Meredith Stensland, Sara Sanders, and Marla Berg-Weger
Advance care planning (ACP) is the process of determining and documenting desired wishes for the end of one’s life. Referred to by such terms as end-of-life planning, advance (health) directives, and living wills, ACP is a relatively new concept within our society, having emerged as a social, political, and ethical issue in the United States only since the 1960s. Researchers and legislators have been challenged in their efforts to examine healthcare decision-making and design appropriate policy to guide practice. This article will define ACP, provide an overview of the history and evolution of the process and the associated legal and ethical issues, and describe the process with three specific populations. In addition, it examines the role of the social work profession in working with individuals and families on planning for the end of one’s life.
Stephen H. Gorin, Julie S. Darnell, and Heidi L. Allen
This entry describes the development and key provisions of the Patient Protection and Affordable Care Act (ACA), which instituted a major overhaul of the U.S. health system, much of which took effect in 2014. The key provisions of the ACA included an individual mandate to purchase insurance, an employer mandate to offer coverage to most workers, an expansion of Medicaid to all persons below 138 percent of the federal poverty level (FPL), minimum benefit standards, elimination of preexisting condition exclusions, and reforms to improve health-care quality and lower costs. This historic legislation has deep roots in U.S. history and represents the culmination of a century-long effort to expand health care and mental health coverage to all citizens.
Jeanette C. Takamura
Public policy advances in the field of aging in the United States have lagged compared to the growth of the older adult population. Policy adjustments have been driven by ideological perspectives and have been largely incremental. In recent years, conservative policy makers have sought through various legislative vehicles to eliminate or curb entitlement programs, proposing private sector solutions and touting the importance of an “ownership society” in which individual citizens assume personal responsibility for their economic and health security. The election of a Democratic majority in the U.S. House and the slim margin of votes held by Democrats in the U.S. Senate may mean a shift in aging policy directions that strengthens Social Security, Medicare, and Medicaid, if the newly elected members are able to maintain their seats over time. The results of the 2008 presidential election will also determine how the social, economic, and other policy concerns will be addressed as the baby boomers join the ranks of older Americans.
Maryah Stella Fram
This entry provides an overview of current knowledge and thinking about the nature, causes, and consequences of food insecurity as well as information about the major policies and programs aimed at alleviating food insecurity in the United States. Food insecurity is considered at the nexus of person and environment, with discussion focusing on the biological, psychological, social, and economic factors that are interwoven with people’s access to and utilization of food. The diversity of experiences of food insecurity is addressed, with attention to issues of age, gender, culture, and community context. Finally, implications for social work professionals are suggested.
Toba Schwaber Kerson and Jessica Euna Lee
Within its 150-year history, public health has grown from a focus on local communities to include countrywide, then international, and now global perspectives. Using the United Nations’ Millennium Goals as its primary framework, this entry provides an overview of global public health within the broadest possible context of the world and all of its peoples. Also provided are the global burden of disease as measured in disability-adjusted life years, global health statistics, current health priorities, and recommendations for action by social workers and other health professionals.
Stephen H. Gorin and Terry Mizrahi
This entry presents an overview of national health-care reform in the United States, from its introduction into the public policy agenda at the turn of the 20th century through policy debates and legislative proposals more than a century later. Specifically, it concentrates on the programs and strategies to obtain universal coverage for health and mental-health services for all Americans at the national level, with limited success. It ends with a discussion of the Affordable Care Act (ACA). Special emphasis is laid on the roles of social workers and their professional organizations during this period.
Michele Rountree and Courtney McElhaney Peebles
Communities of color are disproportionately burdened by the prevalence of HIV/AIDS. Research has shown that race and ethnicity in the United States are population characteristics that correlate with other fundamental determinants of health outcomes. This entry will chronicle the history of the epidemic, report the disparate impact of the disease affecting communities of color, and acknowledge the social determinants of health that contribute to the vulnerability of risk. A call to address the imbalance of health inequities, with a complement of individual-level interventions and new approaches that address the interpersonal, network, community, and societal influences of disease transmission, is discussed.
Vikki L. Vandiver
Since the mid-1980s, managed care has been one approach used to address the economic crisis in the American health-care system. This entry overviews managed care from the perspective of policy, procedure, practice, and system. Specifically, emphasis is given to understanding the emergence and history of managed care, multiple definitions, how it works, and examples of managed care plans, key legislation, existing research, its future, and implications for social-work practitioners.
Victoria M. Rizzo
In 1965, Titles XVIII and XIX of the Social Security Act were passed creating Medicare and Medicaid and laying the foundation for U.S. health policy. Medicare was originally created to meet the specific medical needs of the elderly. Currently, however, individuals with end stage renal disease, amyotrophic lateral sclerosis, and other disabilities may also receive Medicare. Medicaid was established to provide a basic level of medical care to specific categories of people who are poor, including pregnant women, children, and the aged. This entry includes a brief explanation of Medicaid and Medicare and a discussion of current legislative issues.
Jesse J. Harris, Col. USA Ret. and Kyle L. Pehrson, Col. USA Ret.
The history of military social work in the United States is rooted in the civilian professional social work community and is a microcosm of that sector. Military social work has a rich history of providing services to military men and women and their families during periods of peace, conflict, and national crises. They have been involved in humanitarian operations and have participated in multinational peace-keeping operations. Social work in the Army, Navy, and Air Force is tailored to the mission of their particular service. However, joint operations between the services are becoming more frequent. Military social workers adhere to the NASW code of ethics while providing service to an institution with its own unique culture, standards, and values.