occur at critical points in human development, the cumulative effects of disadvantage over the life course, and material and physical constraints--are understood to affect adult health outcomes (Berkman & Kawachi, 2000; Nepomnyaschy, 2009; Yoo, Slack, & Holl, 2009). General susceptibility to disease presupposes a reciprocal relationship between body and brain, in that biological processes mediate the production of hormones produced by the brain in response to psychosocial stress, cumulative disadvantage, risks, and harmful exposures in the social context (Adelrnan, Herbes-Sommers, & Smith, 2008; Berkman & Kawachi, 2000; Center on the Developing Child at Harvard University [CDCHU], 2009; Li et al., 2008; Shonkoff, Boyce, & McEwen, 2009). This condition, in turn, converges with proximal, intermediate, and distal determinants of health to produce population-based health differences, disparities, and inequalities (Li et al., 2008; Warnecke et al., 2008).

The conceptual framework of social epidemiology is strikingly similar to social work's person-in-environment and multisystemic perspectives. Together they inform a working definition of child health inequality:

   Child health inequality is composed of observable
   and verifiable outcomes of health that are
   unequally distributed across child populations,
   threaten to compromise or erode the optimal
   development and well-being of children and
   adolescents, and result from biopsychosocial
   influences over the life course that are shaped
   by pervasive cultural values, economic structures,
   and political decisions mediated by adults.

HEALTH DISPARITIES, INEQUALITY, AND INEQUITY

To operationalize this working definition and be prepared to respond to child health inequality, social workers in all arenas need to be familiar with the themes, terms, and arguments reflected in the literature. Health disparities occur where there is a disproportionate representation of a health condition relative to the size of the population. Carter-Porkas and Baquet (2002) stated that health disparities "should be viewed as a chain of events signified by a difference in: (1) environment, (2) access to, utilization of, and quality of care, (3) health status, or (4) a particular health outcome that deserves scrutiny" (p. 427). Infant mortality is a health disparity in the United States that affects non-Hispanic black people at double the rate of other racial and ethnic groups (MacDorman & Mathews, 2008). …

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