All the brouhaha in Mississippi over Medicaid expansion might obscure a very important fact – that even with all the money, and the biggest workforce, in the world, clinical treatment won’t do much to improve overall health outcomes.   And improving outcomes is, after all, our principal objective, is it not?

Don’t take my word for it.  I just attended a conference of the National Network of Public Health Institutes in New Orleans, at which the kickoff speaker, Dr. Georges Benjamin, MD – executive director of the American Public Health Association – pointed out, emphatically and convincingly, citing a mountain of research evidence, that no more than 10% of health outcomes can be attributed to clinical interventions such as doctor visits.  Far greater impact on health results from environmental, socio-economic, policy, cultural and behavioral factors.  Hence far more attention needs to be given to disease prevention and wellness promotion by affecting those contributing factors than to clinical disease intervention.

And the critical element in successful prevention and wellness promotion efforts?  Easy enough to say, if challenging to effect: “Making the healthy choice the easy choice.”  Now that ‘s something we should all be able to agree on, whatever your position on Medicaid expansion.

In advance of today’s commencement exercise, the School of Social Work packed a room at the Trent Lott Center last night, recognizing the achievements of over 50 Bachelor’s and Master’s of Social Work graduates.  A sizeable spring crop indeed! 

The dean was pleased as punch to address the graduates and their celebrating family and friends, but challenged the new grads to keep learning and to confront the myriad ills of our times.  You face three overlapping tasks, I said in part:

First, study and learn all you can about the big issues of the moment.  Armed with knowledge, you must speak the truth about these issues from a social work perspective, which is the perspective of the disadvantaged and the marginalized, the “99%” who own very little wealth, who are, generally speaking, powerless.  Poverty and inequality, immigration reform, health and mental health care, labor exploitation, war and peace, homelessness, sexual violence – there’s no dearth of what we need to know.  It’s work to keep up, to be sure; but it’s work that must be done if we’re to live up to the calling of our profession to be change activists.  In doing the hard work of continuous learning, I advise you to break out of the American media stranglehold, expand your perspectives.  Do not be content with the omissions, half-truths and at times outright propaganda served up by mainstream television news and what’s left of most American newspapers.   The internet is a wonderful tool for social workers, good for more than Facebook and on-line shopping (or finding a quick quote for a late paper!).  Tune in to serious news sources, especially those that operate outside a narrow nationalist, U.S.-centric perspective – the BBC, for example, or World News Netowrk, or al-Jazeera. 

Second, master the basics of political economy and the operation of our political system, however dysfunctional you may think it is.  I’m sorry to admit that we social work educators need to do a much better job in this regard.  Our “macro” classes give you a taste, but only a taste, of what you need to know.   Like it or hate it, the intersection of economics and politics is where the power behind decision-making and policy-making resides, and that’s where social workers need to take up residency too.  If we’re going to challenge political and economic realities we consider contrary to the interests and well-being of our constituents, we need to first understand them – how the political economy operates, what works and what doesn’t from a social work values perspective.  And then, of course, we need to act on our understanding, because social work detached from social action is not really social work at all, no matter the number and nature of credentials attached to it.   

This suggests the third and most important task of all, which is to embrace an activist mindset in your work and in your life.   Look to build relationships with progressive forces and support them.   Progressive movements, often taking the form of resistance to social service cuts, exist, and more are springing up around the nation all the time.  By all means, join the National Association of Social Workers, but do not be content to attend a conference now and then to collect continuing education units.  Rather, push the NASW to take courageously progressive stands on the important issues of the day.  Above all, look to engage actively within your own community; if there isn’t anything already happening there, start something.  I recently attended a small conference at Mississippi Valley State University, and heard several inspiring stories of resilient individuals in the Mississippi Delta – many of them social workers, I’m happy to say – organizing their communities for action on important issues of housing, youth violence, employment, and more.  Are they eradicating problems, and quickly turning everything completely around?  Usually not; but neither are they rolling over in acceptance of the status quo.  Nor should we give up on political party organizations, which exist in some form in nearly every county in the nation.  It’s not a matter of which party label to rally around, but of raising and pressing on social work issues with a long-term mindset, whatever the party.  A professor of mine many years ago said this to a class on social change, “the problem with most progressives [read: “social workers”] is that they tend to be 100% political only 10% of the time; but long term success lies in reversing those numbers – progressive change agents have to be 10% political 100% of the time.”  In other words, activism needs to be part of who we are, and what we do on a day-to-day basis as social workers.

Now, go out and do great work.  Change the world, as you’ve been taught to do.

Senior Kaylee Gentry, who will be graduating this month, stopped by the Honors College this morning to pick up her graduation medallion. I was so fascinated with her plans to teach in China for the coming year I asked her to tell you about it. What a terrific student!

Today’s Clarion-Ledger carried a piece by Mississippi House of Representative member Cecil Brown, arguing the economic sense of Medicaid expansion.  Rep. Brown is a Democrat, so perhaps subject to out-of-hand dismissal by a good many self-identified fiscal conservatives.  But Brown is also a Certified Public Accountant and financial adviser – a quintessential “numbers guy” and budget hawk in his own right – whose views can be rejected only at risk of serious, self-inflicted injury.

Rep. Brown compares the legislature’s enthusiastic embrace of a Japanese tire manufacturing venture in Clay County to the resistance (to date) of Medicaid expansion.  In both cases, Brown says, “the math is pretty simple.”   To get the tire manufacturing plant, the state will first invest $70 million to create a promised 500 jobs, or $140,000 per job.  Later, the state will spend another $130 millon for 2,000 jobs, at a relative bargain price of $65,000 per job.   Brown supported the deal, and in general supports this kind of economic development for Mississippi.  The University Research Center estimates that the resulting increased economic activity will earn the state back its investment in as little as nine years.

But if the tire plant is a good idea, says Brown, Medicaid expansion is an even better one.  Aside from the potential health benefits of adding 300,000 Mississippi citizens to the insurance coverage rolls, expansion promises to pump $10 billion into Mississippi over ten years, at a state investment of $368 million.  The new funding (following expanded health services), according to the same University Research Center economists, is expected to create 9,000 new jobs.  What’s more, expanding Medicaid avoids some nasty negative consequences of refusing expansion – notably significant loss of revenue to Mississippi hosptials, and penalties to Mississippi employers with more than 50 employees who don’t provide health insurance.

In Rep. Brown’s own words: “The math is pretty simple.  (1) Reject Medicaid expansion and subject small employers to substantial penalties, forego 9,000 new jobs, face the closure of local hospitals and the resulting loss of hundreds of jobs, and reject $10 billion of new federal funds over the next 10 years; or (2) Expand Medicaid, provide 300,000 working Mississippians with health insurance , and create 9,000 new jobs all over the state at a fraction of the cost per job that the Legislature just spent in the single county of Clay.”

Indeed, the math does seem pretty simple.

The last thing Mississippi needs is more bad health news.  But it seems about to get it, as the state is poised to lose 82 social workers focused on women with high-risk pregnancies by the end of June.  Inherently troubling, the development sounds especially damaging considering that Mississippi has the highest infant mortality rate in the country.

What’s going on?  The issue is fuzzy from news reports, but it appears that the high-risk pregnancy program had been housed in the state’s Department of Health until last December, when it moved to a managed-care program under the auspices of the Division of Medicaid.  Now it seems the pregnancy program will be “managed” out of existence, laying off the social workers.

There’s probably more to the story, but on the face of it, this seems like a horrendously bad move.  State health officer Dr. Mary Currier is reportedly working with Medicaid and legislators to get the program moved back under the Department of Health, in hopes of saving the program, the jobs, and, most importantly, a lot of babies at risk of early death.  Let’s pray the good doctor succeeds.