Social workers have made a commitment to advocating for and supporting individuals in need regardless of income, race, gender, and other identities (National Association of Social Workers [NASW], 2017). While this is a value of the profession, there is need for more social workers to support specific communities. For example, there seems to be consensus that public healthcare is unable to provide services to all of those in need, more specifically, those who are uninsured (Jacobson, Dalton, Berson-Grand, & Weisman, 2005). There is a disparity in life expectancy between whites and blacks, which has been attributed to segregation, discrimination, and a lack of access to healthcare that accounts for cultural and community differences (Orsi, Margellos-Anast, and Whitman, 2010). In Michigan, these communities include prison populations, low income communities, and migrant farmworkers (Siefort & Pimlott, 2001; Shultz & Skorcz, 2012; Ayoola et al., 2014; McCullagh et al., 2015). For example, in Detroit, MI, pregnant women in prison require support and education to reduce the high rates of infants born with major health complications (Siefert & Pimlott, 2001). Similarly, this issue is not localized to Detroit. Another city in Michigan that experiences high infant mortality rates, specifically for black individuals, is Flint, MI (Shultz & Skorcz, 2012). Furthermore, previous research discusses the higher likelihood of women to use poor contraceptive methods in low income communities, particularly if they belong to an ethnic minority (Ayoola, Zandee, Johnson, & Pennings, 2014).
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Pregnant women in prison are more likely to give birth to infants with poor health outcomes, often because of a lack of education and prenatal care (Siefert & Pimlott, 2001). Additionally, these women are criminalized, particularly, if they are found to use substances, which is due in part to the construction of the social problem of crack babies (Siefert & Pimlott, 2001; Lyons & Rittner, 1998). The construction of the crack baby phenomenon criminalized black women, instead of accounting for other factors that may have negative impacts on the health of their children (Lyons & Rittner, 1998). While there was a program called Women and Infants at Risk (WIAR) initiated to educate and provide these women with access to care and resources, this program is ultimately selective in nature (Siefert & Pimlott, 2001). Women must meet requirements to access these benefits such as having a sentence that is two years or less, no violent charges, and they can not have drug charges that exceed a certain amount on their person (Siefert & Pimlott, 2001). However, this problem does not only affect women prisoners, as research has reported a lack of education and contraceptive use among women in low income communities (Ayoola et al., 2014). Thus, research has demonstrated a need for more education and greater access to resources for low income women (Siefert & Pimlott, 2001; Ayoola et al., 2004; Shultz & Skorcz, 2012).
While there is a necessity for social workers to address the education and health of pregnant women prisoners and low-income women, social workers also must prioritize advocating for migrant seasonal farmworkers. One issue preventing this population from receiving adequate healthcare, is the lack of cultural sensitivity from healthcare providers (Schim, Doorenbos, and Borse, 2005). It is essential for healthcare providers to integrate cultural norms and practices in treatment plans to provide the best care for their patients (Schim et al., 2005). Furthermore, migrant farmworkers face other barriers to accessing essential care such as the state residency requirement for Medicaid, which can make receiving health insurance more difficult because they work seasonally (McCullagh, Sanon, & Foley, 2015). Additionally, they may be resistant to using the resources and support offered from services because it is unaffordable for them, or it interferes with their ability to work (McCullagh et al., 2015). Migrant farmworkers often make low wages and are not provided with health insurance through their employment; thus, they have limited access to healthcare services even if they wanted to use them (McCullagh et al., 2015).
Social workers also play a key role in connecting legal and medical professionals (Colvin, Nelson, & Cronin, 2012). These social workers advocate for patients and ensure they are getting access to the care they need, often bridging the gap between the legal and medical professions (Colvin et al., 2012). Also, according to Spencer, Gunter, and Palmisano (2010) there is a lack of community health workers, who are essential for connecting low income communities to healthcare resources. However, they are not respected by other professions and are often underfunded; thus, their impact is limited (Spencer et al., 2010).
Thus, previous research seems to demonstrate that low income communities are the most vulnerable and lack access to essential and culturally sensitive healthcare resources (Spencer et al., 2010). While there are programs in place to attempt to address these needs, they are often selective; thus, many individuals cannot access the benefits of these programs (Siefert & Pimlott, 2001; McCullagh et al., 2015). Because of these barriers, social workers must advocate and address these issues so that these populations may access healthcare resources.
The National Association of Social Workers Code of Ethics outlines several ethical guidelines that social workers are committed to following. One of these guidelines is the commitment, social workers challenge social injustice (NASW, 2017). Thus, social workers must advocate on behalf of these individuals to change social policies that prevent them from accessing the care and resources they need. Another key value is the expectation that social workers will acknowledge and respect cultural differences and help empower individuals to address their own needs (NASW, 2017). Therefore, it is imperative that social workers reform policies and address these concerns at the macro and micro levels, so vulnerable and at-risk populations can gain access to healthcare resources essential for survival.
The United Nations Declaration of Human Rights also addresses the infringement on the rights of individuals in these communities. One human right is the ability to move and live in states as they so choose (United Nations, 1948, art. 13). However, the residency requirement of Medicaid infringes on this right as individuals must choose between healthcare and employment (McCullagh et. al, 2015). Additionally, another human right is the right to work in fair conditions for all individuals (United Nations, 1948, art. 23). However, migrant farmworkers often work in conditions without the proper knowledge or precaution to prevent health risks associated with employment (McCullagh et al., 2015). Also, another human right that is not being protected for these populations is the right to necessary healthcare (United Nations, 1948, art. 25). As stated by McCullagh et al. (2015), the lack of access to healthcare for farmworkers is an ethical and moral issue (McCullagh et al., 2015). Furthermore, the criminalization of pregnant women who use substances prevents access to the healthcare necessary to ensure their children are born healthy (Siefert & Pimlott, 2001).
To begin to address the healthcare disparity experienced by low-income individuals, social workers must be aware of the historical context in which current policies were created. For example, the crack baby phenomenon was analyzed by Lyons and Rittner (1998) discussing the implications this social construct had on black women. Black women were punished, especially if their babies were born showing symptoms of addiction, rather than being offered support (Lyons & Rittner, 1998). This pattern can be seen in the research conducted at the prison in Detroit that discussed the poor birth outcomes linked to a lack of prenatal care and education (Siefert & Pimlott, 2001).
On a macro level, social workers can come together to create programs such as the WIAR program, to provide resources and care for vulnerable populations (Siefert & Pimlott, 2001). However, social workers must also ensure that these programs are not highly selective as this prevents many people that need care from accessing it (Siefert & Pimlott, 2001). On a micro level, social workers can consider the implications that laws and policies have had on the individuals they are serving to better address their needs (McCullagh et al., 2015; Brownstein & Allen, 2011). For example, community health workers are key in this role to help social workers connect with hard to reach communities (Spencer et al., 2010). Another approach to educating women to promote better health outcomes, is a community-based approach. Previous research has concluded that educating women on their bodies and changes they may experience with pregnancy as well as providing emotional support, helps promote healthier pregnancies and infants (Ayoola et al., 2014).
Community health workers are essential for providing access to care for underserved communities by educating healthcare providers on barriers these communities face such as language and cultural barriers (Brownstein & Allen, 2011). While community health workers have been shown to be essential and effective in providing equal access to healthcare, they face obstacles such as a lack of funding and respect from other professions (Spencer et al., 2010). However, community health workers could benefit underserved communities greatly as seen in research conducted in Detroit, MI, which found that black men with diabetes experienced lower levels of distress after working with community health workers to gain more support from their healthcare providers (Spencer et al., 2006). Thus, it is essential for social workers to advocate for partnerships with community health worker programs, and for them to raise awareness on the support that can be provided by community health workers (Spencer et al., 2010).
Thus, previous research has shown a need for social workers to become more involved in reducing healthcare disparities in low-income communities (Siefert & Pimlott, 2001; Ayoola et al., 2014; McCullagh et al., 2015; Spencer et al., 2010). Social workers must advocate for better education and support for pregnant women in prison to reduce the number of infants born with poor health (Siefert & Pimlott, 2001). Furthermore, social workers need to advocate for and educate women in low-income communities to support better contraceptive methods among these populations (Ayoola et al., 2014). Also, social workers may reduce the disparities in healthcare by advocating for Medicaid reform and supporting migrant farmworkers in accessing the healthcare they need (McCullagh et al., 2015).
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