INTRODUCTION

In today's busy times, people forget about the most important and precious thing in life, their health. The moment an illness enters our lives unexpectedly and uninvited, we begin to reassess our ranking of values. Health is a state of physical, mental and social well-being, and precisely because of these determinants, we must realize its real and incalculable value. In the entire development of humanity, we can see the effort of people to strengthen and maintain their health, by applying such measures that they want to prevent diseases. We can also explore such an effort in the field of social services, where a social worker closely cooperates with other professionals in order to provide health protection and comprehensive care. The aim of this article is to point out the importance of the education of social workers in the issue of civilizational diseases and the current situation of the rise of civilizational diseases both globally and domestically. We will take a closer look at the possibilities of education for social workers at home and abroad, and at the same time we will shed light on social work in healthcare, which has an irreplaceable place in improving the life possibilities of a client who is disadvantaged in a certain way due to his illness.

CURRENT STATUS OF SOLVED PROBLEMS HERE AND ABROAD

The issue of chronic diseases is a very extensive and continuously stimulating area of research. The current incidence of chronic diseases is constantly increasing worldwide, at the same time the total length of survival is also increasing, as well as the length of complex palliative care, which has been reflected in all areas of health and social care (Hoffman, 2014).

At the present time, the center of interest is changing for individuals who suffer from a chronic disease, shifting from the disease to the patient. Today, the patient is looked at comprehensively, and he is taken care of in terms of health and social care. Chronic disease is viewed through several disciplines, and each scientific discipline has its own point of view, research methods and evaluation (Frej, 2017).

The global goal by 2030 is to have all countries of the world create comprehensive strategies to more effectively reduce these causes of death. An estimated 41 million people died from NCDs worldwide in 2016, accounting for 71% of all deaths. These deaths were caused by four non-communicable diseases, namely:

  • cardiovascular diseases (17.9 million deaths),
  • cancer (9.0 million deaths),
  • chronic respiratory diseases (3.8 million),
  • diabetes (1.6 million deaths), (WHO, 2020).

The continuous increase of civilizational diseases and the necessity of their complex solution requires the essential education of social workers in the given area (Belovičová, 2019).

Social work should respond to challenges in the field of education, given the main national health problems that are caused by the aging of the population, chronic conditions, emerging and re-emerging deep inequalities in the field of health, which are the result of social injustice. In response to these challenges, social work should broaden its practice to focus specifically on improving client care. The best way to meet this challenge is to strengthen outcomes assessment to emphasize the value of the profession and broaden the practice lens to engage social work more with population health, prevention, promotion of health equity, and advocacy (Browne, Keefe, Ruth, et al. 2017).

After the adoption of the Act on Social Services and other reform laws, the Slovak Republic continues to experience a lack of qualified social workers in the field of healthcare, as the top management of healthcare facilities does not show interest in social work as a field that helps in the coordination of social and health services. Healthcare does not have any legislation that would effectively include social workers in healthcare facilities who would sufficiently cover all aspects with all appropriate conditions (Dobda, 2018).

EDUCATION OF SOCIAL WORKERS

The educational preparation that a person receives at university is not sufficient for the current labor market. Flexibility, the ability to modify and expand one's professional skills and abilities is important for its work and professional application, as well as its working career. This places new demands on educational institutions, which must build a broader portfolio of competencies for their students and graduates. At the same time, they should focus mainly on strengthening the ability of adaptability, providing foundations that can be structurally modified for the needs of professional application (Gajdošová, 2018).

Law no. 219/2014 Coll. on social work and on the conditions for the performance of certain professional activities in the field of social affairs and the family and on the amendment and addition of certain laws § 4, paragraph 2, points to the need for continuous education in social work, part of the professional qualification for the performance of social work is the completion of education for supplementing, maintaining and improving the knowledge and skills that are necessary for the performance of social work. In the Slovak Republic, it provides further education of social workers, for example:

  • Association of educators in social work in Slovakia,
  • Association of Supervisors and Social Counselors,
  • Academy of Education and Research in Social Services,
  • Council for counseling in social work,
  • Institute of further education for social workers.

The main purpose of ISVP is to ensure the development of social knowledge and skills of social workers, as well as those interested in certified education in the field of Social Work (Minarovičová, Kováľová, 2014).

EDUCATION OF SOCIAL WORKERS ABROAD

All educational institutions must follow the global standards of social work education formulated by the International Association of Schools of Social Work (IASSW) in the World Guide to Social Work Education publication. This publication documents the differences and similarities of social work education through the description of educational programs in each of the member states (Mátel, 2013).

In Ukraine, since 2016, the process of creating a national public health system has been under construction, on the basis of which important documents were created at the national level. These are the Law of Ukraine on the public health system, regulations of various ministries and a number of government regulations. At the Ministry of Health of Ukraine, the National Center for Public Health began to work actively, and centers began to be created and work in the regions. While building the public health system, Ukraine found that it did not have enough public health specialists. The education system was not sufficiently prepared for this challenge (Mironyuk, 2019).

The Czech Republic, Germany, Austria, as well as the Slovak Republic, have the entire field of further education of social workers based only on the spontaneous activities of educational institutions or civic associations, which many times unsystematically support the improvement of certain activities in the form of short-term educational programs. The system of further education of social workers is very well developed in Hungary, which adopted the law on further education of social workers. We can find a very well-developed system of so-called extension studies after completing a master's degree in the field of social work in the USA (Schavel, 2010).

The US Department of Health and Human Services HHS emphasizes the education and training of health care social workers to serve the needs of people who suffer from chronic illnesses (Harkey, 2017).

Interprofessional education (IPE) for the health professions has proliferated in the US educational landscape over the past decade. Accordingly, the central administration at the University of South Carolina (USC) created an international education committee, which quickly expanded from five members representing five schools and colleges in 2011 to more than twenty. In 2014, this education committee was tasked with providing students from these schools with opportunities for education and IPE delivery. The most significant effort of this committee was the creation and implementation of the IPE core class "Transforming Healthcare for the Future." In 2014, the class included over five hundred students, including all students in the Physical Therapy Program, Public Health and Social Work, and the Department of Communication Sentences and Disorders. Due to different requirements for the curriculum and accreditation of separate programs, courses were created for the fields of medicine, nursing, pharmacy, public health and social work. The main objectives of the course were to focus on:

  • roles and responsibilities,
  • values and ethics for interdisciplinary practice,
  • interdepartmental communication,
  • teamwork.

The courses, which students completed either individually or in small groups, included 3 live sessions and a series of 6 web-based modules through experiential activities (case discussions, readings, interactive exercises, and systems-based problem analysis) conducted in interprofessional teams. This course provided students with basic knowledge of the basics of teamwork, collaboration, care and improved communication in complex healthcare systems. In an interprofessional context, the course allowed students to explore the art and science of teamwork and communication skills, ethical issues, health care disparities, and patient safety, with expanded content since 2014 on cultural competency, social determinants of health, and psychosocial issues relevant to patient care. IPE efforts strive to focus on population health by incorporating public health and social work students into the integration of success. This model may serve for other universities interested in incorporating public health and social work students and faculty into their interprofessional health education programming (Addy, Browne, Blake, et al., 2015).

DISEASES OF CIVILIZATION AND THEIR CAUSES

Imagine a person suffering from a chronic illness as if walking on the dividing line between the past and the future. When he looks back at his life, he sees what the disease took from him and what he had to give up, he does not see his future clearly, there is no way back (Jackson, 2014).

Illness is an expression of the disharmony that takes place between body, mind and soul. We cannot implement treatment until we understand the meaning of the disease and find its cause, because each image of the disease has its own face and statement (Hunyadiová, 2017).

Civilization diseases include:

  • cardiovascular diseases (ischemic heart disease, strokes, myocardial infarction),
  • cancer,
  • respiratory diseases – chronic respiratory diseases,
  • diabetes mellitus,
  • obesity,
  • nervous and psychological disorders,
  • allergy (Sásíková, 2018).

Civilization diseases are widespread worldwide and their incidence is constantly increasing. Three important factors are present in civilization diseases, namely the host, the environment and the disease factor. At the end of the twentieth century, people are increasingly exposed to stress and at the same time the environment in which they live is deteriorating. People do things that are against the laws of nature and detach themselves from it. Society no longer accepts food in its natural composition, people's lifestyle and diet has deteriorated nowadays. On the basis of this and other circumstances, chronic diseases began to manifest themselves, in other words, civilizational diseases. There are several theories related to the growth of chronic diseases. One of them is that the life expectancy of the population increases and the probability of the occurrence of chronic diseases automatically increases. (Frej, 2017).

The Global Burden of Disease (GBD) divided the risk factors of civilization diseases into:

  • Modifiable behavioral risk factors – physical inactivity, poor diet, smoking, alcohol use.
  • Metabolic risk factors - contribute to four key metabolic changes. These include high blood pressure, being overweight, hyperglycaemia (high blood glucose) and hyperlipidaemia (high blood fat).

Number of deaths according to the systematic analysis for the study of GBD:

  • Smoking accounts for more than 7.2 million deaths each year, including the effects of exposure to secondhand smoke.
  • 4.1 million deaths per year due to excessive salt intake.
  • More than half of the 3.3 million annual deaths are caused by alcohol.
  • 1.6 million deaths per year are attributed to insufficient physical activity.

The leading metabolic risk factor globally is elevated blood pressure, which accounts for 19% of global deaths. It is followed by overweight, obesity and elevated blood glucose (GBD, 2015).

According to the World Health Organization, stress is classified as a health epidemic of the 21st century. It is a normal physical and psychological response to sudden danger and prolonged challenges. The human body releases a dose of chemicals, adrenaline, during stressful events. Stress in the short term can be helpful, it gives us energy to get things done. In the long term, stress leads to serious health problems (Drummond, 2019).

PREVENTION OF CIVILIZATION DISEASES

According to the WHO, an important way to prevent and control non-communicable diseases is to reduce the risk factors associated with these diseases. Governments and other stakeholders should use low-cost solutions to reduce common modifiable risk factors. In order to guide policies and priorities, it is important to monitor the progress and trends of non-communicable diseases as well as their risks. If we want to reduce the impact of non-communicable diseases on individuals and society, a comprehensive approach is needed, requiring cooperation from all sectors, including health, finance, education, agriculture, transport, planning and others, aimed at reducing the risks associated with non-communicable diseases. Their intervention for prevention is also important. Management of NCDs includes detection, screening and treatment of these diseases. It provides access to palliative care for people in need. The next steps of interventions for non-communicable diseases, which have a high impact, can be achieved by strengthening early detection and early treatment through primary health care. Such interventions are excellent from an economic point of view, as they can reduce the need for costly treatment if provided to patients in a timely manner (WHO, 2018).

It is necessary to devote enough time to educating clients in the area of ​​lifestyle change, it is a long-term process in the range of months and sometimes even years. We can achieve a more effective and long-term effect thanks to longer educational interventions. Repeated inspections in the form of recurring meetings are important, or we can use information and communication technology tools such as e-learning, telemedicine, social media, eHealth and digital records. We must thoroughly motivate the patient to change his lifestyle by pointing out the development of serious complications and permanent consequences if they do not follow the recommended treatment measures. These measures concern not only the use of prescribed medicines, but also individual responsibility in observing non-pharmacological measures, among which we recommend lifestyle modification, sufficient physical activity, weight loss, quitting smoking, limiting alcohol, stabilizing blood pressure by avoiding stress (Rónayová, Dimunová, 2020).

SOCIAL WORK IN HEALTHCARE

We can define social work in healthcare as a specific activity that has the task of improving the overall health status of individuals, groups and the population. It is provided regardless of age, gender, disability, social affiliation, religion, culture and other socio-demographic differences of the individual, group and community. The purpose of social work in healthcare is to establish a social diagnosis and then implement social therapy. The basic goal is to solve social problems that arose during illness, health impairment, disability and old age. It is necessary to address the social consequences of illness and disability, which significantly affect the social situation of an individual or family, and also disrupt relationships in the social environment that have occurred in a person's life as a result of health and social changes (Šustrová, 2012).

Patients suffering from a chronic disease often experience physical, cognitive and emotional problems such as fatigue, pain, depression, anxiety, panic attacks, memory loss, balance problems, tremors, neurological sensations, difficulties with multitasting, difficulties in regulating emotions, muscle spasms and the like. These health problems are chronic, worsening, not disappearing and rather progressive in nature (Fine, 2015).

Social work in healthcare has the task of improving the life situation of those clients who cannot solve it on their own. It is a part of complex therapeutic and preventive care for a person (Mojtová, 2010). Social work, as well as modern medicine, works with the client from a holistic and integrated perspective. Holistic naming means the rebirth of medicine from a physiological and biological concept of health and disease to a dual and then holistic concept, which takes into account all the properties related to the psyche, physiology, social and spiritual dimensions of health and disease. Social work has the task of using the influence of the psychosocial field on the disease for better adaptation, overcoming difficulties, motivation for treatment, for cooperation and, consequently, for a better quality of life (Kuzníková et al., 2011).

High-quality comprehensive health and social care for citizens is a democratic message and right, which is fully declared and respected by the Constitution of the Slovak Republic. A healthy society must accept the rights of its citizens, make preventive, implementation and legislative efforts for each of its citizens, healthy, sick or disabled, so that they can function in all spheres of their lives. At the same time, society protects its citizens from negative factors that harm them and make their full life impossible (Barkasi, 2016).

The National Association of Social Workers (NASW) describes eight standards of practice that were created for health care social workers to provide high-quality care:

  • All medical social workers in the field of health care must act in accordance with the ethical code of social work.
  • They advocate for clients' rights to self-determination, confidentiality, access to support services and resources, and appropriate inclusion in the decision-making process that affects their overall health and well-being.
  • They support the participation of social work in the development, improvement and integration of the best practices in the health sector.
  • They support the participation of social work in improving the quality of the whole system and in research efforts in health facilities.
  • Promote social work participation in the development and refinement of public policy at the local, federal, state, and tribal levels to promote the well-being of clients, families, and communities served by the rapidly evolving health care system.
  • Increase the quality of social work services provided to clients and families in medical facilities.
  • Inform policy makers, employers and the public about the important role of social workers within the health care continuum.
  • To provide a basis for the development of materials and further education programs related to social work in health facilities.

For social workers, the first and second standards of practice are most important to keep in mind. Health social workers must work with clients in accordance with a code of ethics for social work, which is rooted in a set of core values. Interpersonal relationships, building a positive and lasting relationship with clients by the social worker, whose primary goal is to provide services and promote social justice for all clients, ensuring the fulfillment of all medical and psychological services, are important.

By using education, research and applying them in practice, social workers in the health sector increase their professional competence. Medical social workers defend patients' rights to self-determination. Medical personnel can demand and advocate for the best medical care for a patient, but each patient has the right to decide, based on treatment recommendations, whether to continue treatment. Sometimes there are moments when the patient is not able to speak for himself, for example, if the patient is a child or an adult who has cognitive impairments that prevent him from making decisions for himself. In this case, the family takes over decision-making, based on what is best for the patient (NASW, 2016).

The contribution of social workers to the social work and public health dimensions is that they are sufficiently qualified to significantly influence public health with their orientation to the person in the environment, their skills covering case management, advocacy, policy, clinic, community involvement and community organizing, their sensitivity to communication skills and cultural competence (Zelnick, 2015).

Social work in the field of public health combines the preventive aspect of public health and the orientation of social work to solving problems. Social workers understand the need for interventions tailored to specific populations, adopt a perspective centered on the person in the environment, in the family and provide insight into social conditions that negatively affect health and social determinants of health. On the basis of ongoing challenges, there is expected to be a growing demand for social work in the field of public health, students' interest in formal education, employers excited by the prospect of broader knowledge (Ward, 2015).

Tasks of a social worker in healthcare:

  • Focus on finding clients who need help.
  • Assess the needs of your clients, their support networks and situations.
  • Devise plans to improve their overall well-being.
  • Helping clients adapt to life's challenges, including illness, divorce and unemployment.
  • Help clients solve crisis situations, natural disasters, child abuse.
  • Assisting clients in working with government organizations to obtain benefits.
  • Collaborating with public health communities to prevent public health problems.
  • Contact clients personally and take an interest in their life situation, whether their problem situation has improved (Allen, Spitzer, 2016).

A health social worker helps patients understand their diagnosis and make necessary changes in their lifestyle, housing and health care. It helps people transition from hospital back into their homes and communities, while providing information about services such as home health care or support groups to help them manage their illness. At the same time, social workers are helpful to doctors and other health workers. They help them understand the effects that diseases have on patients' mental and emotional health. From 2019 to 2029, the U.S. Bureau of Labor Statistics projects that employment of social workers in health care will grow by 14 percent, which is much faster than other occupations. Social workers will be needed to help aging populations and their family members adjust to new treatments, medications, and lifestyles (U.S. BLS., 2020).

CONCLUSION

New facts and specifics in the job positions of social workers require constant professional improvement. Creating a system of lifelong education of social workers is one of the relevant possibilities. Graduates of the study field of social work, who in practice encounter various problems while working with clients, point to the need for further education as part of lifelong learning. (Schavel, 2010).

Social workers need public health training to work in the emerging areas of the new health care system. Great emphasis is placed on the need for further education in social work in the field of public health, prevention and population health. The job outlook for health social workers will depend on whether social work awakens to the skills and opportunities of social work in public health. It will begin to expand beyond individually targeted interventions and expand into prevention and other areas of public health. In general, all opportunities for prevention and public health depend on investment and funding from society (Ruth, 2015).

By educating social workers in the issue of civilization diseases, we increase the rate of assistance to chronically ill individuals. We help them feel less isolated and give them hope that social work as a profession is doing everything to improve their quality of life. We firmly believe that in the near future the position of social workers in other departments will be adjusted in Act No. 219/2014 Coll. about social work, as well as their possibility of completing specialized education, specifically in the field of civilizational diseases.

Authors: Mgr. Miroslava Weiss doc. MUDr. Mária Belovičová, PhD.

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