Health Care And Health Challenges

Health Care And Health Challenges:

Chapter 7, Learning Objectives 1-5 on Page 121 are the points to be used in your discussion. All additional sources that you use, including info from the web, Ted-Talks, YouTube etc must be referenced. All additional source input beyond your Textbook reading requirements, will add points to your assignment score. Since this is the first class to start with a new  textbook and as an added help to aid you in completing your assignments, I kept the materials from the previous class. All Material shown in () are optional for your use. If you are drawing information from the old class, please go to the corresponding chapter or material. This could be listed  in a totally different week or module than that we are currently studying.


(Module 8: Poverty

In Module 8 we will explore the central issues and themes related to poverty, social welfare, and policy.

Module Objectives


· Examine what poverty is, how it is defined, how it is measured, and whom it affects.

· Exploration of social welfare policy and the examination of how the official poverty line is set in the United States.

· Examine the natures, theories, and causes of poverty in the United States.

· Explore at-risk populations in relation to poverty.



Poverty and Social Class in America

Popple and Leighninger (2011) argues that there are two definitions to determine poverty. The first definition is “economic; it basically defines poverty as a lack of money and other resources,” whereas the second definition is cultural as not only a lack of money, but also a lifestyle or culture related to being poor” (p. 225). Arguments regarding poverty consist of what is “necessary and desirable,” but what standards fulfill those specific criteria (Kirst-Ashman, 2013, p. 205)? The U.S. government has defined poverty formulaically based on the numbers of individuals living in a household and the amount of earnings that the family brings in (Kirst-Ashman, 2013). Popple and Leighninger (2011) examines the broad categories of poverty definitions between absolute and relative definitions:


1. Absolute: poverty is a fixed and measurable level of income below which an individual can function in a productive and efficient manner in a given society. It is based on calculations derived from minimum costs of food, housing, clothing, and transportation in that society;

2. Relative: poverty is viewed as subjective and a matter of perceptions, views, and opinions based on what members of society constitutes poverty (p. 225-230).


Who Are the Poor?


In 2008, approximately 13.2 % Americans lived at or below the poverty line. It is important to note that the vast majority of those impacted by poverty are children, women, and the elderly. On a regional level, the greatest concentration of those in poverty live in rural areas in the South and Western portions of the United States; however, the distribution of poverty is relatively even. Ethnic minorities are at more risk to live at or below the poverty line; however, the largest number of poor are Caucasian due to the fact that the greater majority of the U.S. population is Caucasian (Popple & Leighninger, 2011, pg. 244-245).

Culture of Poverty

The culture of poverty is a theory proposed by anthropologist, Oscar Lewis in 1959. This theory applies the foundational aspects of anthropology that suggests poverty is a “subculture with its own structure and rationale, as a way of life which is passed down from generation to generation along family lines” (Popple & Leighninger, 2011, p. 257). Lewis proposed that the culture of poverty developed as a reaction to the poor’s marginalization by society as a response “to cope with feelings of helplessness and despair which develop from the realization of the improbability of achieving success” (Popple & Leighninger, 2011, p. 257).

Module 8 Readings:


· Textbook, Chapter  8 & 9

· Poverty in Texas (Links to an external site.)

· Article,“Minimum Wage, Minimal Families” (New York Times)



“People Like Us: Social Class in America”

A Nation of Tribes: How Social Class Divides Us – People Like Us episode #1 (Links to an external site.) A Nation of Tribes: How Social Class Divides Us - People Like Us episode #1

“People Like Us: Tammy’s Story”  (Links to an external site.) Shape, arrow  Description automatically generated

Interesting Links:


· Kids in Poverty, Annie E. Casey Foundation: (Links to an external site.)

· U.S. Federal Poverty Guidelines

·  (Links to an external site.)



Discussion Board:


· Name two myths associated with poverty. What were your assumptions prior? What personal ideas about poverty have changed?

· After watching “Tammy’s Story,” in what ways might the culture of poverty have impacted her family? What are the pros and cons of this theory based on what you read and what you watched? Be specific.

· Describe at least three specific ways the 1996 passage of the Personal Responsibility and Work Opportunity Reconciliation Act (TANF) has impacted how welfare services are delivered today. In what ways?

· In your two response posts, give your peers constructive feedback about their perspective. What other ideas do you have regarding their perspective? Does their perspective help to explain the issue that they picked? Do you agree or disagree with their perspective? Why or why not?


Module 8 Checklist:


1. Complete all of your readings.

2. Completed your original post and response posts.

3. Begin reading Chapter 10 in your textbook.

4. Submit your quiz for the week



Kirst-Ashman, K. K. (2013). Introduction to social work and social welfare: Critical thinking perspectives (4th ed.). Belmont, CA: Brooks/Cole.

Popple, P. R. & Leighninger, L. (2011). Social work, social welfare, and American society (8th ed.). Boston, MA: Pearson).


Minimal Wage, Minimal Families.NYTimes.2013.docx

New York Times

March 4, 2013, 6:00 am

Minimal Wages, Minimal Families


Nancy Folbre, economist at the University of Massachusetts, Amherst.

Nancy Folbre is an economics professor at the University of Massachusetts , Amherst. She recently edited and contributed to “ For Love and Money: Care Provision in the United States. 

Announcing his support for an increase in the federal minimum wage to $9 an hour, President Obama called attention to the needs of children: “Even with the tax relief we’ve put in place, a family with two kids that earns the minimum wage still lives below the poverty line. That’s wrong.”

Perspectives from expert contributors.

Many Americans share his concerns: 71 percent of Americans polled in mid-February by the Pew Research Center for the People and the Press support the proposed increase, including 50 percent of Republicans.

Influential economists have announced their support as well, including many affiliated with the Initiative on Global Markets at the Booth School of Business at the University of Chicago. Of 38 economists in the group, 18 agreed, 4 disagreed, 12 were uncertain and 4 had no opinion or didn’t answer.

Every time increases in the minimum wage are proposed, a centuries-long history of concerns about the impact of the labor market on family life comes into play, setting the stage for fierce debates over regulation. The classical political economists of the late 18th and early 19th centuries believed that the forces of supply and demand would always be constrained by the cost of subsistence, setting a floor under wages. After all, if the wages that workers received were not sufficient to keep them alive, the supply of labor would be reduced, driving wages back up again.

Because people don’t live forever, the costs of subsistence should include the costs of producing replacement workers, namely, raising children. But as many young children and unmarried women began entering wage employment in the 19th century, it became apparent that an increase in the supply of workers without family responsibilities could potentially drive average wages well below the level adequate to support children.

Market forces, in other words, could discourage, even penalize, family commitments.

In the United States, the “family values” argument for a minimum wage gained political traction on the state level long before federal legislation was passed in 1938. As the historian Alice Kessler-Harris explains , this argument bolstered efforts to reinforce traditional gender roles by discouraging the employment of married women. At the same time, it called attention to the difficulties wage earners faced in supporting dependents.

This historical legacy shows up in calculations, like the one President Obama offered above, that seem to presume that a minimum wage for one parent working full-time should be able to support not only two children but also a spouse who stays home to take care of them. Similar assumptions are often used in state-level estimates of the hourly wage required to bring a working family over the poverty line or a higher standard such as a locally designated living wage . On the other hand, these same estimates show that the costs of child care largely wipe out the net contribution of a second earner’s wage income.

As I emphasized in a previous post , conventional measures of poverty are seriously out of date. Application of the Census Bureau’s new Supplemental Poverty Measure suggests that a $9 minimum wage would not necessarily bring working families over the threshold.

Any way you look at it, adults taking responsibility for young children need considerably higher earnings than those who don’t, even taking into account the tax relief President Obama referred to (primarily the earned income tax credit ).

As Lawrence Mishel of the Economic Policy Institute points out , the median worker’s real hourly compensation (real earnings plus benefits) has stagnated over the last 10 years, and the declining real value of the minimum wage has contributed to increased income inequality.

The resulting economic stresses are bad for children, bad for working parents and bad for family formation and stability. In 2010, children represented 24 percent of the United States population, but 34 percent of all those living in poverty.

Critics of the proposed increase in the minimum wage object that it would increase unemployment. But proponents point to considerable evidence, nicely summarized by Brad Plumer at The Washington Post’s Wonkblog, that this potential effect would be small or nonexistent,

Critics like the economist David Neumark also insist that the policy is not effectively aimed at poor families, because many individuals earning the minimum are young people living with their parents. But proponents like Natalie Sabadish and Doug Hall of the Economic Policy Institute emphasize that about 80 percent of workers who will be directly affected are over age 20.

Many young people earning the minimum wage are living at home. Some can’t afford to do otherwise. And while their parents may be helping them out with living expenses, the wages they earn will determine their opportunity to enroll in college, pay off their debts, save money and start a family of their own.

So, the debate circles back to the dilemma acknowledged by classical political economy in the 19th century. The forces of supply and demand, left to themselves, treat labor like any other commodity. But labor itself is produced outside the market, by families and communities who must struggle to find ways to support their contributions to the future.


modules/Module 10 Mental Health/Healthcare and LGBTQ.pdf



LGBTQ Capacity Building in Health Care Systems: A Social Work Imperative

Darrell P. Wheeler and Sarah-Jane Dodd

W orking within a diverse array of health care settings, social workers encounter a variety of client populations, many

of whom we are well prepared to serve. We have specialties in working with children, adolescents, and older adults with mental illnesses, substance use issues, or particular bealth care concerns such as HIV As a profession, we have begun to pay atten- tion to racial and ethnic health disparities that may cut across each of these groups and have actively engaged in efforts of cultural competence. However, we have not, until recently, paid attention to the health disparities and particular health care needs of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) population.

Estimates of the size of the LGBTQ population in the United Sates vary, with Kinsey’s (1948) 10 percent estimate holding almost mythical status. However, a recent estimate generated by Gary Gates at the Williams Institute, who cross-compared a number of different population surveys, put the number of LGB individuals at approximately 3.5 percent of the population and transgender individu- als at 0.3 percent (Gates,2011). Gates noted that this amounts to “9 million LGBT Americans, a figure roughly equivalent to the population of New Jersey” (p. 1). Given this prevalence, it is likely that all social workers will encounter LGBTQ clients on their caseload whether or not they overtly identify their orientation or gender identity.

Throughout history the dominance of a het- eronormative paradigm has resulted in LGBTQ individuals experiencing stigmatization and dis- crimination. This discrimination may manifest as verbal or physical assaults (Kosciw, Greytak, Diaz, & Bartkiewicz, 2010) or as policies that render these individuals’ relationships invisible (such as not being eligible for a life-partner’s social security benefits).

Having been socialized in a cultural environment that is at best beteronormative and at worst ho- mophobic, health care providers frequently make assumptions of heterosexuality in the questions they ask their patients. In turn, patients anticipate that disclosure of sexual orientation will negatively aff< ct the care they receive (James & Platzer, 1999).

The impact of stigmatization of and discrimina- tion against LGBTQ individuals is the potential for uneven care when accessed, or avoidance I of care altogether, resulting in disparities emergi ig within health issues because many unaddress;d social, contextual, psychological, developmental, interpersonal, and environmental factors can pro- duce deleterious outcomes (Mayer et al., 200E)). The extent of these disparities is sufficient cat: se for concern that the U.S. Department of Health and Human Services has elevated sexual orienta- tion from a noted disparity in their Health People 2010 (U.S. Department of Health and Human Services, 2000) objectives to a target group tor concern and improvement in Healthy People 2020 (see topicsobjectives2020/default.aspx). Social work- ers have an important role to play in helping to address this charge.

Social work’s values, as articulated by the NASiW Code of Ethics (NASW, 2008), call on us not oAly to honor the dignity and worth of all persons and to promote social justice, but also to more actively “challenge social injustice,” noting that social woik- ers should “pursue social change, particularly w:th and on behalf of vulnerable and oppressed in(h- viduals and groups of people” (p. 5). Social works rs, therefore, have an ethical imperative to increase th îir capacity to provide culturally competent services to clients of all sexual orientations and gender identitî es, shedding assumptions of heterosexuahty and creating

CCC Code: 0360-7283/11 $3.00 ©2011 National Association of Social Workers 307



more inclusive practices. They should also actively engage in the LGBTQ competency training for aU health professionals.

INEQUALITIES, SOCIAL JUSTICE, AND NEGATIVE HEALTH INDICATORS Recently, the Joint Commission for the Accreditation of Health Care Organizations set for a “road map” detailing requirements for the inclusion of LGBTQ foci within health care settings (Joint Commission, 2010). This document highlights the relevance of this inclusion for health care professionals in several areas, including patient—family engagement, patient assessment, and end-of-life care and directives. For social workers and health care professionals, one of the challenges to effectively implementing these recommendations is having a sufficient database from which we can measure successes.

ABSENCE OF DATA The research available suggests that LGBTQ populations suffer disproportionately from a range of conditions and are at disproportionate risk for others, including obesity, depression, anxiety, sub- stance use and abuse, tobacco use, HIV and other sexually transmitted infections, some cancers, and inadequate cancer screenings (Hussey, 2006; Mayer et al,, 2008; MiUett, Flores, Peterson, & Bakeman, 2007). However, the fuU extent of these disparities and potential others is not known because most studies do not ask about sexual orientation or gen- der identity and, therefore, render this population and their particular health care needs invisible.This invisibility was substantiated by Boehmer (2002), whose content analysis of 20 years of MEDLINE articles (English language only) found that only 0.1 percent addressed LGBT issues. So, for example, her search for “breast cancer” found 26,554 articles, yet only six of those considered LGBT individuals as a separate part of their analysis. The widespread neglect of LGBTQ individuals in public health re- search has devastating consequences for the health of the LGBTQ community. Similar to when health care research and drug trials focused on men and generalized the results to women, the exclusion of sexual orientation as a variable of study prevents the identification of lower or higher prevalence rates of particular diseases among LGBTQ individuals. A potentially catastrophic example of omission was evident in a 28-page special issue of Morbidity and Mortality Weekly Report (Centers for Disease Con-

trol and Prevention, 2004; Kadour, 2005). Despite considerable consensus about the potential for gay youths to be at risk for suicide, the special report made no mention of sexual orientation (Kadour, 2005). As Kadour (2005) pointed out, “data are a cornerstone of any public health system, and the lack of data on sexual minorities correlates with the failure of public health to address this group’s needs” (p. 31).

Health disparities have been defined 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” (Carter-Pokras & Baquet, 2002, p. 427). Although “disparities,” “inequities,” and “inequalities” are sometimes used interchangeably, there are nuanced differences between the terms. The term “health disparity” is often used within the United States, whereas the terms “health inequity” or “health inequality” are used more frequently overseas (Carter-Pokras & Baquet, 2002). Although disparity and inequality are defined as synonymous, representing differences in access or opportunity, inequity suggests some level of ethical judgment that is unfair or unjust (Carter-Pokras & Baquet, 2002). For this reason, some health disparities or inequalities may be unavoidable and “fair,” perhaps because of biological predisposition, for example; an inequity is seen as unfair and has the potential to be avoided. Therefore, it is LGBTQ health disparities created by inequities that social workers have the potential to address through active intervention and capacity building.

The coupling of health insurance and employ- ment in the United States means that employment discrimination experienced by LGBTQ individuals has a negative impact on their access to health insur- ance. Lack of recognition of LGBTQ families means that even when available to workers, health benefits may not also be extended to same-sex partners or their children. These discriminatory patterns and impacts may hold especially true for transgender or gender-nonconforming individuals.

CAPACITY BUILDING AND CHANGE For professional social workers, these service dilem- mas and gaps point to areas for educational, practice, and policy capacity building. Clients’ needs and contextual changes facing service delivery, monitor- ing, and payment systems require that professional social workers incorporate skills allowing them

308 Health & Social Work VOLUME 36, NUMBER 4 NOVEMBER 201



to assist LGBTQ clients and their allies as well as challenge forces that oppose full health care services for people on the basis of their gender identity or sexual orientation.

Social work has an ethical commitment to social justice and advocacy on behalf of vulnerable and disadvantaged populations. Given that commitment, social workers can come together to help eradicate health disparities experienced by LGBTQ people.

Several policy initiatives have the potential to create positive change and reduce the disparities in LGBTQ health markers and risks. Social workers should advocate for changes that

• require the sensitive and appropriate collection of demographic information related to sexual orientation and gender identity. Such data are typically unavailable and, therefore, cannot be used to inform LGBTQ-specific health initiatives (Gates, 2011; Silvestre, 2003).

• promote policies that end workplace dis- crimination, given that in the United States, access to health insurance is largely employer driven.

• promote policies that support same-sex partner access to health insurance for all and removal of the tax burden for those who take advantage of the health benefits.

• require units on working with LGBTQ pa- tients in the training curriculums for all health professionals (medical doctors, registered nurses, occupational therapists, psychothera- pists, social workers, and so forth).

• support funding research that examines health disparities within LGBTQ populations and the LGBTQ cultural competence of health providers so that we can understand both the needs of the population and the specific train- ing needs of those who teach them.

REFERENCES Boehmer, U. (2002). Twenty years of public health research:

Inclusion of lesbian, gay, bisexual, and transgender populations. American Journal of Public Health, 92, 1125-1130.

Carter-Pokras, Q , & Baquet, C. (2002). What is a “health disparity”? Public Health Reports, 117, 426-434.

Centers for Disease Control and Prevention. (2004). Suicide and attempted suicide [Special issue]. Mortality and Morbidity Weekly Report, 53.

Gates, G. (2011). How many people are lesbian,gay, bisexual, and transgender? Los Angeles:The Williams Institute, UCLA School of Law.

Hussey,W. (2006). Slivers of the journey: The use of pho- tovoice and storytelling to examine female to male

transexuals’ experience of health care access. Journal of Homosexuality, 51, 129-158.

James,T, & Platzer, H. (1999). Ethical considerations in qualitative research with vulnerable groups: Exploring lesbians’ and gay men’s experiences of health care—A personal perspective. Nursing Ethics, 6(1), 7 3 – 8 1 .

joint Commission. (2010). Advancing effective communicatio cultural competence, and patient- and family-centered care. A roadmapfor hospitals. Oakbrook Terrace, lL:Autho

Kadour, R. (2005). The power of data, the price of exclu sion. Oay & Lesbian Review, •/2(1),31—33.

Kinsey,A. (1948). Sexual behavior in the human male. Bloomington: Indiana University Press.

Kosciw,J., Greytak, E., Diaz, E., & Bartkiewicz, M. (2OIOi). Tlie 2009 National School Climate Survey: Ttie experi-l enees of lesbian, gay, bisexual and transgender youth in oi nation’s schools. NewYork: GLSEN.

Mayer, K. H., Bradford, j . B., Makadon, H. J., Stall, R. S., Goldhammer, H., & Landers, S. (2008). Sexual gene minority health:What we know and what needs to be done. American Journal of Public Health, 98, 989-995.

Millett, G.A., Flores, S.A., Peterson,j. L., & Bakeman, R. (2007). Explaining disparities in HIV infection among black and white men who have sex with m A meta-analysis of HIV risk behaviors./1/DS, 21, 2083-2091.

National Association of Social Workers. (2008). Code of ethics of the National Association of Social Workers. Washington, DC: Author.

Silvestre, A. (2003). Ending health disparities among vul- nerable LG13T people. Clinical Research and Regulati ry Affairs, 20(2), ix-xii.

U.S. Department of Health and Human Services. (2000, November). Healthy People 2010: Understanding and improving health (2nd ed.). Washington, DC: U.S. Government Printing Office.

Darrell P. Wheeler, PhD, MPH, is dean and profes

Graduate School of Social Work, Loyola University Chicago,

820 North Michigan Avenue, Chicago, IL 60611; e-nihil: Sarah-Jane Dodd, PhD, is associate profes-

sor, Sitberman School of Social Work, City University of Net

York, Hunter College.

WHEELER AND D O D D / LCBTQ Capacity Building in Health Care Systems: A Social Work Imperative 309



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