This chapter will describe the state of health care social work as we enter the new millennium and identify the issues, challenges, and dilemmas facing social work as it develops locally, nationally, and globally and as it strives to maintain functionality in the future. A review of the issues facing social work at the end of the 19th and 20th centuries will serve as the foundation for predicting a future course for the profession during the 21st century.

Four hypotheses are offered to describe the future course of the profession. Remedial approaches infused with a new knowledge about social determinants of health to meet local needs, a linkage to public health methodology and values, institutional approaches such as social development and the prediction that social determinants of health can link the professions knowledge, and practice base with global and local needs are discussed and evaluated. Social Work's current emphasis on remedial approaches in a local context will expand and include a substantive effort toward the achievement of inclusive citizenship, universal equality, freedom, and justice. Future research will include individual level and group level variables to strengthen the social emphasis of social work.