No one is more aware of our nation’s social problems than the people who spend much of their time working with individuals, families, organizations and communities to address society’s chronic problems.
What do they think is the biggest social concern of our time? Is it poverty, crime, domestic violence, immigration law, health care or juvenile delinquency? Is it inequality, homelessness, aging, mental illness, child welfare or drugs?
Seven faculty members from the School of Social Work weigh in on some of these issues and what can be done to solve them.
- Diana DiNitto: A public option is crucial for America’s health.
- Miguel Ferguson: Poverty is our nation’s enduring disgrace.
- Cynthia Franklin: Many paths lead to high school dropout.
- Yolanda C. Padilla: Immigration policy is at a crossroads.
- Namkee Choi: Graying of America brings numerous challenges.
- King Davis: Mental illness should be a part of any health care reform discussion.
- Rowena Fong: Engaging communities can better child welfare.
Cullen Trust Centennial Professor in Alcohol Studies and Education and Distinguished Teaching Professor in the School of Social Work
A public option is crucial for America’s health
The reason the United States and other capitalist countries have a social welfare system is to respond to market failings. A prime example of such failings is the U.S. health care system, which spends more on health care than any other developed nation, leaves tens of millions below the age of 65 uninsured or underinsured and has worse health outcomes than many other countries. This market failure is even more apparent when we consider that public insurance programs have been covering more Americans, while private insurance has been covering fewer. Given this situation, many Americans find it difficult to envision achieving the goal of universal access to health insurance without a public option.
One approach to a public option is to allow Americans of all ages to buy into Medicare on a sliding scale based on their income. Nearly all workers already pay Medicare taxes to finance the health care of retired or disabled workers. They also do so with the promise that they, too, will have Medicare coverage one day. Like the rest of the health care system, Medicare faces financial difficulties, but it is a very popular program that provides quality health care to millions of Americans. Medicare can be made more viable by addressing waste and fraud and by enrolling many more people in the program–those who are younger and healthier. Employers who want to focus more on business and less on negotiating health insurance for employees might welcome a public option to which they contribute. Doctors and other providers would save by dealing with the paperwork of fewer health insurance companies. With guaranteed access to health insurance, some Americans might retire earlier or leave their jobs for other reasons, making room in the labor force for those who need work.
In the spirit of scientific inquiry, we can put the question of public versus private insurance systems to an empirical test. Medicare need not be the only option for those who qualify for a government health insurance subsidy. We could let Americans use their public subsidies or their private health care dollars to purchase private insurance or participate in a public option. This way, we can let the American people decide which plans work best for them.
Associate Professor of Social Work
Poverty is our nation’s enduring disgrace
Among advanced, industrial economies, the contours of American poverty are unique, enduring and inimical to a decent life. Despite abundant national wealth, overall rates of poverty in the United States are the highest among peer nations, with even higher rates of poverty among subsections of the citizenry, including Blacks, Hispanics, women and single-parent families. Poverty in the U.S. reserves its most potent fury, however, against children, who represent the single largest category of poor in the nation.
The list of indecent transgressions to which destitute children are subjected in the U.S. is appalling, and begins in the womb. Compared to the non-poor, poor children are less likely to have quality pre-natal care and more likely to be born with cognitive deficits. They also are more likely to live in crowded and dilapidated housing in neighborhoods with more violence, crime and toxic pathogens and less access to green spaces and community services. They are more likely to experience family instability, episodes of foster care and housing insecurity (evictions, utility cutoffs) and more likely to receive inferior child care and elementary and secondary school educations. Poor children have parents and guardians who are less likely to be college graduates or have jobs that allow paid time off to attend parent-teacher meetings and school events. (Finger pointers who are tempted to blame the entire situation on neglectful parents should know that other countries have successfully mitigated the worst effects of poverty, despite having higher rates of unwed births.)
What to do? On an individual level, those with extra time and resources can and should do more to alleviate the worst effects of poverty in our communities. However, since the scope and depth of the current recession is far beyond the limits of individual charity, action must be taken on a collective level. The levers of government and taxation must be used in a more aggressive and redistributive fashion to address the deteriorating societal conditions and financial circumstances facing low-income families. In the short- term, New Deal-style public work programs could reduce unemployment and modernize the infrastructure that is lacking in practically every major American city. In the long-term, universal health care and Caretaker Resource Accounts–$5,000 annually for every family with children under 13 to be used for education, child care or retirement–could offset large costs that caretaking exerts on families.
If political will is lacking, I suggest we use the recent generosity exhibited towards multimillionaire football team owners and Wall Street executives as inspiration.
Stiernberg/Spencer Family Professor in Mental Health and Coordinator of Clinical Social Work Concentration in the School of Social Work and Faculty for the Dropout Institute in the Meadows Center For Preventing Educational Risk
Many paths lead to high school dropout
One of the biggest social issues facing America is high school dropout. Numbers of high school dropouts differ based on the statistical methods used to calculate dropout rates. What most everyone agrees on is that high school dropout is a growing problem. When youth do not receive a high school education they are put at greater disadvantage and their shortcoming is quickly translated into social problems and lost revenues for our society. Social and economic measures show that youth who drop out of school often experience negative life outcomes compared to their peers who graduate. High school dropouts earn less, have poorer job prospects, have poorer health and mental health, and are overrepresented in the U.S. prison population. When job earnings are considered from ages 18-64 dropouts earn $400,000 less than their peers who complete high school. The lost tax revenue can be up to a quarter-million dollars for each dropout.
Youths at higher risk for dropout are from urban schools, those from low socio-economic and ethnic minority backgrounds (for example, Latinos, Blacks, and Native Americans) and with disabilities (for example, mental health disorders). High school dropout is not confined to any one group, however, because dropout spans urban and suburban schools. It is merely a question of the degree of risk and as studies have shown, youth from different socioeconomic backgrounds may drop out of school depending on their life circumstances.
Reasons for dropout can be grouped into individual, family and school/academic problems and may range from issues like financial hardships, adolescent pregnancy, serious stress and loss, substance abuse, family problems and learning differences. Although, it is difficult for any one factor or group of factors to accurately predict dropout, signs of dropout can be seen in a youth’s school performance such as absences from school, behavior problems, failing grades in core subjects and lack of grade promotion.
Because many paths lead to dropout not just one solution will prevent it. The best dropout strategies include targeted programs that address the specific needs of students at-risk to drop out (for example, school-age parents, those with problems reading), as well as, school-wide approaches that address school climate and context (for example, smaller high schools, supportive relationships with teachers). Dropout is not a one-time event but is a process that can be prevented when policy makers, practitioners, researchers and families work together to implement the best practices that help all youths succeed in school.
Yolanda C. Padilla
Professor of Social Work and Women’s and Gender Studies
Immigration policy is at a crossroads
Strong families have created the foundation for the thriving U.S. Latino community. Latino communities are filled with hustle and bustle, decent home ownership and parents who work two jobs. Historically, Latinos, especially children of immigrants, have been characterized by healthy beginnings and steady educational and economic mobility. The policies we create today can support this vitality and advance economic prosperity or they can threaten or even reverse current gains. Key among these policies is immigration policy.
Why does contemporary immigration policy have the potential to dramatically change the course of Latinos as a whole? Latino families cannot be neatly separated into various immigrant statuses: those who are citizens and those who are not. In reality, immigrant families tend to be mixed status, families that contain a mix of citizens and noncitizens. Thus, any policy denying social access–to health care, education and public benefits–to any segment of the immigrant population is apt to affect the social and economic prospects of the larger Latino population.
The fate of a large segment of our country is at stake. The Latino population is projected to grow significantly in the next few decades, making up 24.4 percent of the nation’s population by 2050, nearly double the current 12.6 percent. Already, nearly 25 percent of children younger than age 5 are Latino. Texas is projected to become a majority Hispanic state as early as 2026.
We are at a crossroads. Experts agree that without attention and better policies, Latino immigrant families will begin an irreversible downward trend toward pervasive poverty. There is no doubt that Latinos have strong values and a desire to achieve. If we continue our course of closing access to work, denying benefits, blocking access to higher education and instituting ‘immigration reform’ that does nothing to strengthen families, we will have disabled the Latino community for generations. U.S. history has repeatedly shown that unequal protection under the law breeds entrenched poverty and all that comes with it–social, educational and occupational stagnation. And the effects persist through generations. We have a responsibility to document and speak up about the ramifications of today’s policy proposals for tomorrow’s Latino population–to do our part to help change the course of Latino history to one that builds upon current Latino successes.
Professor of Social Work
Graying of America brings numerous challenges
An increasing number of older adults (age 65 and older) in the population poses unprecedented challenges in the United States and in most other parts of the world. A graying of society requires a host of support systems–retirement pensions, health care, housing and social services–for its seniors.
The cost of expanding and sustaining these systems is a serious financial issue. The Social Security program is projected to have insufficient funds within the next three decades. Although morbidity in late life has been decreasing, the number of frail older adults requiring an array of health care services will continue to increase. Without substantial reform, Medicare and Medicaid (which pays a large portion of nursing home care) will constitute an increasing share of the federal budget. Older adults who suffer from chronic illnesses and cognitive impairment must also have access to formal care systems to manage their daily living and maintain their quality of life. A serious shortage of trained healthcare and social service workers coupled with financial constraints will continue to be barriers to availability and accessibility of these services.
There is no simple solution to the multitude of challenges of an aging society. Higher taxes, reduced benefits and other sacrifices are inevitable to support the systems of care. However, one lesson we have learned is that public systems like Social Security and Medicare are much more effective and efficient than private programs. We need to shore up, not dismantle, public systems of care, while striving for continued economic growth.
Prevention also is less costly than treatment. We need to establish a universal public health care system that focuses on preventive care for people of all ages, while continuing research on ways to cure debilitating physical and mental health conditions. We need to invest in the development of new technology for more economical and widely available elder care practices.
Another important task in an aging society is to tap into the vast human resources available in well older adults and help them lead productive and meaningful lives. A majority of older adults, in their 70s and 80s, can continue their contributions to society through paid work and/or volunteering if they have such opportunities. We need to establish an infrastructure that will harness the collective wisdom and energy of older adults to benefit society and older adults themselves.
Robert Lee Sutherland Chair in Mental Health and Social Policy in the School of Social Work
Mental illness should be a part of any health care reform discussion
Recent replications of national studies conducted in 1994 found that close to 30 percent of the population of the United States has a diagnosable mental illness during the year. About 90 million Americans are potentially affected, although many of these illnesses are self limiting and require minimal if any care. Mental illness results in $195 billion in lost productivity through loss of earnings alone and an additional $124 billion in treatment costs. The emotional burden to families is incalculable. The total cost of mental illness in the United States far exceeds $500 billion annually. Clearly, prevention and treatment of mental illness are seminal issues of our time, although considerable progress has been made in diagnosis and evidence-based treatment of mild to moderate disorders.
Two additional reports issued this century identified major weaknesses in the United States system of mental health. The system remains highly fragmented with limited collaboration within the system and even more limited networking with primary health care. Extensive disparities exist by race, ethnicity and culture in access to quality care, accurate diagnosis and effective treatments. Minority mentally ill are more likely to be involuntarily committed, involved with the police and retained in jail. Stigma towards anyone with a mental illness remains a significant barrier in the workplace. Close to 63 percent of persons with mental illness are not competitively employed. It has also been noted that persons with mental illness tend to die 25 years younger than persons without such diagnoses. The 1960s policy of deinstitutionalization has resulted in close to 700,000 homeless mentally ill, many of whom have co-occurring substance abuse problems. Throughout the nation, local jails have become the new mental institutions, now housing as many persons as the old state hospitals did in 1955 at their zenith.
In the debate on health reform, there is a need for robust discussion of the need to integrate mental and physical health care, eliminate disparities, shift inpatient mental health to general hospitals, broaden information technology and leverage federal funding. My research and that of colleagues in Virginia and Florida centers on a data base of 500,000 admissions to state mental hospitals in an effort to examine the status of these issues and how to create new policy directions.
Ruby Lee Piester Centennial Professor in Services to Children and Families in the School of Social Work
Engaging communities can better child welfare
Childhood is supposed to be about happy memories and having parents who are always there for you. Children growing up in the public child welfare system are usually not experiencing this kind of security nor growing up in an intact family. They have been taken out of their homes by child protective services and placed in foster care or adoptive homes. Most occurrences are because their biological parents have neglected or abused them primarily due to drugs, but also because of criminal offenses, mental illness, the stress of poverty, abandonment and domestic violence.
Child protective services in public child welfare is committed to the permanency, safety and well being of children but often fall short because of high staff turnover, limited resources and lack of priority in legislative mandates and budgets. Meanwhile children whose parents have had their parental rights terminated wait in foster care placements until a permanent home or setting can be found for them. According to 2006 national data, of about 510,000 children in foster care, 67,000 had been in care for more than five years. Too many children are in the public child welfare system for too long and change “homes” and “parents” too often. It is very difficult for children waiting that long to find a “permanent home,” feel safe and have a positive attitude toward their future.
Several approaches have been initiated to reduce the number of children in foster care.
Family Group Conferencing is a preventive approach encouraging child welfare families to include all biological and fictive kin family members in the treatment planning to help keep the at-risk child out of child protective services. Kinship Care is another public child welfare initiative primarily involving grandparents who assume the role reversal of being a foster care or adoptive parent to their biological grandchild. This keeps the child close to family members but causes a real strain on the aging grandparent who is not receiving sufficient social service resources or financial assistance to assume this humongous task.
Community responsibility and engagement are critical to helping child protective services find resources for biological parents and kinship care grandparents. Faith-based agencies and churches have provided assistance in finding more stable homes. Community development projects connecting child welfare families living in the neighborhood with employment add to family stability. If it takes a village to raise a child, it takes a community to save a family.