This ability to enter the marketplace by billing for clinical services accelerated the dominant interest in clinical practice, while deterring social work interest in pursuit of practice with larger macro social matters. The emergence of the Diagnostic and Statistical Manual of Mental Disorders ( DSM) in 1952, which used the International Classification of Diseases (ICD), sixth revision, as a model to develop the first DSM, provided the means for diagnostic billing as with the ICD, giving the profession occupational recognition in the marketplace. There is a significant initiative occurring that seeks “to infuse the foundational macro component of our profession into the classroom and field to achieve a more equal footing with its clinical counterpart.” The idea of promoting macro practice gained momentum when President Obama declared himself the “community organizer-in-chief,” (Rothman & Mizrahi, 2014). Mary Richmond and others like her promoted clinical work, looking primarily at individuals as the source of their conditions. Jane Addams and others promoted the generalist perspective looking at the environment, policies, housing, health care, and justice issues, in addition to individual conditions. The early years of the social work profession were marked by the search for identity, which continues to the present day as an ongoing challenge. In: Settersten RA, Angel JL (eds) Handbook of the sociology of aging.Macro Matters - The Need for Specialization Beyond the Micro-Clinical Level Silverstein M, Giarrusso R (2011) Aging individuals, families, and societies: micro-meso-macro linkages in the life course. Sauzet O, Leyland A (2017) Contextual effects on health inequalities: a research agenda. Kelly-Irving M, Tophoven S, Blane D (2015) Life course research: new opportunities for establishing social and biological plausibility. Final Report of the Commission on Social Determinants of Health. Lancet 379:1567–1568Ĭommission on Social Determinants of Health WHO (CSDH) (2008) Closing the gap in a generation: health equity through action on the social determinants of health. This lack of evidence hampers the effective design of institutional interventions in the form of policies or preventive measures taken by the institutions themselves.īlum RW, Bastos FIPM, Kabiru CW, Le LC (2012) Adolescent health in the 21st century. Thus, there is a striking lack of theoretical and empirical knowledge about the role of institutions, i.e., those societal entities which form a central link between the individual and the macro-level, in producing patterns of health inequalities in the different developmental stages from early childhood to early adulthood. In turn, negative compositional characteristics (e.g., low average SES or class climate) and contextual factors (e.g., low teaching quality, bad infrastructure, or working conditions) may add additional health risks to those already present. A healthy, positive institutional environment in a school can, for instance, help children from low social classes to compensate risks from other domains. However, it is likely that health inequalities can either be aggravated or attenuated by institutional determinants. In terms of socioeconomic inequalities in health, characteristics of different institutional contexts were often measured only at the individual level, while the compositional and contextual characteristics of the respective setting itself were seldom studied. Contextual factors, in contrast, focus on the shared organizational, cultural, social, and physical factors of the institution, meaning the built environment, quality of sanitary facilities, the number of teachers and their qualification, and even the availability of healthy food at school. Compositional features, for example, refer to student characteristics in classes and schools measured by aggregating information from students to the class or school level, such as the average level of the psychosocial learning environment or the proportion of students with specific socioeconomic background characteristics. For example, the school provides students with differential learning and developmental opportunities that are determined by group composition and schools’ contextual characteristics. Here, the meso-level generally includes group-level characteristics which can be separated into “compositional” factors (which people are found in an institution) and “contextual” ones (characteristics of an institution). It is likely that characteristics of these institutions have an independent contextual effect on health above and beyond the individual level.
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