SCIE Research briefing 33: The contribution of social work and social care to the reduction of health inequalities: four case studies

By Esther Coren, Wendy Iredale, Paul Bywaters, Deborah Rutter and Julie Robinson

Published: June 2010

Review date: June 2013

Introduction

This briefing argues that support given as social care can help improve health and reduce health disadvantage. Improving access to social care interventions is therefore important to any strategy for reducing health inequality. The concept of health inequalities refers to the avoidable health disadvantage people experience as a result of adverse social factors, such as lack of economic or social capital, or marginalisation. People with higher socioeconomic position in society have better life chances and more opportunities to flourish. They also have better health. The two are linked: the more socially and economically advantaged people are, the better their health. Moreover, a person’s social and economic status often develops incrementally: a young person raised without support from parental figures is more likely to develop long-term physical or mental illness, is more likely to miss out on schooling and lack educational qualifications, and is then more likely to be unemployed or in insecure, ill-paid or unfulfilling employment and substandard housing, as well as more likely to suffer ill health and early death: ‘Inequalities in health arise because of inequalities in society – in the conditions in which people are born, grow, live, work, and age’.

These factors, and consequent health disadvantage, particularly affect people who use social care, raising the question of the role of social care in reducing inequality and disadvantage.

The Strategic Review of Health Inequalities Fair society, healthy lives was conducted in the wake of a World Health Organisation (WHO) commission on the Social Determinants of Health, to form the basis for a strategy for addressing health disparity in England. Inspired by early reports of the Review, the Social Care Institute for Excellence (SCIE) brought together a number of academics who were concerned to evidence and demonstrate the central role that social care and social work might have in contributing to the reduction of health inequality. We found no evidence that social care as currently organised can reduce social inequality across the board, but we did find examples to illustrate the role of social care in promoting the welfare of all, and alleviating or equalising the health disadvantage experienced by particular groups. Although largely completed before the publication of the Marmot Review in 2010, we believe that this briefing complements that document.

Key messages

  • Inequalities in UK health outcomes are widening. Although the Marmot Review makes few references to social work and social care, it concedes that social care recipients are likely to be among the most disadvantaged of populations.
  • There is no systematic body of research evidence that focuses on whether social work and social care has a direct effect on the distribution of health outcomes at the individual or population level.
  • However, the health of most users of social care services is already damaged and for many this is a central factor in their involvement with social care services. Social work and care interventions targeted at social care clients, and at the general population, can reduce health disadvantage across the life course.
  • To illustrate this, we chose interventions from across the life course. Studies referred to all measured impact on health. They are Sure Start/Children’s Centres; the placement of looked-after children with kinship carers; support for parents with intellectual disabilities, and extra care housing for older people at risk of entering care. Research shows that social interventions impact on health disadvantage in individuals and populations, but to impact on health inequality, they must be adequately and sustainably resourced.
  • The key message of this briefing is that social work and social care practitioners work with some of the most disadvantaged groups in our society, and this offers many opportunities to improve the lifetime health of those most at risk. The achievement of health benefits and healthcare cost savings requires financial and research investment in the social care sector.

About the development of this research briefing

Scoping and searching

Five scopes were completed July 2009, on overall topic, plus four illustrative topics. Further searching took place betwen September and November 2009. 

Research briefing methodology

SCIE research briefing methodology was followed throughout (inclusion criteria; material not comprehensively quality assured; evidence synthesised and key messages formulated by author): see research briefing methodology for a full description. 

Peer review and testing

The Project Advisory Group included topic and methodology experts who all reviewed key messages. Topics too broad to include user/provider participation. Product and key messages were peer reviewed by an independent professor of social care.

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