Creating Healthier Communities: The Value of Community Health Workers

The reasons to strengthen and modernize the nation’s public health system are numerous, such as H5N1 Bird Flu, more frequent and severe weather events, and more people living with chronic diseases. These challenges to the nation’s health will require multiple solutions including a focus on the importance of Community Health Workers (CHWs). In fact, any efforts to holistically improve health in this country should include such community-based workers.

Community Health Workers are frontline public health professionals that share life experience, trust, compassion, cultural and value alignment with the communities where they live and serve, according to the National Association of Community Health Workers. Community Health Workers provide services in communities they know well and can play an important role in addressing health disparities and reducing healthcare spending on preventable disease.

The Common Health Coalition, a newly-formed partnership whose mission is to improve the nation’s health system through innovative partnerships between healthcare and public health, recently issued a call to action to its members and partners challenging them to showcase community health worker initiatives that connect the gap between health care and public health.

By “taking” the Challenge, members are joining a movement to advance these types of partnerships. The Challenge also includes a funding opportunity for interested organizations – called the “Catalyst Awards.” These monetary awards are intended to fund organizations that demonstrate existing work and/or a strong capacity to integrate CHWs in ways that strengthen partnerships and help inform tools and resources for others.

The Coalition is translating lessons from the COVID-19 pandemic into concrete action steps in pursuit of a reimagined and more effective health system. Community Health Workers have proven to be a key component for catalyzing partnerships between healthcare, public health, and community organizations and for improving community health, and these types of partnerships should be sustainably expanded across the country.

“Community health workers are a key bridge between healthcare, public health, social services, and the communities they serve.  This trusted workforce helps individuals and families navigate these systems, connect people to services, and address barriers to achieving optimal health.  Healthcare, public health, and policymakers should take action to strengthen and integrate community health workers into their strategies to improve community health and advance health equity,” said TFAH President and CEO J. Nadine Gracia, M.D., MSCE, in a press release announcing the Coalition’s challenge. Dr. Gracia serves as the Common Health Coalition’s Strategic Advisory Council Co-chair and as a member of the Steering Committee.

With the U.S. spending nearly 20 percent of its gross domestic product on healthcare, expanding support for and engagement of Community Health Workers could help reduce that spending. A study published by the Milbank Memorial Fund reported that Community Health Workers working with Medicaid beneficiaries with chronic diseases helped prevent costly hospitalizations and save $2,500 per enrollee annually. The study noted that not only do well-designed community health worker programs reduce hospitalizations for chronic disease, they also contribute to improving mental health, promote healthy behaviors in individuals, and increase patient participation in primary care.

Another study published by the American Heart Association showed that Community Health Workers working collaboratively with care managers and other specialists in Maryland and Pennsylvania helped significantly decrease blood pressure of individuals with previously uncontrolled blood pressure levels and one other risk factor. Due to its importance, the report was highlighted by the U.S. Surgeon General.

Whether working through community-based organizations, places of worship, faith-based organizations, hospitals, clinics, or other settings, Community Health Workers bring knowledge and lived experience of a community’s culture and language to health education and a personal touch to connecting people to services that address health-related social needs such as nutrition and access to healthcare, safe housing, and transportation.

This is particularly evident in Spanish-speaking communities and households where CHWs are often referred to as promotores. Over 18 percent of Latinos in the country lack health insurance, according to UCLA’s Latino Data Hub. Promotores use their intrinsic connection with and knowledge of the cultural norms of communities they serve to provide vital resources to their fellow community members and help build trust and lifelong connections between their communities and public health initiatives.

“There’s a direct through-line between promotoras and community clinics and health centers,” said Maria Lemus, executive director of Visión y Compromiso (VyC), a California-based organization providing leadership training and advocacy for promotoras.

Promotoras within the VyC network were instrumental in mobilizing scores of Californians of Latino descent to get vaccinated against the COVID-19 virus, Lemus said. VyC said its network of promotoras was responsible for arranging testing and vaccine appointments and referrals for nearly 50,000 people at the height of the COVID-19 public health emergency and developed and provided cultural humility training for nearly 10,000 contact tracers.

These workers promote prevention  in holistic ways as well. One study found that a network of promotores in Allegheny County, Pennsylvania were able to help increase physical activity and improve dietary practices in communities with growing Latino populations. Latinos have higher rates of obesity compared to non-Hispanic white people, and efforts like this can help lower those disparities.

Despite their effectiveness, funding and resources to support promotores and their work is often limited, Lemus said.

“We’re on the front lines every day,” Lemus said. “To see promotoras as just volunteers is a misconception.”

TFAH has encouraged federal and state policymakers to increase and diversify the public health workforce in an effort to meet the growing needs of individuals, families, and communities, address non-medical drivers of health, and reduce health disparities. Community Health Workers are an important component of the health workforce and play a critical role in meeting these goals.