In a broad sense, the term "welfare" refers to the well-being of an individual or group. "Welfare" is also used in reference to a set of government programs meant to provide assistance when circumstances threaten the well-being of an individual or family. Groups other than the government also provide social services. Some, such as Goodwill and the Salvation Army, provide social services as part of their main mission. Provision of social services is a side issue for other organizations such as churches. However, many church denominations operate dedicated social welfare organizations, such as the St. Vincent de Paul Society (Catholic) and the Jewish Family and Children's Services. In times of crisis, some of the groups that provide social welfare services also provide disaster relief.
The World Health Organization (WHO) forms a link between health and the distribution of money, power, and resources. According to the WHO, the conditions in which people live influence a population's health. These circumstances are influenced by the distribution of money, power, and resources. The WHO's concern is that unequal distribution of money, power, and resources contributes to unfair and avoidable differences in health. The WHO takes the position that social welfare systems ought to address social and economic conditions that contribute to illness and prompt the need for medical care in the first place. The WHO aims to improve poverty, social exclusion, unemployment, and poor housing, which prompt the demand for medical care.
In 2002, at the Social Determinants of Health Across the Life Span Conference held in Toronto, Canada, social scientists identified 11 social determinants of health: early life, education, employment and working conditions, food security, gender, healthcare services, housing, income and its distribution, social safety net, social exclusion, and unemployment and employment security.
A sampling of nongovernmental programs offering social services in the United States includes Catholic Charities, Jewish Family Services, Lutheran Social Services, the Salvation Army, Volunteers of America, Habitat for Humanity, Prison Fellowship (assistance for prisoners, ex-prisoners, and their families), and Teen Challenge (recovery programs for addicts.)
Historically, churches have provided for both spiritual and physical needs for their members, especially in instances where the church was a political and economic force. There is a verse in the Bible that instructs people to feed the hungry, give drinks to the thirsty, welcome the stranger, clothe the naked, and visit the sick as well as those in prison (Matthew 25:35).
When King Henry VIII established the Anglican Church in 1534, he removed responsibility for social welfare from the Catholic Church and placed it instead with the state. Justices of the Peace were authorized to raise funds for the relief of the poor. In addition, the poor were put into different categories: those who wanted to work but could not because of unemployment in the area or lack of skills (deserving poor); those who could work but would not (idle poor); and those who were too old, too ill, or too young to work ("impotent" or deserving poor).
In 1601, the Elizabethan Poor Laws placed responsibility for welfare on the 15,000 local church parishes in England and Wales at the time. Two types of relief were offered: "outdoor relief," which called for the poor to remain in their homes and receive funds or "in-kind" hand-outs, such as food or clothes; and "indoor relief," which called for the poor to be placed in a poorhouse, hospital, orphanage, or workhouse, depending on circumstances. These Poor Laws attempted to make a distinction between those who were poor due to illness or because of factors such as an especially harsh winter, and beggars, who relied on charity as their sole livelihood.
Recognizing that state-run services did not reach many in need, St. Vincent de Paul established the Ladies of Charity in 1617.
The British Parliament's Poor Law Amendment Act in 1834 provided for countrywide central control over relief services. Local decisions were still needed and were made by local administrators who supervised locally elected "guardians." The law also eliminated welfare outside of the workhouse. This provision proved unworkable, however.
Partly as a result of the thoughts expressed by Reverend Henry Solly in his paper "How to Deal with the Unemployed Poor of London, and with its 'Rough' and Criminal Classes," England's Charity Organization Society was founded in 1869, with the intent of filling in gaps in state-run relief programs, and combating both double-coverage and double-dipping. The organization was formed with the intent of coordinating the activities of many groups providing relief.
The U.S. federal government's earliest program for public welfare was soldiers' pensions, which, in one form or another, had been awarded to veterans since Revolutionary times. The groundwork for social welfare programs in the United States was laid during the Progressive Era in the early 20th Century, when state-run programs for workmen's compensation (in Wisconsin and ten other states in 1911) and relief for widows and children (in Illinois, also in 1911) were introduced. Over time, such programs were adopted by all states.
In 1933, President Roosevelt created the Federal Emergency Relief Administration to grant states matching funds for state and local unemployment outlays. The measure was later expanded to provide medical care to recipients of unemployment relief programs. In 1935, the Social Security Act was passed. In addition to establishing the insurance program now known as Social Security, the legislation provided unemployment insurance, old-age assistance, aid to dependent children, and grants to states so that they could provide various forms of medical care. The Social Security Amendments of 1954 made accommodations for worker disability.
In 1965, the Medicare bill provided health coverage to almost all U.S. citizens 65 years of age or older. Originally an agency under the Department of Health and Human Services, the Social Security Administration was established as an independent agency in 1995. Social Security had responsibility for the Medicare program until a 1977 reorganization created the Health Care Financing Administration (HCFA), at which time the HCFA assumed administrative responsibility for Medicare. In 2001, HCFA was renamed the Centers for Medicare & Medicaid Services.
In 1972, Congress federalized what had been called "adult categories" by creating the Supplemental Security Income program within the Social Security Administration. Adult categories included those who needed assistance because of age, blindness and, after 1950, other disabilities. As a result, some three million individuals left state welfare rolls and were cared for under the Social Security Administration.
In order to address perceived abuses, such as participants not seeking work or people having children in order to receive higher welfare payments, the welfare system was revamped in 1996 with the Personal Responsibility and Work Opportunity Reconciliation Act (Welfare Reform Act). Control of welfare programs was returned to states and funded through federal block grants. The legislation placed time ceilings, initially two years (now five), on certain kinds of aid and included work requirements. In addition, rules for qualifying for Supplemental Security Income were tightened by disallowing benefits for many legal immigrants and those disabled by drug or alcohol addiction.
In 1999, the Ticket to Work and Work Incentives Improvement Act became law, providing disability beneficiaries with a voucher for vocational rehabilitation services and employment services. The law also provided incentive payments to service providers when beneficiaries returned to work.
In 2001, President George W. Bush established the federally funded Office of Faith-Based and Community Initiatives (OFBCI) by executive order. The goal of the OFBCI is to improve faith-based and community-based programs and increase their capacity to provide federally funded social services. He also established Centers for Faith-Based and Community Initiatives at the Departments of Health and Human Services, Housing and Urban Development, Labor, Justice, and Education. Eventually, Centers for Faith-Based and Community Initiatives also were established at the Departments of Agriculture, Commerce, Homeland Security, Veterans Affairs, the Small Business Administration, the Agency for International Development, and the Corporation for National and Community Service.
Religious communities often contribute time and money to programs to help the needy on a local, regional, national, and international basis. Examples include local food banks and soup kitchens, continuing efforts to provide labor and money to help Gulf Coast victims of Hurricane Katrina, and participation in overseas mission trips.
President Barack Obama's administration has left in place the basic faith-based structure established by the Bush administration and has established a 25-member President's Advisory Council. According to the Rockefeller Institute, President Obama appears to favor more of a policy-setting role, compared to the Bush program, which generally funded community programs through federal agencies.
General: The provision of U. S. social welfare is important, because it affects most citizens, either as participants in a social-service program or as financial supporters by means of payroll deductions and taxes. Today, one in seven Americans receives a Social Security benefit, and more than 90% of all workers are in jobs covered by Social Security. Federal spending on Social Security, Medicare, Medicaid, and Unemployment/Welfare and "other mandatory spending" in 2008 was $1.5 trillion (52% of the overall federal budget of $2.9 trillion). The $1.5 trillion does not include the funds used to administer the Departments of Health and Human Services ($63.3 billion), Housing and Urban Development ($35.2 billion), and Education ($56.0 billion), all of which have at least some involvement in the administration of social welfare programs.
Welfare coverage: Social welfare programs generally address human needs that are unmet due to unforeseen circumstances, usually beyond one's control, or that can arise due to one's stage in life or a disability. Broadly speaking, social welfare programs respond to unemployment, sickness, disability, widowhood, old age, motherhood, and childhood. Although most social service programs address individual and family needs, some provide aid to communities, such as economic development grants or publicly funded housing programs. Medicaid is a federally funded but state-run program, and qualification requirements and program elements vary from state to state.
Welfare recipients: Some services are rights-based. That is, they are available by virtue of the recipient's belonging to a group or class, such as by being a citizen. In countries such as Canada, for instance, it is the right of all citizens to have free access to healthcare services. Other services, such as most welfare services in the United States, are available only to those who demonstrate that they are in need (means-tested).
Providers and administrators of social services: Social service programs may give people money directly, pay service providers, provide insurance so that service providers are paid, or provide the services themselves. The needy may be helped by federal, state, or local (city or town) social welfare programs. Local branches of national or international welfare organizations such as the Salvation Army and Goodwill also provide services. Religious communities provide aid both through local ministries and national or international organizations. A wide range of civic organizations such as the Lion's Club and Kiwanis International offer aid as part of their community-service charter. Trade unions have a long history of providing for the needs of their members, and they were a principal provider of unemployment compensation prior to the broad adoption of state-run unemployment insurance programs early in the 20th Century.
In the United States, the social welfare system is fragmented, because it is not really a true "system." The Rockefeller Institute explains that human service programs were created at different times and are funded differently. Some are government-administered while others are administered by private organizations. Also, human service programs have different goals, rules, and administrative processes. Therefore, both clients and practitioners may see the "social services system" as confusing and difficult to manage.
The connection between the social services system and the individual or family in need is the case worker. The case worker understands details about services offered and qualification parameters. Through personal meetings, telephone calls, and application forms, the case worker learns about the individual or family applying for aid, and can therefore make informed recommendations both to those seeking aid and the agency that employs the case worker. In addition to facilitating the application process, the case worker can guide applicants to services offered by other organizations.
Social service administrators:
There are several government-run welfare programs in the United States.
Temporary Assistance for Needy Families (TANF) provides cash to households with little or no money to enable the care of children, the elderly, or other household dependants. To qualify for this benefit, heads of households must agree to participate in work programs or occupational training.
General Assistance (GA) is a program providing limited-time cash assistance to single adults or married couples without dependent children who have medical or mental health limitations that keep them from working for longer than 30 days. Programs vary from state to state.
Supplemental Security Income (SSI) is a federal income-supplement program designed to cover the cost of basic needs (food, clothing, and shelter) to aged, blind, and disabled people who have little or no income.
The Child Support Program either subsidizes or provides 100% of child-care fees so that parents or caretakers are available to work or participate in job training. Utah's Child Care Subsidy program is available to parents who are employed or in an occupational training program, and whose income does not exceed family-size-related levels. Although individual states are responsible for administering many social welfare services, and although there are differences state by state, both in services provided and qualification parameters for determining income levels, states use poverty-level guidelines, which are published each year by the U. S. Department of Health & Human Services.
Utility assistance programs provide the needy with heat, electricity, gas, or water. Like the child support program, the program provides a subsidy or full payment. The state of Utah's Home Energy Assistance Target program provides utility payment assistance to the disabled, elderly, and families with preschool-age children that meet certain requirements.
The Supplemental Nutrition Assistance Program (SNAP), formerly called the Food Stamp Program, helps households acquire food, freeing what income they have for other uses. Applicants must meet certain requirements. For instance, lawful permanent residents who are active duty members or veterans of the U.S. armed forces, or are a spouse or a child of a veteran or active duty service member, can apply if they meet income requirements. Children of illegal immigrants who are born in the United States are U.S. citizens, so they qualify for many social service programs, including food stamps.
The Medical Assistance Program (Medicaid) provides state-administered medical coverage to those without medical insurance. Most of the time, those who are receiving TANF, GA, or SSI can receive full medical assistance benefits, covering visits to doctors, hospital visits, prescriptions, and most other medical expenses. Medicare, a similar program, is a rights-based program for citizens and permanent residents older than 65 years, and their spouses, who have worked at least 10 years in Medicare-covered employment. Some who are not 65 years and who are disabled or certain medical conditions may also qualify for Medicare.
Crime rate reduction: Describing the effects of his New Deal social welfare programs during an address to the National Parole Conference in 1939, President Franklin Roosevelt said that they would remove factors that contribute to crime. Since then, social scientists have examined their success.
A study published in 2007 examined the effect of per-capita relief spending on crime during the Great Depression. It found an inverse correlation between welfare spending and rates of burglary, robbery, and auto theft. It suggested that increasing relief spending by 10% would lower per-capita property crime 0.15-0.24% (statistically significant). Observing a difference of $50.60 (in 1967 dollars) in per-capita relief spending between 1932 and 1938 (the years with the greatest New Deal relief spending), it was determined that property crime was 24-39% lower than it otherwise would have been without the increased relief spending.
In 1998, University of Connecticut researchers found that higher levels of welfare assistance were associated with lower homicide rates. The researchers examined data from 437 large metropolitan counties in the United States. In 1988, the same researchers demonstrated that monetary assistance and welfare participation rates are inversely associated with property crimes.
In 2008, it was reported that crimes to obtain property (excluding offenses such as arson, assault, forcible sex, and homicide) increase by six percent from the beginning of the month, when food stamps are distributed, to the end of the third week after food-stamp disbursement. The researcher suggested that spreading payments out over time would smooth out and reduce levels of crime. Other studies have reported a higher consumption of drugs and food outside the home soon after individuals receive their welfare checks, concluding that people resort to crime when their welfare money has been spent.
Welfare may improve health: Income has been identified as one of the social determinants of health. Since cash allotments are a principal means of delivering social welfare, researchers have examined the relationship between income, poverty, and health. A study of two populations of adults totaling 28,131 in Copenhagen, Denmark, and its suburbs found individuals in the highest income quarter had lower mortality than those in the lowest quarter. The researchers also studied the relationship between community-based income disparities and mortality, and found none. Many social scientists consider that Denmark has a social-democratic regime, while the United States is said to have a liberal regime.
Classes of welfare states
General: A welfare state is generally a country that provides a great deal of social services that are rights-based rather than means-tested. One qualifies for rights-based services by one's membership in a group or class, such as by being a citizen. Means-tested services, on the other hand, are available only to those who demonstrate need. Politics undoubtedly influence social welfare programs. Social scientists often examine social welfare programs in light of underlying political systems. Danish social scientist Gosta Esping-Andersen proposed in 1990 such a grouping of modern, developed capitalist countries. In 1999, he admitted that welfare-regime schemes are set in place at a single point in time, and could not remain valid for long due to political changes.
Classifications of welfare states help social scientists and policy makers understand the relationships between a country's economic underpinnings and social welfare program design, funding, and effectiveness. Looking at poverty rates in what they called "advanced industrial democracies," researchers observed differences in wealth redistribution across three classes of welfare states (social democratic, conservative democratic, and liberal). They found that 22.3% of the population in liberal welfare states (including the United States) aged 25- 59 had income less than 50% of the median (in other words, they were poor) before taxation and transfer. After taxation and transfer, 13.0% could be classified as poor. In Christian democratic welfare states, which included Germany, redistribution of wealth by taxation and transfer moved the poverty level from 18.4% to 8.3%.The effects of taxation and transfer are most pronounced in social democratic welfare states (such as Sweden), where redistribution moved the poverty line from 18.5% to 4.1%. Despite the presence of means-tested programs directed at the poor, liberal welfare states had the highest poverty levels and lowest degree of poverty reduction, perhaps because the programs are not generous enough.
Liberal regime: A liberal regime relies on market forces, directing its social welfare programs mostly to those who demonstrate a need. Qualification tends to be strict, and programs are designed with incentives such as "minimum-subsistence level" payments, in order to encourage recipients to leave the public dole. Most programs are funded through taxes rather than through payments by participants. Used by the United States, Australia, New Zealand, Canada, United Kingdom, and Ireland.
Conservative regime: Philosophically, a conservative regime targets the family with its welfare programs. Conservative regimes rely more on compulsory contributions for funding. Program participation depends on occupation, level of earnings, and level of contribution. Used by Germany, Italy, Japan, France, Finland, and Switzerland.
Social democratic regime: A social democratic regime provides a high level of social services for all citizens. Funding is through taxation. Used by Austria, Denmark, Belgium, Norway, Netherlands, and Sweden.
Poverty and poor health: A principal mission of the social welfare system is to provide access to healthcare . The WHO says that those in wealthy countries such as Germany pay as little as 11.3% of medical expenses directly, with social health insurance or the government paying the rest. On the other hand, in low-income countries such as the Democratic Republic of the Congo, 90% of medical expenses are paid directly by households to healthcare providers. When healthcare demands a large portion of one's income, health can be affected in two ways. First, people may not seek medical care or may discontinue treatment because they do not have enough money. Second, in order to seek or continue medical care, people may divert funds from other necessities of life, such as food, clothing, or housing.
Social services programs open the healthcare system to individuals who otherwise may have been excluded. Social service programs affect health indirectly, as well. A study published in 2007 examined the relationship between welfare spending and infant mortality. Infants under one year of age comprise the population most vulnerable to economic downturns. The researchers found that welfare spending reversed the short-term increase in infant mortality that occurred after the beginning of the depression and before the New Deal relief programs took effect. The New Deal relief programs also reduced suicides, deaths due to infectious, parasitic, and diarrheal diseases, and possibly homicides.
Poverty is associated with poor health, including poor nutrition, higher anxiety levels due to the lack of resources, employment in work that may include occupational hazards, increased exposure to crime, and less access to medical care. Welfare payments are meant to alleviate such problems by increasing income, presumably allowing recipients to behave in a more healthy way. Medicaid increases access for the poor to medical care.
Research has linked economic inequality with health inequities. It has been reported that economic inequality weakens population health by creating poverty. Social- and health-support infrastructures become weaker because of economic inequality. Economic inequality reduces social cohesion and civil commitment. Such research is valuable in the public health sector to guide policy making intended to reduce economic inequality.
With 6.3 deaths per 1000 births, the United States is ranked 33rd in infant mortality, according to United Nations World Population Prospects 2006. However, the United States is ranked first in per-capita healthcare spending, according to the World Health Organization (WHO).
Urban planning: Health disparities between people of different races and economic classes have been linked to factors in the urban planning domain, such as housing, transportation, streetscapes, and community or social capital. There often is a disconnect between urban planners and those making policy for healthcare social services. Psychological stress has resulted when urban restructuring caused demolition of houses. Social welfare systems may be poorly equipped to handle the consequences of urban renewal. There is a need for better collaboration between those responsible for city planning and those responsible for providing social services. Land-use decisions and the influence of the "built land" on population health should be considered.
FUTURE RESEARCH OR APPLICATIONS
Limiting social welfare programs: Independent regulatory bodies may be agents for both performance improvements and social justice. Continued research into the role of individual responsibility may help fine-tune the rationing process, giving administrators the ability to control the aid provided to those who are needy because of their own doing. Tightening the qualification parameters for Supplemental Security Income in 1996 to stop providing assistance to drug addicts, alcoholics, and legal aliens is an example of fine-tuning the rationing process.
Central vs. local control: The issue of central vs. local control persists and is one of concern. Responsibility for most U.S. social welfare programs was transferred to individual states in 1996, and block-grant federal funding was provided to states. However, challenging economic times can soften funding commitments and can threaten state and local governments' own revenue-generating capabilities. As a result, researchers at the Rockefeller Institute believe that there are increasing differences in social service programs among states, because states with high income levels used their own funds to compensate for withdrawn federal funds, and poorer states could not. As a result, the system is creating gaps in service availability. Policy makers will need new input from social scientists to prioritize addressing the gaps.
Updating welfare-state classifications: When classifying types of welfare states in the 1990s, Gosta Esping-Andersen examined developed capitalist countries only.
Preparing for population shifts: Immigrant Latino families and children represent the fastest-growing population in the United States. Special training programs for child welfare workers are needed to accommodate the unique needs of this population. Those needs include cultural and language differences, complex immigration-related legal concerns, issues related to civil rights, and limited access to healthcare due to a high proportion without insurance.
U. S. Healthcare System Overhaul Debate: The U.S. government is currently trying to overhaul the healthcare system. The specifics are numerous and are being vigorously debated. In particular, there are differences in opinion about the cost of the program and tactics for ensuring that healthcare is available to all. The United States is not alone among developed countries with healthcare problems. In fact, the National Center for Policy Analysis says that all developed countries face rising costs, inadequate quality, and incomplete access to care.
This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
- Corburn J. Confronting the challenges in reconnecting urban planning and public health. Am J Public Health. 2004 Apr;94(4):541-6.
- Dettlaff AJ, Rycraft JR. Adapting systems of care for child welfare practice with immigrant Latino children and families. Eval Program Plann. 2009 Jul 16.
- Kabisch S. Urban shrinkage and challenges for the public health-care service. Gesundheitswesen. 2007 Oct;69(10):514-20.
- National Center for Policy Analysis (NCPA). http://ncpa.org
- Natural Standard: The Authority on Integrative Medicine. www.naturalstandard.com
- Nunes R, Rego G, Brand©o C. Healthcare regulation as a tool for public accountability.
Med Health Care Philos. 2009 Aug;12(3):257-64.
- Osler M, Prescott E, Gr©nb©k M, Christensen U, et al. Income inequality, individual income, and mortality in Danish adults: analysis of pooled data from two cohort studies. BMJ. 2002 January 5; 324(7328): 13-6.
- Raphael, D. Health inequities in the United States: prospects and solutions. J Public Health Policy. 2000;21(4):394-427.
- The National Bureau of Economic Research (NBER). www.nber.org
- The Nelson A. Rockefeller Institute of Government. www.rockinst.org
- U. S. Department of Housing and Urban Development. www.hud.gov
- Social Security Online. http://www.ssa.gov
- Welfare Information. www.welfareinfo.org
- World Health Organization (WHO). www.who.int
Copyright © 2011 Natural Standard (www.naturalstandard.com)