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An Evaluation of the Public Health Paradigm: A View of Social

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An Evaluation of the Public Health

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Rachelle Ashcroft
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DOI: 10.1080/19371918.2014.893856

An Evaluation of the Public Health Paradigm:

A View of Social Work

Rachelle Ashcroft
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School of Social Work, Renison University College, University of Waterloo,

Waterloo, Canada

This article engages in a critical review of the public health paradigm to determine the compatibility
with social work’s guiding value of social justice. This critical examination explores the history,
epistemology, and view of health underlying the public health paradigm. Implications of the public
health paradigm’s view of health on social work practice and discourse is examined.

Keywords: Public health, paradigm, social work, discourse

It was during my social work practice that I became curious about the broader health context
and how that may be assisting or hindering my practice. I wondered about the comingling of
assumptions and beliefs that inform health care structures and that may be affecting on my social
work practice. Mostly, I wanted to know what assumptions and beliefs in the health care context
could best assist me as a social worker to meet the needs of the clients and families that I was
working with. For that reason, I began an academic investigation examining the most dominant
health paradigms to determine how consistent health paradigms—like public health—are with
social work’s core value of social justice.
This article engages in a critical review of how the public health paradigm is consistent with
social work’s guiding values and examines the implications of the public health paradigm’s view
of health on social work practice and discourse. My use of the term paradigm is inspired by Kuhn
(1996) in two different ways. Kuhn (1996) described paradigm in a way that it “stands for the entire
constellation of beliefs, values, techniques, and so on shared by the members of a given commu-
nity” (p. 175). Second, paradigm also “denotes one sort of element in that constellation, the con-
crete puzzle-solutions which, employed as models or examples, can replace explicit rules as a basis
for the solution of the remaining puzzles” (p. 175). Paradigm has been a useful way to conceptu-
alize assumptions and beliefs that contribute to a particular health community (Ashcroft, 2010).

SOCIAL WORK VALUES IN PRACTICE

The deconstruction of the public health paradigm is done in a way to explore compatibility with
social work values—in particular social justice. Social justice is the pursuit of equity in society

Address correspondence to Rachelle Ashcroft, School of Social Work, Renison University College, University of
Waterloo, 240 Westmount Road North, Waterloo, Ontario, N2L 3G4, Canada. E-mail: rachelle.ashcroft@uwaterloo.ca
Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/whsp.

606
 PUBLIC HEALTH PARADIGM 607

and is “concerned with human well-being” (Powers & Faden, 2006, p. 15). As Payne (2005)
pointed out, it is one of the profession’s core values. In particular, “social workers promote social
fairness and the equitable distribution of resources, and act to reduce barriers and expand choice
for all persons, with special regard for those who are marginalized, disadvantaged, vulnerable,
and/or have exceptional needs” (Canadian Association of Social Workers [CASW], 2005, p. 5). In
this article, coherence with social justice means that we will need to examine the larger systemic
and structural forces impacting on health, while constantly recognizing that “inequalities are
interactive” (Powers & Faden, 2006, p. 5). This widens our focus beyond individual distributive
justice and signals a departure from the prevailing view of social justice as embodied in most of
the current scholarship on the subject (Powers & Faden, 2006). In a World Health Organization
(WHO) report, Friedli (2009) described a need for the inclusion of social justice in mental health:
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“a focus on social justice may provide an important corrective to what has been seen as a growing
over-emphasis on individual pathology” (p. iv). Social workers who consciously incorporate social
justice into their practice do so in a manner that will “attempt to address immediate crisis and
emotional pain while keeping in mind the bigger picture of oppressive policies, practice and
social relations” (Baines, 2007, p. 5). Although social work as a profession does not materialize
in the same way everywhere (Payne, 2006a), its underlying values tend to be congruent from one
place to the next—which encourages the sort of value-based exploration I will conduct in this
article.

TYPOLOGY OF SOCIAL WORK

To understand the relationship of social work within the public health paradigm, I will draw
on Payne’s (2005, 2006b) typology of social work. Payne’s typology helps to demonstrate how
individual health paradigms conceive of health and impact on social work practice. Payne’s (2005,
2006b) typology has been used for a similar type of deconstruction of the social determinants of
health and political economy paradigms (Ashcroft, 2010). Payne (2005, 2006b) described three
fundamental views of social work; each of these views outlines a particular way of the interplay
that manifests (Payne, 2005, 2006b). All three views shape social work practice to various degrees
(Payne, 2005, 2006b). These three views of social work are: the therapeutic view, social order
view, and transformational view.
The therapeutic view strives for an optimal well-being and growth of the clients and commu-
nities that social workers are involved with (Payne, 2006b). The social order view sees social
work a component of welfare services to individuals within society (Payne, 2006b). Here, social
workers meet individuals’ needs by adopting maintenance approaches. The intent of social work,
according to the social order view, is to assist people during periods of difficulties until time
that a state of stability is achieved. The transformational view of social work strives for social
change with the intention of fostering more egalitarian relationships in society so that the most
disadvantaged can obtain power (Payne, 2005, 2006b). The transformational view is guided by
values of social justice and equity, and believes personal or social empowerment cannot take place
without large-scale transformations (Payne, 2005, 2006b).
Because I have presented an overview of Payne’s (2005, 2006b) typology elsewhere (Ashcroft,
2010), I will not elaborate. However, I encourage those unfamiliar with Payne’s (2005, 2006b) to
seek out this alternate source or Payne (2005, 2006b) directly. Payne’s (2005, 2006b) typology
helps to determine the public health paradigm’s compatibility with social work’s core value of
social justice. Furthermore, Payne’s (2005, 2006b) framework is used as a method of evaluating
where social work may be typologically situated within the public health paradigm. Further,
Payne’s (2005, 2006b) typology also provides a systematic method that helps compare social
work between various health paradigms (Ashcroft, 2010).
 608 R. ASHCROFT

EPISTEMOLOGICAL WORLDVIEWS

Part of my deconstruction of how the public health paradigm affects social work will involve taking
into account various epistemological views. Epistemology as a philosophical domain explores
not only what constitutes knowledge, but also how knowledge is acquired and produced, what
is accepted as truth, and how truth is accepted as such. Epistemology guides what theories
we embrace and how we approach research. Maynard (as cited in Crotty, 1998) told us that
“epistemology is concerned with providing a philosophical grounding for deciding what kinds of
knowledge are possible and how we can ensure that they are both adequate and legitimate” (p. 8).
In this article I will use epistemology as an analytical lens through which I will seek to clearly
recognize, explore, and evaluate what is promoted as knowledge—including underlying beliefs
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and values—within the public health paradigm.

PUBLIC HEALTH PARADIGM

The public health paradigm is pervasive in influencing contemporary health and is historically
rooted in the West. Charles-Edward Winslow defined public health as: “the science and the art
of preventing disease, prolonging life, and promoting physical health” by way of “organized
community efforts for the sanitation of the environment, the control of community infections, the
education of the individual in principles of personal hygiene” and “the organization of medical and
nursing services for the early diagnosis and preventative treatment of disease” (cited in Schneider,
2006, p. 5). This definition is still considered applicable today. Public health has a broad scope
and according to the Institute of Medicine (1988), the mission of public health is defined as “the
fulfillment of society’s interest in assuring conditions under which people can be healthy” (p. 7).
Public health’s essence is “organized community efforts aimed at the prevention of disease and
promotion of health” (p. 41). The public health paradigm has a broad scope and includes goals
and approaches aimed at the promotion of societal health.
A variety of contributors appear to have significantly shaped the development of the public
health paradigm. The state’s interest in controlling bodies en masse is thought to have developed in
the 18th century in conjunction with the birth of clinics, the growing demand for individual health
care, and the desire to maintain a strong labor force (Foucault, 2003; Lupton, 2006). Historically,
this is when Western societies began to consider “disease as an economic and political problem
for societies, not just an individual concern” which in turn directed the need for “collective control
measures” (Lupton, 2006, p. 34).
With the onset of industrialization, imperialism, and urbanization, the number of epidemic
diseases increased. This led to the rapid institutionalization of local health departments in seaports
and industrial urban settings (Turnock, 2009). “Concerns about the spread of infectious diseases
such as cholera, smallpox, yellow fever and the plague : : : resulted in measures being taken by
the state to confine bodies and control their movements” (Lupton, 2006, p. 33). By the turn of
the 18th century in the West, charitable and religious organizations were “supplanted by state
apparatuses directed towards policing behaviours believed conducive to the spread of disease”
(p. 34). Along with religious institutions, the social elite and men of wealth took responsibility
for public health provisions (Scutchfield & Keck, 1997; Solomon, Murard, & Zylberman, 2008).
The control of infectious diseases soon became the major focus of public health, and those
considered questionable were its primary targets (Powers & Fadden, 2006). According to Lupton
(2006), “immigrants to Canada were especially targeted by quarantine regulations and subjected to
medical examinations upon arrival, thus marking them as the dangerous, potentially contaminating
Other” (p. 33). The measures and strategies guided by public health at this time seemed to be
influenced more by political and public pressure than by scientific evidence because the causes of
 PUBLIC HEALTH PARADIGM 609

disease were in dispute. “Health regulations were : : : more in response to political influence or
pressure : : : than in response to shifts in scientific thinking” (Scutchfield & Keck, 1997, p. 11).
Quarantine and sanitationism were the primary methods employed by public health and were
promoted as the most effective methods to prevent the spread of disease.
The germ theory and bacteriology added legitimacy to the public health paradigm by linking
disease to specific microbes (Kunitz, 2007). “The germ theory : : : became a professional ideology
for : : : public health that was focused more on individuals than on the environment” (p. 13).
This provided a rationale for the need to monitor bodies and eventually led to the emergence of
epidemiology, which continues to be centrally situated in the public health paradigm. Epidemiology
studies patterns of disease that occur in human populations and attempts to localize the contributing
factors. It is often considered the basic science of public health; its central goal is to determine
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the causes of new diseases and provide prevention mechanisms to deter the spread of diseases.
“Epidemiologists look for common exposures or other shared characteristics in the people who are
sick, seeking the causative factor” (Schneider, 2006, p. 9). Any “risks to the health of populations”
are the central focus (Scutchfield & Keck, 1997, p. 4). The concept of “risk factor” evolved
from epidemiology’s foundation in statistics and continues to foster the belief that the society
requires surveillance by the state. “Disease became constituted in the social body rather than the
individual body, and deviant types were identified as needful of control for the sake of the health
of the whole population” (Lupton, 2006, p. 33). During the postwar period another shift in the
public health paradigm led to the institutionalization of the healthy lifestyle, in which individual
behaviors became a primary target of those seeking to prevent and manage illness (Solomon et al.,
2008).
The public health paradigm comprises a coalition of professions and consists mainly of those
disciplines associated with epidemiology and statistics, biomedical and environmental sciences,
and health policy and management. Understanding the health promoted by the public health
paradigm requires an understanding of the assumptions underlying epistemology.

Assumptions about Epistemology

The public health paradigm is largely influenced by an objectivist epistemology: it favors inquiry
that privileges medical science and professional knowledge. The primary means of attaining knowl-
edge is through scientific methodology. From this basis, the public health paradigm searches out
links between cause and effect but looks toward society as its object of investigation. Employing
scientific and rational modes of analysis, knowledge pertaining to disease causing microorganisms
can be identified. Linear cause and effect relationships guide knowledge production; objective truth
and knowledge can be derived only from the external world. Another objectivist characteristic of
the public health paradigm is its heavy reliance on statistics. By employing scientific knowledge
in a rational manner, the public health paradigm believes that its utilitarian goals toward health
can be achieved.
Epidemiology occupies a central position in the public health paradigm; it is primarily through
epidemiology that statistics are used to calculate risks, generate causal links, and provide guidance
and recommendations in the development and maintaining of standards of health. Knowledge of
standardized norms is devised and used to determine if the increase in disease frequency is above
the expected rate. Objectivism views knowledge interpretations and opinions of the expert as
reliable with professional knowledge legitimated and reinforced through license and regulation
(Harthorn & Oaks, 2003).
Although the public health paradigm is primarily informed by an objectivist epistemology, there
appears to be additional epistemological influence. For example, some scientifically controlled
studies include randomized controls while others that study “human populations, usually using
observational rather than experimental methods” (Schneider, 1996, p. 74). Further, additional
 610 R. ASHCROFT

epistemological influence appears in the public health paradigm’s use of “risk categories.” The
determining of risk categories in target populations involves an influence of social construc-
tionism. Thus, social constructionism is another influential epistemology in the public health
paradigm. Constructionism views meaning and knowledge as things that materialize from our
interactions with the world; meaning and truth are constructed, not discovered—and this can result
in different people formulating meaning and truth in different ways, even when referring to the
same phenomenon (Crotty, 1998). From this perspective, Berger and Luckman (1966) described
how knowledge is socially constructed and reified in social processes. Knowledge “is contingent
upon human practices, being constructed in and out of interactions between human beings and
their world, and developed and transmitted within an essentially social context” (Crotty, 1998,
p. 42).
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Knowledge and values that inform risk categories within the public health paradigm are often
based on universalized Western norms; thus, construction of risk categories is socially situated.
To disseminate knowledge in a way that increases the perception of risk, the construction of
“risk categories” is assumed to be a necessity in order to facilitate target measures. The public
health paradigm is especially interested in communities and localities, particularly when it defines
populations at risk. The concept of “locality” is itself an example rooted in constructionism in the
sense that what is “local” exists conceptually in relation to other locals or to the national. Knowl-
edge of what is considered “local thus appears as fundamentally negotiated between localized and
nationalized conceptions” (Solomon et al., 2008, p. 12).
Objectivism and constructionism meld together as influential epistemologies in the public
health paradigm. Objectivism assumes that citizens are rational and maintain agency to take
measures against the socially constructed “risk categories.” This is essential to how public health
realizes and develops its goals and strategies and relays health messages. The public health
paradigm develops knowledge but positions responsibility to act on knowledge as a community
responsibility. The public health paradigm is largely founded upon an objectivist epistemology
and is promoted as such by those within the paradigm. However, there are also elements of
social constructivionism within this paradigm that revolves around the development of risk, risk
categories, and the determination of the locale. Both epistemologies are influential in guiding the
public health paradigm’s assumptions about health.

Assumptions about Health

The public health paradigm perceives health on a broad scale: for instance, it considers how
disease affects whole populations, and primarily in biological terms. It assumes that human disease
is largely attributed to microorganisms, and major epidemics are the result of “bacteria, viruses,
or parasites” (Schneider, 2006, p. 139). The public health paradigm also assumes that individual
habits and behaviors contribute to disease and contamination and “regards the community as its
patient” (Schneider, 2006, p. 6). Public health is often preoccupied with anticipating the risk of
various forms of disease and illness (Harthorn & Oaks, 2003) and views health as something
that can be achieved through intentional acts of restraint, perseverance, and commitment (Lupton,
2006; Schneider, 2006).
The paradigm relies heavily on epidemiology to determine whether a disease should be consid-
ered relevant to public health. It assumes that by identifying the causes of disease it will arrive at
the correct strategy to prevent them. Public health takes as a central focus the personal risk factors
that are considered integral to the development of disease and poor health, such as smoking, diet,
and exercise. Knowledge is “overtly aimed at increasing perception of risk as a technique to
produce “12mphasiz change” (Oaks & Harthorn, 2003, p. 7). Western norms have historically
been influential in the construction of risk categories to guide “public 12mphasiz” (Kunitz, 2007,
 PUBLIC HEALTH PARADIGM 611

p. 15). For instance, though the public health paradigm may consider a larger body type to be “at
risk” of disease, this same body type may be considered healthy and desirable in a non-Western
locale.
Through organized community efforts, public health assumes a multidisciplinary approach that
spans a broad range of professional disciplines but largely dominated by nursing and epidemiology.
The public health paradigm approaches health through a five-step process that includes defining
the health problem, identifying associated risk factors, developing and testing community-level
interventions to control or deter perceived threats to public health, implementing interventions to
improve population health, and monitoring the interventions to determine their efficacy (Schneider,
2006). The public health paradigm assumes that health promotion and disease prevention are
the appropriate methods for attaining its goals (Schneider, 2006; Scutchfield & Keck, 1997).
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Health promotion uses epidemiological data as a guide to set goals and encourage individual
12mphasiz and community adherence, relying heavily on other people to alter their 12mphasiz.
According Lupton (2006), health promotion “maintains that the incidence of illness is diminished
by persuading members of the public to exercise control over their bodily deportment” (p. 35).
Scutchfield and Keck (1997) described how the most commonly targeted behaviors are the
“use of tobacco, the excessive use of alcohol, unhealthful nutritional practices and sedentary
lifestyles [which] cannot be altered without the direct willing participation of the individuals
affected” (p. 6). This tactic encourages self-control based on the universalized norms promoted
by the public health paradigm. Even the promotion of broader environmental issues is often
reliant on individual community members adhering to recommendations. For example, public
health pesticide campaigns encourage individual citizens to minimize chemical lawn-care product
usage (Toronto Public Health, 2009). Although the paradigm largely focuses on individuals,
some epidemiologists have even extended their analysis to incorporate “broader concerns with
environments, social conditions, and even the political context within which environments are
created and sustained” (Raphael, 2006, p. 124).
Research within the public health paradigm is interested in the population impact. This is
achieved with epidemiology relying on large data sets to understand and explain determining
factors related to illness, disability, and disease (Bailey & Handu, 2012; Baum, 2008). “The most
important goal of epidemiology as a field is to discover ways to prevent morbidity and mortality”
(Bailey & Handu, 2012, p. 22). Social work research methods differ with much smaller sample
sizes and aims than epidemiology. For example, social work research tends to be largely descriptive
and less so explanatory (Thyer, 2009). Both professions depend on each other to understand a
public health phenomenon.
In practice, the public health paradigm develops prevention strategies that fall into three
categories. Primary prevention tends to be the foundational approach assumed by public health and
is aimed at circumventing adverse events before they occur in the general population. Secondary
prevention is considered to be narrower in scope and is geared towards identifying and intervening
in the behaviors of at-risk groups within the population. The tertiary level of prevention tends to
be 13mphasi on a small number of impacted individuals afflicted with a disease or injury and
mainly seeks to halt transmission of illness to the greater population (Scutchfield & Keck, 1997;
Sexton, 2006). Primary prevention strategies are the dominant mode of intervention promoted by
the contemporary public health paradigm.
The public health paradigm assumes that the most effective means to achieve utilitarian
health is through health promotion and disease prevention. Individual citizens are encouraged
to adopt behaviors and lifestyles that are congruent with the health norms promoted by the public
health paradigm. Populations determined by public health to be “at risk” of harm or disease are
targeted with prevention strategies. Environmental threats, lifestyle, and individual behaviors are
the primary concerns of the public health paradigm.
 612 R. ASHCROFT

Coherence with the Value of Social Justice

Social justice is one of social work’s foundational values and needs to be a core value in order for
a health paradigm and the approaches it promotes to be considered transformational. Determining
the public health paradigm’s coherence with the value of social justice requires an examination
of how congruent this paradigm is in recognizing and challenging structural inequities in the
pursuit of social equality. There are some who argue that the value of social justice is inherently
imbedded in public health. For example, Powers and Faden (2006) argued that the “foundational
moral justification for the social institution of public health is social justice” (p. 80) and that the
public health paradigm is in alignment with social justice because it is “understood as having
utilitarian commitments to bring about as much health as possible” (p. 81). Beauchamp (1976)
reiterates this view when he states that “the historic dream of public health that preventable
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death and disability ought to be minimized is a dream of social justice” (as cited in Schneider,
2006, p. 19). Krieger and Birn (1998) also described the value of social justice as the foundation
of public health: they refer to social justice as compelling desire of public health to improve
overall utilitarian health. Although these views show that public health is built on a foundation
of striving for overall health, they do not say anything about whether public health recognizes
and is willing to face the structural challenges and inequalities that impede social justice’s full
expression. Other than a few notable exceptions in practice, the public health paradigm does not
attend to structural inequities (Raphael & Bryant, 2006) but is instead largely “focused upon
protection from environmental threats and modifying individual risk” (p. 348).
The public health paradigm appears to ignore the structural causes of ill health in its episte-
mology and approaches to health. “The tendency has been to accept the prevailing orthodoxies of
public health and health promotion, focusing upon statistical measures, cost effectiveness and the
evaluation of measurable effects, but devoting comparatively little attention to the critical analysis
of the political implications of such endeavours” (Lupton, 1995, p. 1). However, in operation
the public health paradigm finds itself targeting those most disadvantaged. “One critical moral
function of public health : : : is to monitor the health of those who are experiencing systematic
disadvantage” (Powers & Faden, 2006, p. 81). According to Lupton (2006), public health’s focus
on those experiencing systemic disadvantage is due less to its desire to realize more equitable
structures than with its desire to promote society’s dominant norms. “Those of foreign nationality,
the poor and the working class have historically been singled out for attention by public health
authorities as agents of disease, requiring forcible ‘hygiene’ programmes sometimes involving
the destruction of their homes and isolation from the rest of society” (Lupton, 2006, p. 33).
Powers and Faden (2006) indicated that the public health paradigm seeks “to be vigilant for
evidence of inequalities relative to those in privileged social groups, and to intervene to reduce
these inequalities insofar as possible” (p. 88); nevertheless, there is too little evidence of this in
the literature to suggest that the paradigm is fully coherent with the value of social justice. At
least one public health advocate believes that public health should not even entertain issues of
social justice. According to Kunitz (2007), “Richard Epstein writes that public health should not
be conflated with social welfare but should stick to what it has traditionally done best: controlling
epidemics of infectious diseases” (p. 106). The public health paradigm often converts systemic
and structural issues into problems of the individual, even when it is populations that are at risk.
The result is that the public health paradigm and the methods it predominantly employs have
“depoliticized risk, diverting attention toward individual predisposition and away from the social
and institutional factors that contribute to risk” (Nelkin, 2003, p. viii).
Although the public health paradigm appears at first glance to attend to some elements of the
value of social justice it does so in a limited manner. In theory, as well as in public health’s pleas
for healthy policy, the paradigm identifies some of the larger structural issues that contribute to
health yet, except for a few exceptional examples (see Peterborough County-City Health Unit,
 PUBLIC HEALTH PARADIGM 613

2014), has not translated recognition into operation (Raphael & Bryant, 2006). Although the public
health paradigm brushes up against social justice it does not appear coherent with the value of
social justice to the extent that it addresses and challenges structural inequities.

View of Social Work Practice

According to Payne’s (2005, 2006b) typology, social work practice in health as promoted by the
public health paradigm appears to fall between the therapeutic and social order view, with some
influence of the transformational view (Figure 1). The public health paradigm situates social work
practice even closer to the social order view and to the transformational view.
Social work has been historically linked with the public health paradigm since the 1920s,
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when the profession expanded to meet the needs of public health’s burgeoning preventative
programs (Doucet, Larouche, & Melchin, 2001). According to the view of health promoted by the
paradigm, social workers are situated among other multidisciplinary professionals as the experts
in determining and carrying out intervention strategies. Social work practice revolves around the
targets and risk groups identified by epidemiology (Ruth, Sisco, & Wyatt, 2008).
The public health paradigm assumes an approach to health that is population or group oriented
often with focus on those experiencing systemic disadvantage. This suggests that social work will
encounter structural issues. It is for this reason that the discourse of social work is influenced by
the transformational view. However, the primary strategies that social work employs under the
public health paradigm remain 17mphasi on the individual and likely do not address structural
issues to a large extent. From this perspective, social work “is unlikely to be in a position to make
much contribution” (Payne, 2006a, p. 120) to tackling larger systemic problems. As a result, social
work practice in this context is situated closer to the social order and therapeutic views of social
work than the transformational view of discourse.
In accordance with the view of health promoted by the public health paradigm, the role of social
work practice is to focus on those directly affected by biological disorders—or, more importantly,
those “at risk” of acquiring biological disorders. The task of social work practice is therefore
to encourage individualized intervention strategies that are in alignment with the therapeutic or
therapeutic-reflexive view of social work. From this perspective, social work primarily engages in
preventative strategies directed at curbing harmful individual behaviors and identifying potential
risks through the use of risk assessments. Direct intervention strategies based on the public health

FIGURE 1 View of social work from public health paradigm.

 614 R. ASHCROFT

paradigm’s view of health are highly individualized (Mackelprang, Mackelprang, & Thirkill, 2005).
However, the transformational view of social work may appear more in alignment with those social
workers engaged in the development and promotion of public health policy. Further influence of
the transformative view may be present if social workers strive to improve environmental-based
activities.
In the context of public health, social work practice also falls under the social order component
of Payne’s typology (2005, 2006b) because it focuses on encouraging and maintaining behaviors
that accord with the normative values identified by public health. “Social work has historically
played a role in the maintenance of a moral social order” (Payne, 2006a, p. 121). Thus, the view
of social work that evolves from the public health paradigm “18mphasizes its role in maintaining
a social order in societies” (p. 121). Social work in alignment with the public health paradigm
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includes the social order view, therapeutic view—and to a lesser extent, transformational view in
practice.

CONCLUSION

This article engages in a critical review of how the public health paradigm is consistent with social
work’s guiding value of social justice. This critical examination explores the implications of the
public health paradigm’s view of health on social work practice and discourse. One of the goals
of undertaking this academic exercise is to provide social workers knowledge and tools that can
be used to reflect upon the assumptions and beliefs that guide the health contexts within which we
practice. By fostering this type of critical reflection, I also aim to better prepare social workers to
make decisions in their practices in a way that will better address needs related to health equity.

ACKNOWLEDGMENTS

The author wishes to thank Dr. Anne Westhues. In addition, the author wishes to thank the Trans-
disciplinary Understanding and Training on Research–Primary Health Care fellowship program,
and to the Social Aetiology of Mental Illness postdoctoral fellowship program.

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