Health for All or the Happy Few? Challenges of interprofessional collaboration between social work and primary health care for citizens with chronic care needs

Griet Roets, Dries Cautreels

Keywords: social work, chronic care needs, health and social care in the community

Introduction:

Striving towards Public Health through engaging in Primary Care connects with what Milligan and Wiles (2010, 745) describe as a ‘community turn’, as it refers to a transformation where systems of public service delivery and welfare state arrangements itself are at stake. It implies a shift away from institutional, formal and professional services towards informal care in the private sphere of our societies, meaning self-care and informal care of families and communities, and towards… primary health and social care in the community.

This connects with the field of care and support for citizens with chronic care needs, where de-institutionalisation strategies have been promoted as a reaction on very poor living conditions in (residential) institutions. The original understanding of de-institutionalisation in the 1960’s-70’s hereby refers to the closure of residential care settings, based on ‘the movement of individuals from an institutional setting to a community setting’ (Gibson 2001, 96). However, recent research indicates that ‘community-based care’ often leads to dismantling the architectural hospital model-alike carcasses of residential care settings, while the circulation of oppressive, institutional cultures remains in a variety of settings (Roets et al. 2022), whether ‘community based’ or not.

Method:

Our contribution is based on an extensive systematic literature review, that is historically grounded.

Results:

The creation of synergies between social work and social care, and public health and primary care shows that current welfare state reforms expect a high level of self-responsibility and self-determination of citizens with chronic care needs, their families and/or an informal network .

Conclusions:

We conclude that we need to take a critical stance towards the historical paradigm shifts in the provision of care, where the shift from ‘cure’, to ‘care’ and ‘support’ have been framed as progress. These professional orientations should not be seen as solely conflicting paradigms, but require mutually reinforcing orientations.

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