This research column introduces an exciting concept that is impacting the entire social work field. The Grand Challenges project is bringing the social work profession together to work on and solve 12 major problems in our society. While oncology social workers do not work directly on big societal problems, we work with patients and families who are affected by these issues almost daily.

The idea of the “Grand Challenge” is not new, nor is it unique to social work. In 1900, a German mathematician, David Hilbert, presented a list of 23 unsolved “mathematical puzzles” to an international society of mathematicians. His challenges galvanized the efforts of mathematicians all over the world for the next century. Since that time, many groups have launched Grand Challenges projects to inspire, align and focus scientific and practical energy toward meeting society’s greatest needs.

In social work, it was the American Academy of Social Work and Social Welfare (AASWSW) that got today’s Grand Challenges project off the ground. In 2013, a group of leaders in social and health sciences, educators and policy experts identified 12 societal level problems that have not been solved, and partnered with social work’s national organizations, interest groups and academic entities to begin to figure out how to solve them. The AASWSW looked for challenges that the science suggested could be ameliorated by social work intervention within a reasonable time period.

Three of the challenges seem especially pertinent to oncology social workers:  “Close the Health Gap,”  “Reduce Extreme Economic Inequality” and “Build Financial Capability for All.”

What oncology social worker does not see how poverty, racism, unhealthy environments and unequal access to quality education and employment affect the health of our patients and their families? Oncology social workers see the effect of unequal access to healthcare resources, and how those who lack financial stability are less able to access the best treatments. When we work with patients with lung cancer and some head and neck cancers, we see the effect of the failure to prevent tobacco use. When we work with patients with breast cancer, we see how lack of access to early screening leads to poor outcomes. When we work in chemotherapy centers we see how those without insurance (or with limited policies) may have to forgo care—or face bankruptcy. We see that in addition to the stress of cancer and its treatments, the financial burden can be an added stressor for patients and families. Financial strain can impact every area of life, including future financial well being as credit, medical debt, work, income and health insurance (to name just several) are all impacted. We cannot overlook the fact that those most likely to suffer from lack of prevention, early detection, the high cost treatment and long-term financial stress are most often the poor, minority and immigrant populations.

The Grand Challenges project advocates that social work look beyond the individual/family level and focus effort on the broad social determinants of health:  poverty, racism, unhealthy environments and unequal access to quality education and employment. It encourages researchers to use existing science and develop new scientific understanding of these broad problems to better improve future health.

The Grand Challenges project reminds us of the tremendous impact social work had in the early part of the 20th century, bringing down the infant mortality rate, fighting tuberculosis (TB) through improved sanitation and better housing, and fighting for improved conditions and wages for laborers.

While the challenges are broad and address societal-level problems, it is not hard to see how these broad issues underlie much of our work as oncology social workers. In fact, if we were able to reduce income inequality, improve education and increase social justice, we would be better able to focus on the psychosocial impact of the cancer itself. Perhaps we would also be able to focus more of our efforts on the prevention and early detection of cancer.

The AASWSW website lists all twelve of the Grand Challenges, and provides extensive materials on each one. The Grand Challenges project asks oncology social workers and researchers to think not only about what we can do for today’s patients, but also to recognize and formulate strategies to do something about the underlying problems that can make the cancer experience so much more difficult.