“There is no logic that can be superimposed on the city; people make it, and it is to them, not buildings, that we must fit our plans.”

-Jane Jacobs-

Urban renewal projects have only recently started to address the human needs of residents beyond providing basic shelter, and much of this progress has only been made in response to the violence and persistent poverty surrounding many public housing communities constructed in the 1950s and 60s. However, it is especially difficult to make the argument for increased funding for public housing considering the arguments many economists make against public housing. Critics argue that public housing projects often perpetuate the cycle of poverty by concentrating poor communities in high-density spaces. The suburbanization of poverty has also complicated the problem of ending cycles of poverty in communities, since many residents are being forced out or urban centers and away from the resources and opportunities cities contain.

Cabrini-Green Housing Project
Source: Time Magazine

Death and Life

Jane Jacobs, in her influential book The Death and Life of Great American Cities (1961), argued that urban planners should consider the benefits of building mixed-use developments and attempt to construct spaces that promote natural social exchanges within a community. In one example, Jacobs compared the high amounts of crime occurring in isolated malls to lower rates among highly visible neighborhood stores, thus rejecting the stereotype of isolated suburban communities as inherently safer than cities.

Redefining the American Dream in Suburbia

Suburbs were initially developed to reward homeowners with privacy and self-contained households. Instead of encouraging interdependency (as inherently occurs in interactions in an American urban environment), suburbs encourage self-sufficiency and conformity simultaneously. The suburban conceptualization of the American Dream involves valuing privacy and private property more than human relationships and sharing resources.

However, urban centers continue to be at the center of American economic life. Young professionals are becoming ever more attracted to the rich community life and conveniences of residing in metropolitan areas. Along with the influx of wealthier and younger populations came two newer and interlinked phenomena: gentrification and the suburbanization of poverty.

As reported in The Atlantic,

“between 2000 and 2011, the population living in American subrubs below the poverty line increased by 29 percent.”

Therefore, many impoverished people are finding themselves pushed out of American cities and consequently cut off from many job opportunities and public services. The poor now inhabit the cookie cutter, private homes formerly occupied by middle-class families, but find isolation to be a curse rather than a blessing. For example, suburban areas are often cut off from major transportation resources, leading suburbanites to rely on cars to take them to jobs, community centers, and essential businesses. However, many poor residents cannot afford cars, and so find themselves in the impossible situation of not being able to find accessible jobs but unable to afford rent in business centers without well-paid employment.

"Remember your humanity and forget the rest."

-Bertrand Russell-

As popular opinion becomes more and more skewed towards cynical ideas regarding the state of American affairs on a domestic level, many are also drifting toward isolationism. One of the best examples of this growing suspicion about involving America in international problems is the ongoing controversy regarding the civil war in Syria. Many critics questioned the presumption of the US government to consider spending government resources on a foreign intervention when there are so many other domestic issues in need of attention. The controversy was perhaps summed up best in this meme, which began circulating last summer:

Social workers often struggle with the indefinite limitations involved in making macro level change, and this is especially true when one considers global social issues. Although the United Nations Declaration of Human Rights reflects many of the values also upheld by the NASW Code of Ethics, it is difficult to conceptualize of how social workers can forward the ideals of social justice through international interventions. However, one of the most effective interventions social workers can use is helping to build and influence international organizations and raise awareness.

International Organizations

The International Federation of Social Workers, founded in 1928, has taken up the responsibility of serving as a consultant for many other international organizations, including UNICEF and WHO. Their stated mission is to: "promote social work to forward social development, advocate for social justice globally, and facilitate international cooperation."IFSW promotes best practice models of service delivery on a micro level, supports anti-war movements, and identifies important contemporary issues within the profession.

The IFSW is an important resource for social workers who are considering global issues and how to apply social work principles to international problems. In addition, globalization has fundamentally changed the way ideas and inventions pass between borders.

Capitalist Invasions
Globalization also affects many domestic issues. For example, the international economy has improved living conditions for many populations, and made many resources more accessible for people in need. However, globalization also has a profound and often destructive impact on many cultures and economies. Part of being a socially conscious social worker is reflecting on the wider applications for social justice theories and critiquing the pros and cons of a globalized economic system. Therefore, we must consider the power dynamics existing between industrialized countries like the US and developing nations.


Even while the wealth gap widens in the US, many developing nations are experiencing economic booms and increasing levels of economic and educational attainment. Increasing wealth has led to huge population and cultural shifts, but these developments are dependent on promoting environmentally destructive ideals, consumerism, and violent competitions for resources. While it may be overwhelming to consider international issues while so many difficult domestic problems are worsening or remain unresolved, it is important to consider the ideals that social workers worldwide have committed to emphasizing and supporting. Therefore, part of taking a holistic approach to problems is considering the global implications for micro level changes and behaviors and promoting a form of social justice that rejects isolationism.

"Reality is not always probable, or likely."

-Jorge Luis Borges-

Theory
Following the example of the evolution of generalist social work, conceptions of mental illness have progressed over the years to encompass micro, mezzo, and macro factors that influence mental well-being. The change was not simply one of perception, but a huge philosophical and paradigm shift. The movement involved the integration of postmodern ideas regarding the nature of consciousness into conversations about mental illness. 

Michel Foucualt
Source: Tresnormale.com

Perhaps the biggest influence on postmodern philosophical ideas regarding mental health was Michel Foucault, who published Madness and Civilization: A History of Insanity in the Age of Reason in 1961. Foucault wrote a history of mental illness and treatment from the Middle Ages up until the 1960s. His work was critical of the mental health profession and subjective views of mental illness. Foucault discussed the social stigmas and cultural assumptions that led to labeling people as mentally ill, and also addressed the oppressive power dynamics that influence how non-conformists become labelled mentally ill.

Foucault shattered the illusion that mental illness was simply a biological disorder. Modern psychologists and social workers now approach mental illness in a more holistic way, and many question the institutional and social structures that impose discriminatory practices on people with mental health issues and dehumanize their patients/clients.

The most essential difference between old views like the dichotomy of conformity versus illness, chronic mental illness versus wellness is the current emphasis on the ecological model. The ecological model emphasizes the importance of adapting an individual to their environment and vice versa. Therefore, modern social workers seek to identify and influence the multiple biopsychosocial, intrapersonal, familial, communal, and political systems that contribute to mental health.

Application

At my internship at Mercy Behavioral Health, we use the Assertive Community Treatment model of care in order to provide community-based services for our consumers. The ACT model was developed in the 1970s in order to address the needs of newly released mental patients during the process of deinstitutionalization. The ACT model emphasizes personalized and comprehensive services and integrates ideas about the many aspects of wellness, including spiritual, emotional, and physical health. The Community Treatment Team I intern for is made up of vocational counselors, substance abuses counselors, therapists, nurses, a peer specialist, and psychiatrists who all work together to provide services for our consumers.

Essential to CTT's functioning is the dual value of human relationships and independence. We teach our consumers self-sufficiency, but also encourage them to socialize and build relationships with others. In addition, our therapeutic aim is to raise our consumer's cognitive awareness of self-defeating behaviors and encourage activities oriented towards recovery.

Interestingly, my placement does not discuss diagnoses very often. Instead, we focus on discussing people's symptoms and level of functioning. Therefore, we focus on the person-in-the-moment, rather than imposing the schema and preconceptions associated with the labels associated with mental health diagnoses. 

"We were falling women."

-Margaret Atwood-

It has long been controversial to use access to birth control as a political tool, but the issue has become especially visible as a part of the debate over healthcare reform. In addition, many states have recently passed measures restricting the operations of abortion doctors and clinics. For example, North Carolina passed a law in July of this year that eliminated insurance coverage for abortions for public employees, imposed restrictions on clinics that led to the closure of the last operational clinic (FemCare) in August,

Moral Monday Protests in North Carolina
Source: The Daily Kos

and prevented insurance policies operating under the new federal healthcare exchanges from providing abortion coverage. While the NASW outlines values regarding the right to self-determination, there are also numerous historical and social factors to consider when analyzing the impact of family planning services on individuals and society.

War on Poverty, War on Women
Let's first consider the history of charities and family planning services. Margaret Sanger, the heroine of the reproductive rights movement, founded the American Birth Control League in 1921. The League merged with Planned Parenthood in the 1940s to become the largest provider of sexual and women's health services in the US. However, Sanger's personal beliefs about the need for birth control were openly racist and classist. Sanger was an outspoken eugenicist, and she once stated: "more children for the fit, less for the un-fit -that is the chief aim of birth control". Therefore, family planning services can also be associated with methods to maintain the status quo; in Sanger's case, to oppress groups seen as too inferior to have children.

However, during Johnson's War on Poverty the argument shifted away from eugenics and became a discussion about improving living conditions for the poor and later, women's rights. Beginning in 1965, federal funding was explicitly made available for family planning services in order to reduce the poverty rate. Title X of the Public Health Service Act of 1970 provided the bulk of federal funding for family planning services until 1985. Since then, Congress has refused to renew Title X, but other federal programs like Medicaid have stepped in to ensure continued federal funding for family planning services. Plenty of evidence has been provided demonstrating that access to family planning services improves conditions in poor communities and has far-reaching impacts on many other social concerns.

Source: dianedew.com

healthcare services in the US.

For example, the Donohue-Levitt hypothesis alleges that the overall decline in the crime rate that occurred in the 1990s can partly be explained by the passage of Roe v. Wade in the 1970s. Studies demonstrate that legalized abortion also led to a reduction in teenage drug use, teenage pregnancy, and infanticide. Less controversily, access to women's healthcare services, IUDs, and other forms of birth control besides abortion have led to greater gender equality and improved overall health and wellness for many disadvantaged groups, particularly poor women.

The Privilege of Being Able to Plan
Regardless of the racist history of the family planning movement, we should consider the (perhaps unintended) consequences of wider access to family planning services on gender equality and the alleviation of poverty. As many critics note, restricting access to birth control services often does not lead to the elimination of family planning efforts, since wealthy women are still able to access services. Instead, it further widens the gap between privileges afforded to the wealthy versus the poor -in this case, the privilege of being able to safely and responsibly decide when to have children.

Banksy, Nola Girl with Umbrella

"The avoidance of taxes is the only intellectual pursuit which still carries some reward."

-John Maynard Keynes-

Last year, I spent a lot of time helping people prove they were disabled in order to collect about $950 a month in disability benefits. While my office did not take on cases without merit, there were certainly some disabled clients who walked a fine line between sometimes being able to work part-time at minimum wage jobs and being disabled profoundly enough to collect benefits.

Hidden Unemployment

Source: The Lovely Addict

In March, This American Life aired a piece called "Trends with Benefits" about the increasing cost of Social Security disability claims. Right now, 14 million people collect Social Security Disability Insurance or Supplemental Security Income.* Many economists argue that rising disability claims result from two trends: an aging workforce, and a changing economy. Because the rise in the number of claims is tied to the slowing of the economy, people have labeled the group of borderline disabled Americans who collect Social Security benefits the "Hidden Unemployed". 

What happens to vulnerable people in America? 
During the course of my work, I discovered two things: 

1. Part of the process of making a disability claim involves proving that one can no longer do the kind of work they have been trained to do. 
2. Most of our clients were unable to afford current housing and living costs, even with disability benefits.

The first fact means that the application process is easier for people who have only performed unskilled work. This group is also more vulnerable to work injuries and the effects of outsourcing. The second is just plain depressing, since disabled people often require assistive care and expensive accessible housing units. In 2009, the National Coalition for the Homeless reported that 13% of homeless people are physically disabled, and 26% suffer from chronic mental illnesses. Clearly, many disabled people are clinging to a hole-ridden safety net.

*SSDI is a conventional insurance program funded by payroll contributions. SSI on the other hand, is a social safety net program for people who have not worked enough to pay into the system. It is funded by general tax revenues.

The Life & Death of the American Social Security System

Source: Modern American Poetry, The Great Depression

During the social and economic upheavals of the Great Depression, American politicians finally recognized an opportunity to create an organized program which would provide ongoing substantive care for the elderly and disabled. The resulting creation of the Social Security Administration meant that the US government could reduce national poverty through a future-oriented insurance program. However, the system was not without its flaws; changing demographics, rising inflation, and lower tax revenues now threaten to deplete the trust fund that supports Social Security by 2033.

Source: The Simpsons

How to Help Old & Disabled People

If we don't change our current tax structure, Social Security is doomed to fail within the next century. Social service workers see themselves torn between reinforcing a system which barely works at all and pushing for larger reforms. However, the backlash to Mitt Romney's comment about the "47% of voters who are dependent on the government" shows that many people are learning to acknowledge the problems with our tax and safety net systems and attribute the cause to social and economic issues, not the failure of the disabled and working poor to take "personal responsibility".

"Laughter is the best medicine for when you cannot afford health insurance."

-Probably an American-

Have you seen this video?
Some key statistics regarding pre-Obamacare healthcare:

• Only about 28% of Americans get their insurance through government-funded programs.
• The US spends about 18% of its GDP on healthcare costs. Australia pays 9%.
• A month of the drug Lipitor in the US costs $124. In New Zealand it costs $7.
• America has higher rates of obesity, but less alcohol and tobacco use than most developed countries. 
• Tort reform (i.e., state laws passed to guard against frivolous malpractice lawsuits), have led to a .1% drop in health costs. Defensive medicine only accounts for 2% of our total health spending.

Healthcare is a unique part of the economy, and research suggests that it is a fairly inelastic market. Healthcare companies won't change enough because of competition; there's just not enough incentive to do so. Therefore, Obamacare will probably not lower healthcare costs to nearly the level of countries that provide socialized medical services.

Source: Invendo-Medical, Colonoscope

Up Yours
In an article focused on the price of American colonoscopies, Elisabeth Rosenthal of The New York Times examined the difference between American health companies and comparable but cheaper varieties of care in other countries. Competition actually played a role in raising the cost of a procedure in her case study. Rosenthal found:

"The high price paid for colonoscopies mostly results...from business plans seeking to maximize revenue; haggling between hospitals and insurers that have no relation to the actual costs of performing the procedure; and lobbying, marketing and turf battles among specialists that increase patient fees."

Rosenthal's example shows that healthcare is a capitalistic industry, and generally has no real drive to provide better or cheaper care. Business executives only need to ensure that every part of the system is profitable by constructing ways to maintain high profit levels for the companies, doctors, and administrative personnel who provide services. The threat to UPMC's tax exempt status demonstrates that even supposed charitable institutions are not immune from corporate influences.

In the future, everyone will die from typhoid and blood poisoning. Like Oregon Trail. 

Source: The Oregon Trail

True story: in 1911, the whiskey maker Jack Daniel died from blood poisoning he contracted after kicking a safe. Research shows that unless a new generation of antibiotics is developed in the next few decades, it's possible we'll all be felled by similarly preventable bacterial infections and diseases. The problem is that there is no market incentive for pharmaceutical industries to produce new antibiotics. Indeed, The Washington Post reported in 2012 that pharmaceutical companies are shutting down antibiotic labs. The reasons? Technical troubles, excessive regulation, and lack of profitability.

Life in not a race. It's a marathon.
Antibiotics, which cure diseases quickly and permanently, are less profitable than maintenance drugs like insulin, so companies aren't investing in new ones. Meanwhile, deadly superbugs are popping up in hospitals worldwide. As The Post reported, "it's a case of evolution outrunning capitalism."

In an article for Jacobin, Leigh Phillips argues that cases like this are proof that it is actually essential to socialize some parts of the medical industry; without political support for research, there will simply not be an incentive to develop new antibiotics...and many of us will eventually die from quaint diseases like cholera and dysentery.

Social Welfare and Health Policies
Social service workers have long been confined by immediate client needs to advocating on behalf of individual patients. By creating an opportunity for everyone to buy affordable health insurance, Obamacare allows us to broaden our efforts to include other policy reforms.

Although Obamacare has many faults, it represents a step in the direction of creating transparency within the health care industry, lowering prices for some patients, and preventing medical bankruptcies caused by paying for uninsured procedures. However, policy makers have to take a comprehensive approach to disentangling the messy dynamics of a profit-driven healthcare system. As the "superbug" articles demonstrate, complacency is dangerous.