Health and Human Services: Key Concepts and History

Health and Human Services: Foundations

• Central questions from the introduction: What is health? What are human services? How do health and human services relate to one another?
• Real-world overlap:
  • In the United States, the federal government includes the Department of Health and Human Services (HHS) as a major branch. $ext{U.S. Department of Health and Human Services}$
  • The Wellstar College of Health and Human Services (at Kennesaw State University) embodies the same broad field in higher education.
  • Many universities offer undergraduate and graduate degrees in health and human services.
• HHS mission (as stated by hhs.gov):
  • "to enhance the health and well-being of all Americans, by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services." $ext{Mission}_{ ext{HHS}}$
• College/academic mission (Kennesaw State University):
  • Vision: "to work collaboratively with diverse people and communities to improve health and well-being." $ext{Vision}_{ ext{Wellstar}}$
  • Emphasis on championing health and wellness.
• Two common elements in the definitions:
  • 1) Promoting and sustaining health and well-being for individuals and communities.
  • 2) Practice and service to diverse populations through a broad range of professions and settings.
• The field is defined broadly as health and human services, though this umbrella also contains a more specific discipline (Human Services) within it.
• Broad sense of health and human services:
  • Encompasses work designed to enhance the capacities of individuals, families, and communities to live as fully as possible.
  • Requires integration of multiple systems that affect health and well-being: biological, ecological, built environment, social-cultural, political, economic, and healthcare systems.
  • If something goes wrong in any one system, health and well-being can be impacted significantly.
• Professions at all levels of society:
  • Medical professions (clinical care for bodily health).
  • Environmental scientists and public health practitioners (ecosystem- and environment-related health).
  • Social work and human service professionals (social supports, belonging, economic needs, political rights).
  • Healthcare and public health systems (disease prevention and health promotion).
• The field’s breadth shows how health and well-being are pursued across multiple professions and settings.
• Distinctions between health and well-being:
  • Health and well-being are closely linked but defined differently across contexts, cultures, and professions.
  • Definitions are influenced by family, community, media, and political discourse; not always universal or common-sense in all contexts.
• The book’s approach:
  • Recognizes multiple lenses and theories that shape definitions of health, well-being, and care.
  • Plans to discuss how Western medicine, public health, social services, and other frameworks define and pursue well-being.

Defining Health, Well-Being, and Lenses for Practice

• Health and well-being are not simple, fixed concepts; they vary by culture, institution, and historical period.
• Common-sense definitions can obscure alternative views, potentially limiting innovation and the ability to address diverse needs.
• The way we think about health shapes practice choices and who is served.
• Western medicine is a commonplace approach to health and well-being in many contexts.
• Lenses beyond Western medicine (e.g., public health, community-based practice, social determinants of health) can broaden understanding and improve care.

Western Medicine: Core Concepts and History

• Western medicine often focuses on states and processes inside the body, especially when the body is failing or when preventing failure.
• Key Western medical professions include: $ext{medical doctors}, ext{ nurses}, ext{ physical therapists}, ext{ dieticians}, ext{ and pharmacists}$
• Approaches in Western medicine include physical interventions such as:
  • Surgery
  • Medications
  • Exercise
  • Behavior modification
  • Other biomedical interventions
• Core goal: maximize biophysical functioning and improve quality of life for individuals.
• Central concept in this paradigm: disease.
• Definition of disease (historical): the absence of ease or comfort. In the broad sense, disease means a disruption in well-being.
• Historical development of disease concepts:
  • Up to the 1400s: internal body structure was largely unknown; autopsies were forbidden.
  • Causes of disease largely unknown; treatments based on guesswork.
  • 18th century: autopsies became permissible, enabling new understandings of disease mechanisms. $ext{Autopsy}_{ ext{permitted}}^{ ext{18th century}}$
• Shift in authority and social relations:
  • As medical science advanced, doctors became the primary experts on the body.
  • This created new power dynamics and social relations that spread through European society and colonization.
  • Western medicine was framed by colonial power as a civilizing force, often eclipsing other cultural understandings of health.
• Why Western medicine succeeded and expanded:
  • Effective diagnosis and treatment of bodily malfunctions.
  • Improvements in life expectancy and reductions in physical suffering.
  • Innovations include surgical techniques, medications, vaccines, preventive medicine, and public health interventions (e.g., clean water, hygiene).
• Critical tensions and biases in diagnosis and care:
  • Social biases (race, gender, class, sexuality) affected diagnostic accuracy and treatment access.
  • Historical examples of pathologizing non-normative identities and groups:
  • Homosexuality labeled a disease until 1973. (See Abelove, 2019)
  • Hysteria in women and other diagnoses used to control behavior (e.g., moral insanity).
  • Drag examples like enslavement and drapetomania in enslaved people. (Byrd & Clayton, 2001; Drescher, 2015; Garb, 1997)
• Contemporary concerns:
  • Persistent gaps in care for people of color and women; debates around reproductive health.
  • Gay plague of AIDS highlighted delays in recognizing health risks in marginalized groups (e.g., gay men vs heterosexual populations) (Abelove, 2019).
• Important caveat:
  • Western medicine’s success is tempered by colonial history, social biases, and the potential neglect of non-Western or marginalized health perspectives.
• Overall takeaway:
  • Western medicine remains a dominant framework for health, but health and well-being are shaped by multiple perspectives and power dynamics that influence how disease is defined and treated.

Human Services: Broad Field, Roles, and Origins

• If Western medicine is the dominant approach to health, human services represents the broader field that attends to care and well-being across social institutions and communities.
• Broad definition: human services involve practices aimed at enhancing the capacity of individuals, families, and communities to live as fully as possible.
• It encompasses care beyond clinical treatment, including social supports, community-based services, and policy-level work to ensure accessibility and equity.
• The field covers a broad range of professions and settings (healthcare included, but not limited to it).
• A key tension: while some use the term to refer to a distinct discipline, others use it as an umbrella for multiple disciplines that address health and well-being.
• The field’s practical focus:
  • Building authentic relationships between workers and those served, at both individual and institutional levels.
  • Emphasis on relational practice and client capacities for agency through collaboration.
  • Practice sites often located where clients live (e.g., non-profit agencies, community settings) rather than solely in offices.
• The historical origins of human services as a distinct field:
  • Emerged during the 20th century in response to the crisis of large psychiatric asylums and the need for community-based care.
  • The Community Mental Health movement (US) sought to close large institutions and move care into community settings.
  • Italian psychiatrist Franco Basaglia played a pivotal role in reforming asylums in Italy (1961) and closing them in favor of community-based, patient-led care models. He linked asylum conditions to wartime experiences and pushed for radical reforms. (Basaglia, Scheper-Hughes & Lovell, 1987)
• Basaglia’s reforms in Italy and the broader Community Mental Health movement spurred concerns about who would provide care in the community, leading to the development of paraprofessional roles in human services to deliver frontline support.
• Evolution of practice:
  • From paraprofessional to bachelor’s, master’s, and doctoral degrees.
  • Expansion beyond social work to include psychology, sociology, criminology, child and youth studies, gerontology, and related fields.
• Client populations and focus:
  • Initially emphasized marginalized and vulnerable populations, but the scope broadened to all ages and a wide range of presenting issues.
• The contemporary interpretation of Health and Human Services combines medical care with social, economic, and policy strategies to promote holistic well-being.

The Book’s Structure and Core Topics

• The textbook outlines a multi-chapter exploration of Health and Human Services (HHS) as an academic discipline and professional field:
  • Chapter 1: The Question of Disciplines – defining disciplines, multi-disciplinarity, and interdisciplinarity; the role of transdisciplinary approaches
  • Chapter 2: History – brief history of health care and human services; the value of historical perspective and what is left out of dominant historical accounts
  • Chapter 3: How We Think – shifting definitions of health and care; tensions between science and non-Western or alternative approaches; interdisciplinary perspectives
  • Chapter 4: Social Justice – role of social justice in access to health and well-being; professional associations’ commitments; health determinants; globalization and capitalism
  • Chapter 5: Intersectionality – interlocking systems of oppression; how class, race, gender, sexuality shape service delivery
  • Chapter 6: Ethics – central to all HHS professions; ethics codes; frameworks (Utilitarian, Rights-based, Care Ethics); ethical problem solving; historical lapses
  • Chapter 7: The Question of Care – need for clarity on what care means; relational, ecological, and feminist ethics of care perspectives
  • Chapter 8: Economics of Health and Human Services – non-profit vs for-profit; corporatization; financial structures shaping care
  • Chapter 9: 21st Century Challenges and Proposals – climate change, biodiversity loss, cyber tech, pandemics, and potential interventions
  • Chapter 10: Who Do We Serve – diversity of populations; recognizing varied life experiences and needs
  • Chapter 11: Where Do We Work – diverse practice settings (hospitals, clinics, public health departments, labs, advocacy groups, NGOs, businesses)
  • Chapter 12: What Do We Do and How – clinical and non-clinical paths; nursing, medicine, psychotherapy, public health, administration, research
  • Chapter 13: Professionalism – definitions, historical roots, and the tension with corporatism within HHS
  • Chapter 14: Accreditation – licensing and accreditation pathways for different professions (e.g., physicians, nurses, psychologists, epidemiologists)
  • Chapter 15: Determining Your Fit – self-reflection on values, interests, and strengths to guide career planning
• References listed to support the text:
  • Abelove, H. (2019). The Politics of the “Gay Plague”: AIDS as a US Ideology. In Body Politics (pp. 3-17). Routledge.
  • Ackerknecht, E. H. (2016). A Short History of Medicine. JHU Press.
  • Basaglia, F., Scheper-Hughes, N. E., Lovell, A. M., & Shtob, T. T. (1987). Psychiatry Inside Out: Selected Writings of Franco Basaglia. Columbia University Press.
  • Byrd, W. M., & Clayton, L. A. (2001). Race, medicine, and health care in the United States: a historical survey. Journal of the National Medical Association, 93(3 Suppl), 11S.
  • Drescher, J. (2015). Out of DSM: Depathologizing homosexuality. Behavioral Sciences, 5(4), 565-575.
  • Foucault, M. (2002). The Birth of the Clinic. Routledge.
  • Garb, H. N. (1997). Race bias, social class bias, and gender bias in clinical judgment. Clinical Psychology: Science and Practice, 4(2), 99.
  • Naidu, T. (2021). Modern Medicine Is a Colonial Artifact: Introducing Decoloniality to Medical Education Research. Academic Medicine, 96(11S), S9-S12.

Health, Well-Being, and Ethics in Practice

• Health and well-being depend on multiple interacting systems (biological, ecological, social, political, economic, built environment).
• Ethical care requires attention to social biases and power dynamics that affect diagnosis and treatment.
  • Examples of biases and misclassifications in history:
  • Race, gender, class, and sexuality biases in medical practice.
  • Historic pathologizing of non-normative sexualities and identities (e.g., homosexuality as a disease until 1973).
  • Gendered diagnoses (e.g., “hysteria”) and misclassification of enslaved individuals (drapetomania).
• The ethics of care involves relational approaches and attention to social determinants of health, not just biomedical facts.
• The field’s integrity depends on aligning practice with both professional ethics and broader social justice principles.

Care, Interdisciplinarity, and the 21st Century Outlook

• Interdisciplinarity and transdisciplinarity are central to HHS, reflecting real-world work in teams that cross traditional disciplinary boundaries.
• In the 21st century, HHS must address:
  • Climate change and biodiversity loss
  • Rapid advances in cyber technology and data use
  • Global health threats and pandemics
  • The politics of health economics and the balance between nonprofit, public, and private sector roles
• The book argues for integrating diverse epistemologies and practice models to improve health and well-being for all.

Populations, Settings, and Professional Pathways

• Populations served are diverse, with varying challenges, resources, and experiences.
• Practice settings include hospitals, clinics, public health departments, laboratories, advocacy groups, social service organizations, and businesses.
• Role diversity within HHS:
  • Direct clinical care (nursing, medicine, psychotherapy, physician assistants)
  • Leadership, administration, and policy (public health officials, program directors, researchers)
• The continuum from direct care to systems-level work reflects the field’s breadth and the importance of collaboration across disciplines.

Professionalism, Accreditation, and Finding Your Fit

• Professionalism is a core feature across HHS fields, with its own history and evolving definitions.
• Accreditation and licensing ensure standards of practice across professions (e.g., medicine, nursing, psychotherapy, epidemiology).
• Determining your fit involves reflecting on values, interests, experiences, goals, and strengths to guide educational and career paths.
• The text emphasizes self-reflection and planning as essential steps in pursuing a meaningful career in HHS.

Key Concepts and Formulas (Summary Notes)

• Core purpose: health and well-being through integrated care, social supports, and systemic interventions.
• Definitions:
  • Health and well-being are context-dependent and multi-dimensional.
  • The field comprises diverse practices aimed at enhancing individual and community capacity for living well.
• Disease concept in Western medicine can be viewed as:
  • $ext{disease} riangleq ext{absence of well-being}$
• Major biases historically shaping care:
  • Race, gender, class, sexuality biases influence diagnoses and treatment access.
  • Example biases include misdiagnosis and pathologizing minority populations.
• Key historical shifts:
  • From forbidden to allowed autopsies, enabling deeper disease understanding. $ext{Autopsy}_{ ext{modern era}}$
  • Colonization linked to the spread of Western medical norms and the marginalization of alternative health knowledge.
• Paradigms and theories mentioned:
  • Western medicine as a dominant paradigm; other approaches (public health, social work, environmental health).
  • Care ethics, relational ethics, ecological concepts of care, and feminist ethics of care as sources for alternative approaches to health and well-being.
• Social justice and intersectionality:
  • Health outcomes are shaped by social determinants and interlocking systems of oppression.
  • Institutions, corporate capitalism, and policy choices influence access to care and well-being.
• Economics in HHS:
  • Non-profit vs for-profit models; increasing corporatization and its impact on services and priorities.
• 21st century challenges:
  • Climate change, technology, pandemics, and evolving political economies require adaptive, multi-disciplinary responses.

References (Key Works Cited in the Transcript)

• Abelove, H. (2019). The Politics of the “Gay Plague”: AIDS as a US Ideology. In Body Politics (pp. 3-17). Routledge.
• Ackerknecht, E. H. (2016). A Short History of Medicine. JHU Press.
• Basaglia, F., Scheper-Hughes, N. E., Lovell, A. M., & Shtob, T. T. (1987). Psychiatry Inside Out: Selected Writings of Franco Basaglia. Columbia University Press.
• Byrd, W. M., & Clayton, L. A. (2001). Race, medicine, and health care in the United States: a historical survey. Journal of the National Medical Association, 93(3 Suppl), 11S.
• Drescher, J. (2015). Out of DSM: Depathologizing homosexuality. Behavioral Sciences, 5(4), 565-575.
• Foucault, M. (2002). The Birth of the Clinic. Routledge.
• Garb, H. N. (1997). Race bias, social class bias, and gender bias in clinical judgment. Clinical Psychology: Science and Practice, 4(2), 99.
• Naidu, T. (2021). Modern Medicine Is a Colonial Artifact: Introducing Decoloniality to Medical Education Research. Academic Medicine, 96(11S), S9-S12.