Inequalities in health and community-oriented social work: lessons from Cuba?

Social justice is, as the World Health Organization Commission on Social Determinants of Health (WHO CSDH, 2008) reminds us, ‘a matter of life and death’. While the stark differences in mortality rates and life expectancy between rich and poor countries might be the most obvious example of this, it is also true that ‘Within countries, the differences in life chances are dramatic and are seen in all countries – even the richest’ (WHO CSDH, 2008: 26). As the Commission demonstrates, the roots of these inequities lie in social conditions, suggesting an important role for social work in this area. Unfortunately, the Commission says very little about the type of social work that might be appropriate: nevertheless, the report does provide fresh impetus to the debate about what social workers might contribute to tackling health inequalities. In this article, we suggest that a community-oriented approach to social work is required. In making a case for this, we review the progress of the government’s drive to reduce inequalities in England,1 arguing that this has, thus far, been largely unsuccessful because it has primarily been pursued through health-care services, while addressing the wider (social) determinants of health has been a secondary consideration. In contrast, we offer the example of Cuban community-oriented social work (COSW) which has helped maintain population health at a level that stands comparison with much wealthier nations, despite the hardships and inequalities which followed economic collapse in the 1990s. In many ways the Cuban situation is unusual, perhaps unique, so we are not arguing that Cuban social work methods can be readily transferred. Rather, we suggest that, in the neglected field of tackling health inequalities, social workers can learn from the general approach taken in Cuba. To establish the context of this discussion, we begin by defining key concepts: COSW itself, health inequalities and inequity, the health gap and the health gradient

Led rather than leading? research on homelessness in Britain

This article examines the history of British homelessness research and its politicization over the past 40 years. The relationship between homelessness research and policy has been developing since the 1960s, and by the 1990s the majority of research was undertaken within the policy arena. In part, this has arisen because of the way in which research has been funded in the UK, with funding being dominated by government or those seeking to criticize its policies. To varying degrees, this is also attributable to the acceptance of a homelessness paradigm, which was ultimately no more than an ideological construct, the definitions of homelessness within British legislation. Fuelled by the growth of homelessness and an increase in charitable activity, the volume of research grew during the 1980s and 1990s, but without concurrent methodological and theoretical development. Recent academic critiques of British homelessness research are reviewed, including the movement towards re-conceptualizating homelessness

Under Strain? Exploring the Troubled Relationship between Health and Social Care

Relationships between the NHS and social care services over the past 25 years have a poor history. This article examines the strategies that have been used by central government and by local NHS and social care organizations to overcome difficulties of service co-ordination. The authors conclude that policies reflecting ‘networked’ modes of governance may stand the best chance of success, although evidence of improved impact and outcomes still remains scarce. © CIPFA, 2005