Health Care and Illness

Until the 19th century, abortion law was nonexistent and abortion was not seen as a moral issue. However, by the turn of the 20th century, abortion was legally defined and controlled in most states. The landmark Supreme Court case, Roe v. Wade (1973), marked the legalization of abortion but did not end the controversy that existed. Legislation at both the federal and state levels has added restrictions on abortion, making it difficult for women to exercise their reproductive rights. Social work's commitment to promote the human rights of women compels social workers to be aware of and involved in this issue.

Although it was once widely held that development through toddlerhood was the only significant time of tremendous brain growth, findings from neuroscience have identified adolescence as a second significant period of brain-based changes. Profound modification of brain structure, function, and connectivity, paired with heightened sensitivity to environment, places adolescence both as a heightened period of risk and importantly as a time of tremendous opportunity. These findings are of key relevance for social-work policy and practice, for they speak to the ways in which the adolescent brain both is vulnerable to adverse conditions and remains responsive to positive environmental input such as interventions that support recovery and resilience.

Although rates of adolescent pregnancy have exhibited a downward trend since 1991, the United States continues to have a significantly higher rate than other industrialized nations. Adolescent pregnancy, especially in early and middle adolescence, has long-term developmental and economic impact on the teen and her child, in addition to high social costs. This entry describes the current trends in adolescent pregnancy in the United States, and examines factors reported in the research literature as associated with adolescent pregnancy, discusses federal policy directed toward adolescent pregnancy prevention, and identifies various intervention programs.

Adult day care centers provide important health, social, and support services for functionally and cognitively impaired adults and their caregivers. The adult day care services are underutilized, however, because of the shortage of centers, caregivers' lack of awareness of and resistance to using services, and the mismatch between the needs of potential consumers and their informal caregivers and the services provided by the centers. To foster and support the expansion of adult day care centers, lessons learned from national demonstration programs need to be disseminated, and social workers need to be trained to provide essential services at the centers.

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.

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.

Dementia is not a disease, but a group of symptoms so severe that they inhibit normal functioning. Alzheimer's disease is the most common type of dementia in older persons impacting not only the person with the illness but the entire family. Obtaining an accurate diagnosis is essential in order to assure appropriate and timely care and to exclude reversible causes of dementia. Social workers can play key roles throughout the course of the illness as educators, therapists, supporter and advocates for improved policies and services.