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March/April 2007

The Top 5 Social Justice Issues Facing Social Workers Today
Social Work Today
Vol. 7 No. 2 P. 24

Editor’s Note: For National Professional Social Work Month, we took an informal survey of some of our advisors and contributors on what they consider to be the top five social justice issues facing social workers today. There were many different responses, but the issues that follow were the ones that showed up most frequently on the lists. We asked individual social workers to write an essay about each issue. Read those essays about the challenges our survey respondents regarded as the most serious that society faces today and compare them to your own list.

Celebrating Diversity
By Lorraine Gutiérrez, PhD, LMSW

Our commitment to social justice and antioppressive work brought me into social work and keeps me here. Growing up in the late 1960s and early 1970s, the power of the people to transform society and work toward greater gender, racial, and ethnic equality was clear. During my undergraduate years, I learned that social workers active in the progressive movement were at the forefront of policies that reduced working hours, restricted child labor, and created public health clinics to improve conditions for low-income families. These models for how we can change our society shaped my involvement in organizations to end violence against women and work toward the empowerment of diverse groups.

My path as a social worker is not unique. Regardless of our setting, all social workers are engaged in work related to oppression and social injustice. We are more aware than most people of the challenges faced by children and families living in poverty, the inadequacy of our “safety net” of human services, the disproportionate incarceration of men of color, and the challenges experienced by those living with disabilities. We do this work while living and working in a society where groups have mobilized to restrict or eliminate existing rights such as public education for immigrants and the children of immigrants, domestic partnerships for gay men and lesbians, and access to reproductive healthcare for adolescent women. Surviving and thriving as a social worker requires that we have a true appreciation for human diversity and understand how social identities affect access to resources.

Throughout our history, social workers have been agents of both liberation and oppression. During the same era that we founded social settlements, we were involved in the incarceration of Native American children in boarding schools. While we were actively involved in crafting the Social Security Act, we participated in the deportation of Mexican American families who were “public charges.” While we participated in civil rights movements in the 1950s and 1960s, we referred many women of color to doctors who sterilized them against their knowledge. Our approach to diversity within our communities will influence whether we work toward social exclusion or inclusion. Will we work toward the rejection, tolerance, acceptance, or celebration of the different groups that make up our communities?

If we are to work toward social justice, we need to engage in the work involved in celebrating difference and diversity. I use the word celebrate based on its original meanings, which refers to honor, respect, or recognize. We must move beyond tolerating or accepting those who are different from ourselves to a position of cultural humility that requires us to question our own background and experiences to work in partnership with others. When working from this perspective, we, as social workers, must be engaged in ongoing self-assessment and awareness of how power differences affect our ability to be genuinely helpful. This process is an essential element of social justice work.

Celebrating diversity means working as an ally and advocating for marginalized and oppressed groups. We are allies to others when we can recognize and use the sources of our privilege to advance the rights of those who do not share our own identities or backgrounds. We need to ask ourselves how we can use the knowledge we have of unjust practices toward individuals and groups in society to work toward changes to improve their situation. Our knowledge and experience can be used to join with others and create new movements to reduce poverty, improve access to healthcare, support families, and eliminate discrimination on the basis of our social identities.

The United States is becoming an increasingly multiracial, multicultural, and multiethnic society. At the same time, conditions of economic inequality by gender and race have not improved. These trends in the substance and structure of society challenge our profession to evaluate how we address these demographic shifts. It is our responsibility as social workers to strategically use our position and privilege to work toward greater equality. There is no other ethical choice.

— Lorraine Gutiérrez, PhD, LMSW, is professor and director of the joint interdisciplinary doctoral program in social work and social science at the University of Michigan. She has more than 25 years of experience as a social worker and educator in multiethnic communities.

Child Welfare
By Judith M. Schagrin, LCSW-C

Social justice means all citizens are entitled to the same rights and services. I am deeply concerned that we continue to fail the children who are abused, neglected, and just plain unwanted. Foster children, who depend on society’s largesse for their very existence, go largely unseen. Because these are children, they don’t fund any political campaigns, lobby any elected representatives for an opportunity to be heard, or organize any marches to advocate for better services. They have no voice if we don’t speak for them.

It’s not that we haven’t tried to organize a functional child welfare system. Since the start of our modern-day foster care system in the mid-1880s, when Charles Loring Brace started the Orphan Train Movement to resettle orphaned children from New York City to states in the Midwest and beyond, there have been numerous efforts to get it right. We have strategically planned, privatized, transformed systems, thought outside the box, been accountable, computerized, wrapped around, and done more with less. But as a national priority, the nation’s child welfare system is nearly an afterthought. Without the occasional sensationalized child death, I suspect these families would fall off the radar altogether. Unfortunately, the story they have to tell often isn’t pretty, revealing a troubling underbelly of our society. Some prefer to keep these images far away, finding comfort in denial.

While we are a country of people who profess to love their children, there were 3 million reports of child maltreatment in 2004. Experts believe this represents only one third of actual incidents. More than 800,000 reports were found indicating a rate of 2.9 per 1,000 children. That’s not surprising, considering how staunchly we defend our right to physically discipline our children. As long as no injuries result, parents may hit their children with impunity.

Four children die from maltreatment every day, a number largely undercounted. Neglect, often associated with poverty, leads to slightly more child deaths each year than abuse. According to the 2005 census, 17.6% of children under the age of 18 live in poverty; the federal poverty level is $20,000 per year for a family of four. Of children in female-headed households, an appalling 42% exist under the poverty line.

Three years ago, news that Maryland could no longer afford our zoo’s elephants generated far more outrage than our child welfare hiring freeze. The freeze lasted three long years, leaving children’s needs overlooked and ignored. We are a wealthy country not just in money but in talent and brains. Surely we can muster the will to develop and support a top-notch child welfare system? What will it take for our children’s needs to grab the public’s attention with the same fervor as our zoo’s elephants?

As for solutions, let’s create the public will to do it better. Let’s reinstate the White House Children’s Conference—derailed by President Reagan in 1980—and bring together national experts from around the country. Lobby hard for loan forgiveness for social workers willing to specialize in child welfare. Enlarge the sphere of influence for social workers by running for a local, state, or federal office—or electing a colleague.

Our children have only a handful of years to be children, only a brief period to build the foundation for a productive and satisfying adulthood. It’s time we got it right—the children can’t wait.

— Judith M. Schagrin, LCSW-C, is the assistant director for Children’s Services at the Baltimore County Department of Social Services. She was named the 2004 Social Worker of the Year by the National Association of Social Workers.

Healthcare Reform
By Libby Gordon, MSW

I live in the healthiest state in the nation. This is according to America’s Health Rankings, issued yearly by UnitedHealth Group. I must admit, I felt pretty good about this, as I traveled to and from the gym, ate my yogurt and veggies, and took the stairs at work. This blissful denial lasted all of one day. The next day, while attending a health disparity task force meeting, I was brought back to reality: You can live in the healthiest state in the country and still be surrounded by desperate need. No statement drove this home so effectively as the African American public health worker who stood up and proclaimed, “My zip code is dying. Why, in a nation of so much, is my zip code dying?”

Why are 46.6 million people without health insurance (383,000 right here in my healthy state)? Why is employee-sponsored health insurance disappearing? Why are the numbers of uninsured African Americans, Hispanics, and immigrants so disproportionate to that of Caucasians? Why is the number of uninsured children—8.3 million—again on the rise, when it had been dropping steadily since 1998? And why aren’t more people as outraged as the public health worker who burst my bubble of denial?

Although these are questions without simple answers, social workers have a tradition of striving for solutions. To begin, we must understand who are most affected by the disparity in health insurance coverage. The Kaiser Commission on Medicaid and the Uninsured (KCMU) reported that families with incomes 200% below the poverty level run the highest risk of being uninsured. Contrary to public perception, however, 81% of the uninsured are in families where at least one adult is working. Also at high risk of being uninsured are minorities and immigrants. According to the Center on Budget and Policy Priorities (CBPP), African Americans (19.6% uninsured) and Hispanics (32.7%) are much more likely to lack insurance than Caucasians (11.3%). Meanwhile, 43.6% of noncitizen immigrants are without insurance. Lastly, 8.3 million children (11.2%) are presently uninsured, and their future looks grim. In Fiscal Year 2007, which began October 1, 2006, the children’s health insurance programs—which are block grants, not entitlement programs—face federal funding shortfalls in 17 states. This amounts to an estimated $800 million and equals the cost of covering 530,000 low-income children.

The recent escalation in the number of uninsured individuals is largely attributed to a continuing decline in employee-sponsored insurance (ESI). Even when employers do offer insurance, employees frequently cannot afford the skyrocketing premiums. A recent report from KCMU found that between 2001 and 2005, ESI premiums increased by no less than 9% per year. Meanwhile, employees’ earning grew by only 2.2% to 4%, making it difficult to keep pace with insurance payments.

The consequences for those who cannot afford or are not offered health insurance are life-altering. KCMU has found that they are less likely to receive preventive care, such as mammograms, and are more likely to be hospitalized for avoidable conditions. These misguided attempts to contain costs by denying treatment of minor conditions often result in the development of problems that are both more expensive and more serious. Those without insurance are likely to have problems paying medical bills—nearly one quarter are contacted by collection agencies. Most importantly, the Institute of Medicine estimates that 18,000 Americans die prematurely each year because they lack health insurance. If the uninsured were to gain continuous health coverage, mortality rates could be reduced by 5% to 15%.

These inequalities are not inevitable. Solutions do exist and can be created with an eye to both effectiveness and cost containment. Policies can be implemented to locate and enroll individuals who are eligible for public programs, while eligibility for these programs can also be expanded to cast a wider net. ESI premiums can be lowered, and employers with a certain number of employees can be required to pay a set percentage of their payroll on health benefits. Affordable health insurance plans can also be made available to small employers. Children’s health insurance can become an entitlement program, providing coverage to any who are in need.

It was not hyperbole for the public health worker to say her zip code is dying. Chances are, some of those 18,000 people who died prematurely—the minorities, the poor, the children—were her neighbors. So long as some zip codes remain endangered, social workers have a mission: to see the whole picture, the one that rankings do not show, and to advocate for those in need. Perhaps, then someday the health rankings will be a cause for all zip codes to celebrate.

— Libby Gordon, MSW, has experience in various healthcare fields. She previously worked in a transitional care unit, and she is currently the patient services manager for the Minnesota Chapter of The Leukemia and Lymphoma Society. She is also a hospital emergency department social worker.

Center on Budget and Policy Priorities. (2006). The Number of Uninsured Americans is at an All-Time High. Retrieved January 17, 2007, from here. http://www.cbpp.org/8-29-06health.htm

Kaiser Commission on Medicaid and the Uninsured. (2006). Changes in Employees’ Health Insurance Coverage, 2001-2005. Retrieved January 25, 2007, from here.http://www.kff.org/uninsured/7570.cfm

Kaiser Commission on Medicaid and the Uninsured. (2006). The Uninsured and Their Access to Health Care. Retrieved January 17, 2007, from here.http://www.kff.org/uninsured/1420.cfm

Poverty and Economic Injustice
By Mimi Abramovitz, MSW, DSW

“True compassion is more than flinging a coin to a beggar. It comes to see that an edifice which produces beggars needs restructuring.”
— Martin Luther King, April 4, 1967, New York City1

The Bible says the poor will always be with us, but it does not say why. Since then, some observers have blamed the victim, choosing to punish the “undeserving” and offer a meager safety net to the “deserving” poor. In contrast, social workers believe poverty has many complex causes, including low wages, a lack of jobs, racism, sexism, and other forces beyond individual control. We favor helping rather than punishing people and changing rather than protecting a problematic status quo.

However, for the past 30 years, the fight against poverty and injustice has been an uphill battle. Indeed, major economic dislocations and victim-blaming public policies have taken their toll on the capacity of the three traditional sources of income—marriage, markets, and the state—to protect people from poverty even when they work hard and play by the rules.2 Instead of cushioning the blows of the sagging economy as they once did, today’s leaders confront wage stagnation and slow job growth with tax cuts for the rich, spending cuts for the poor, and a war in Iraq. The results include mounting rates of poverty, hardship, and social problems—all of which fall into social work’s domain.

Mounting Poverty
In 2005, 12.6% of the population (or 37 million people) were poor—up from its all-time low of 11.3% in 2000 and higher than in 1979.3 Even the higher African American (24.9%) and Latino (21.8%) rates and the lower Caucasian (8.3%) rates rose above their all-time 2000 lows.4 Meanwhile, the American Dream—the promise that work pays—faded for the working and middle class. In 2004, 7.8 million people aged 16 or older spent at least 27 weeks either working or looking for a job but earned below–poverty-level wages in companies that provided few basic benefits such as healthcare or parental leave. More than 58% of these “working poor” women and men were on the job full-time and 90% worked at some time during the year—twice as many African Americans and Latinos as Caucasians.5 Thanks to tax cuts and corporate welfare, inequality also reached new highs. In 2005, the top 20% of households accounted for a record 50.4% of the national income, up from 49.8% in 2000 and 43.2% in 1970. In contrast, the bottom fifth’s share fell from 4.4% in 1970 to 3.6% in 2000 to 3.4% in 2005.6

Mounting Hardship
Poverty, in turn, takes its toll on people’s lives. In 2004, 40% of poor and 14% of nonpoor families faced food, health, or housing insecurity, considerably more families of color than Caucasian families.7 The situation has worsened over time. From 1987 to 2005, the number of people lacking food security rose from 31 to 35 million; those without health insured soared from 31 to 46.5 million while the number of households paying more that 30% of their income for rent jumped from 31% (1978) to 49% (2005).8-10 These losses were further compounded by a lack of social investment in low-income communities exposing people to: crumbling neighborhood infrastructures (e.g., abandoned housing, poor schools, lack of services, unemployment); interpersonal violence (e.g., battering, rape, child abuse); and community violence (e.g., gang fights, drive-by shootings, surveillance, police brutality, sexism, and racism).

Mounting Social Problems
Social workers know firsthand that people confronted with chronic deprivation and/or harsh living conditions often feel unsafe, insecure, and powerless. We also know that people cope with the desperate condition by harming themselves (e.g., self-medication, dropping out of school, unsafe sex, ineffective parenting, inability to hold a job, lack of self-care, and suicide) and/or others (e.g., crime, assault, battering, rape, homicide). Social workers have the know-how and the professional obligation to help people undo negative coping and promote positive coping—both self-advocacy (e.g., seeking needed social, health, and financial assistance) or social advocacy (e.g., community activism).

Given social work’s location between the client and society, we can either leave solving poverty to the economists or join the fight for economic justice. A growing consensus holds that exposure to economic hardship and adverse conditions often precedes the rise of individual and social problems rather than the other way around, as previously presumed.11 This conclusion translates into a mandate for prevention and social change. Some fear that making individual and social change a fundamental part of our work politicizes a previously objective and unpolitical profession. Yet, to argue for neutrality itself becomes a political stance—one that tolerates government neglect, compromises our profession’s ethics, and otherwise favors the status quo by letting it stand unchallenged. Since social work cannot avoid the political, it is far better to address these issues explicitly than to pretend they do not exist. The middle ground, if one ever existed, has fast receded. We must decide which side we are on. In the words of Martin Luther King, Jr., “Our lives begin to end the day we become silent about things that matter.”12

— Mimi Abramovitz, MSW, DSW, is professor of social policy at Hunter College School of Social Work and The Graduate Center, City University of New York. She is the author of Regulating the Lives of Women: Social Welfare Policy From Colonial Times to the Present and Under Attack, Fighting Back: Women and Welfare in the United States and coauthor of The Dynamics of Social Welfare Policy and Taxes are a Woman’s Issue: Reframing the Debate. She is currently writing a book on the history of activism among poor and working class women in the United States since 1900.

1. King, M. L. ‘“Beyond Vietnam — A Time to Break Silence.” Speech delivered April 4, 1967, at a meeting of Clergy and Laity Concerned at Riverside Church in New York City. Retrieved from here.

2. Abramovitz, M. (2007). “Women and Poverty: The Role of Marriage, Markets and the State.” In: Broussard, A., & Joseph, A. (Eds.). Family Poverty in Diverse Contexts, NY: Haworth Press (forthcoming).

3. DeNavas-Walt, C., Proctor, B. D., & Lee, C. H. U.S. Census Bureau, Current Population Reports, P60-231, Income, Poverty, and Health Insurance Coverage in the United States: 2005, Table B-1. (Poverty Status of People by Family Relationship, Race, and Hispanic Origin: 1959 to 2005.) Retrieved January 2, 2007, from here.

4. U.S. Department of Labor, Bureau of Labor Statistics. (2006). A Profile of the Working Poor, 2004. Report 994, p. 1. Retrieved from here.

5. DeNavas-Walt, C., Proctor, B. D., & Lee, C. H. U.S. Census Bureau, Reports, P60-231, Income, Poverty, and Health Insurance Coverage in the United States: 2005, Table A-3 (Selected Measures of Household Income Dispersion: 1967 to 2005). Retrieved January 2, 2007, from here.

6. Sherman, A., & Shapiro, I. (2005). Hardship Indicators Point to a Difficult Holiday Season: National Policy Response is Off Kilter. Center on Budget and Policy Priorities. Retrieved January 2, 2007, from here.

7. Nord, M., Andrews, M., & Carlson, S. (2006). Household Food Security in the United States, 2005, U.S. Department of Agriculture Economic Research Report No. (ERR-29). Table 1A (Prevalence of Food Security and Food Insecurity in U.S. Households, 1998-2005), p. 5. Retrieved January 1, 2007, from here.

8. DeNavas-Walt, C., Proctor, B. D., & Lee, C. H. U.S. Census Bureau, Current Population Reports, P60-231, Income, Poverty, and Health Insurance Coverage in the United States: 2005. Table C-1 (Health Insurance Coverage by Race and Hispanic Origin: 1987 to 2005). Retrieved January 2, 2007, from here.

9. Wardrip, K. & Pelletiere, D. (2006). Recent Data Shows Continuation, Acceleration of Housing Affordability Crisis, Research Note #06-05, National Low Income Housing Coalition. Retrieved January 3, 2007, from here.

10. Albernaz, A. (2007) Study examines link between poverty, mental illness (June 2005 Issue). NePSY.com Retrieved from: http://www.masspsy.com/leading/0506_ne_cover_study.html; Heflin, C. & Iceland, J. Povery, Material Hardship and Mental Health. Retrieved from here.

Heflin, C. Poverty, Material Hardship And Mental Health; Albernaz, A. (2007). Study Examines Link Between Poverty, Mental Illness (June 2005 Issue) NePSY.com January 2007 volume 14, #11 l

11. VeganVanguard.com Support Quotations. Retrieved from here.

Affordable Housing
By Frederic G. Reamer, PhD

Recently, I attended a meeting at the National Association of Social Workers’ (NASW) headquarters in Washington, D.C. NASW’s offices are located a stone’s throw from the U.S. Capitol, one of the most architecturally impressive and symbolically important buildings in the world. During my walk, I was overwhelmed by the majesty of the scenery but sadly, and ironically, I was also overwhelmed by the number of (apparently) homeless people I passed during my walk from the Capitol to NASW, men and women sleeping in broad daylight on concrete slabs and park benches. The juxtaposition—the contrast between the stately halls of Congress and the stark evidence of America’s poverty and affordable housing crisis—was one of the most stunning I have ever encountered.

Understandably, social workers concerned about affordable housing have focused primarily on the nagging problem of homelessness, particularly among people struggling with mental illness, addictions, and persistent poverty. However, the troubling problem of homelessness is merely symptomatic of a broader crisis of affordable housing, one that has profound implications for social workers’ clients.

Housing costs are staggering in many American communities. The National Coalition for the Homeless reports that approximately 3.5 million people—1.35 million of them children—are likely to experience homelessness in a given year. According to Harvard University’s Joint Center for Housing Studies, nearly one in three American households currently spend more than 30% of income on housing, and more than one in eight spend upwards of 50%. Approximately 2.5 million households live in crowded or structurally inadequate housing units.

It is essential for social workers to understand the magnitude and nature of this country’s affordable housing crisis and its implications for practice. The principal causes of the contemporary affordable housing crisis are complex. The demand for affordable housing is affected by increases in poverty and growth in the number of U.S. households. In addition to ordinary population increases, growth in the number of people needing housing also results from declining marriage rates and an increase in the average age at which people first marry, which postpone the combining of households.

Coinciding with increasing demands for affordable housing are threats to the nation’s supply. Declining and expiring federal housing subsidies, disappearing tax incentives to invest in and build low-income housing, restrictive and exclusionary zoning practices, demolition and abandonment of older housing stock, and gentrification join to reduce the number of affordable housing units in many communities. Consistent with one of the most basic laws of economics, increasing demand combined with diminishing supply can lead to skyrocketing costs.

To be effective advocates for clients and informed participants in the public policy arena, social workers must have a firm grasp of possible solutions. Social workers should seek to preserve the existing stock of affordable housing by pushing for programs that rehabilitate low- and moderate-income housing and advocating for preservation of existing subsidies for low- and moderate-income housing.

Also, social workers should seek to expand the supply of affordable housing through tax incentives that underwrite subsidized mortgages for builders, progressive and enlightened zoning practices that promote the “fair share” development of affordable housing across communities, and creation of housing trust funds fed by a renewable stream of income (for example, via real estate transfer taxes, interest on real estate escrow accounts, interest from government loans, and developer fees).

Social workers have an enduring tradition of concern about individuals’ most basic needs, including housing. One of the profession’s principal trademarks is its simultaneous concern with individual well-being and related public policy issues. Certainly, social workers must be concerned about the basic housing and shelter needs of individual clients. At the same time, however, social workers must be engaged actively in the advocacy, public debate, and policy formation that are so essential to the provision of safe and affordable housing. To do otherwise would be to stray from social work’s time-honored mission.

— Frederic G. Reamer, PhD, is a professor in the School of Social Work, Rhode Island College. He has served as a commissioner of the Rhode Island Housing and Mortgage Finance Corporation (the state’s housing finance agency) and as senior policy advisor for housing in the Rhode Island governor’s office.