Community Health Workers: Leading Alongside Communities to Advance Equitable Well-Being
Community Health Workers partner with community members to advance health and well-being, elevating the wisdom of communities and the expertise of residents by strengthening skills, sharing resources, and building trust. Community Health Workers are essential members of both the communities they serve and their local or regional health care systems.
While Community Health Workers are often employed by health care institutions, they work in communities to expand the vital conditions we all need all the time to reach our full potential. We know that health is not achieved in a doctor‚Äôs office. Community Health Workers meet people where health happens: in our homes and neighborhoods.
Members of Community Health Workers and Allies for Systems Transformation team recently shared their experiences, demonstrating how Community Health Workers are essential resources to advance well-being now, as we respond to the coronavirus crisis, and as we turn to recovery and resilience.
The following is an excerpt from a recent conversation with the group:
Chair, Community Health Worker and Covid-19 Writing Group
Community Health Workers and Allies for Systems Transformation
‚ÄúI am dedicated to addressing inequities through systems transformation. As a person with lived experiences of inequities, as a Community Health Worker, and as a Community Health Worker ally, I believe in the essential role of Community Health Workers to address health inequities and social issues.‚Äù
Teresa Campos Dominguez
Community Health Worker
Community Partnership and Capacity Building Unit of Public Health Division of Multnomah County Health Department, Portland Oregon
‚ÄúI was inspired by Community Health Workers in Mexico for many years--and brought those experiences with me to the U.S. As an immigrant, I went through so much and knew that I wanted to help others. Being a Community Health Worker to support others is the right thing to do.
Community Health Worker, New York, NY
Milken Institute Center for Public Health Advisory Board, Washington, DC
‚ÄúBecoming a Community Health Worker is my second career. I was looking for an interpersonal approach and wanted to build community capacity. When I started as a Community Health Worker, I realized that, as a profession, we did not have the support we needed. I become an organizer, launching the Community Health Worker Network of New York City--and have helped others organize, too.‚Äù
Rumana Rabbani, MHA, PhD Student
Health Policy & Management Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
Chair, pre-APHA CHW Summit, CHW Section, American Public Health Association
‚ÄúI became a Community Health Worker ally in 2014 while taking a community-based participatory research class. I realized that Community Health Workers are absolutely critical to addressing social determinants of health and equity. I am currently exploring ways to sustain and scale the role of Community Health Workers--and ensure that Community Health Workers are integrated into the field of public health.‚Äù
What is your definition of a Community Health Worker?
Teresa: A Community Health Worker is a community member who is trained, has the skills needed, and goes back to my own community.
Sergio: The definition of a Community Health Worker caused confusion over the years and often depended on the health care institution employing the worker. As a community, we developed our own definition that was accepted by the Department of Labor in 2008.
Assist individuals and communities to adopt healthy behaviors. Conduct outreach for medical personnel or health organizations to implement programs in the community that promote, maintain, and improve individual and community health. May provide information on available resources, provide social support and informal counseling, advocate for individuals and community health needs, and provide services such as first aid and blood pressure screening. May collect data to help identify community health needs.
Rumana: Lived experience is an essential component of what it means to be a Community Health Worker. Lived experience drives your empathy and in-depth knowledge that cannot be gained through formal training.
Community Health Workers (CHWs) are trusted community members who promote health in their own communities and have played a vital role in health systems around the world. While recognition of CHWs‚Äô role by the formal health system is a recent occurrence, the CHW profession has its roots in natural helping systems that have existed throughout history. These systems became formalized in areas where large sectors of the population lacked health care and the conditions for good health. As such, since its inception, the CHW profession has been dedicated to addressing and eliminating social and health inequities. Community Health Workers are frontline workers in addressing inequities.
- Community Health Workers and Allies for Systems Transformation
Bernice: Given that this is both a global and local team, it is important to recognize that Community Health Workers are defined differently in different countries, often with broader roles outside the U.S. At its core, Community Health Workers serve as a voice for the voiceless to address inequities.
Photo courtesy of Teresa Campos Dominguez
How do Community Health Workers work with communities to advance equitable well-being?
Sergio: I was invited to build Community Health Worker capacity in Tobago, a very underdeveloped island. It‚Äôs a resort community and everything is imported from Trinidad. Economic opportunity is very limited in Tobago, with 80% of the population unemployed. I provided the training. I didn‚Äôt tell people what to think or do--I helped to develop skills.
The Community Health Workers decided to create a micro-economy and set up a contract with one of the hotels to sell their produce. One health worker started a vegetable farm, another fruit trees.
We‚Äôre community organizers. We use popular education techniques. We help build capacity and skills, but the Community Health Workers use their knowledge however they want to meet their needs.
Bernice: While working for the United Nations in Iraq, I was charged with trying to address gender inequities during the war. I needed to engage local and international nongovernmental organizations to help me with this work. When we weren‚Äôt getting women from the community to engage in the process, I knew I needed to pull from my Community Health Worker background to meet people where they are.
I went to the first home and met with the women there. We spent three hours drinking tea--and not talking about gender inequities. I went back and met with them again. And again. On the fifth meeting, we began to come up with solutions to increase access to healthcare, to address food security.
I needed to let the community drive the agenda and drive the solutions. Taking the time to drink tea meant taking the time to build relationships and to understand what the community needed--not what we thought they needed.
What are you seeing that Covid is making visible?
Rumana: The Coronavirus has exposed the ways we have institutionalized racism in our communities--and in the way we think about health care. Community Health Workers are so essential to communities and can play a part in addressing legacies of trauma and exclusion.
Teresa: As Community Health Workers, this crisis has revealed what we already knew. People don‚Äôt have access to what they need, the Internet, food--medical care that they understand.
What is giving you hope?
Bernice: We are all connected--and are weaving our experiences toward systems transformation. This crisis shows me the individual and collective power of voice to inform change.
Rumana: Our work, as the Community Health Workers and Allies for Systems Transformation team, gives me hope. We are making incremental changes that make a difference over time. This is a failing forward moment for our country. When you fail, you have to pick yourself up and try again.
Sergio: You can look at a crisis in two ways: you can be overwhelmed or see it as an opportunity. We know that we will need extensive contact tracing. We know that people are going through extreme experiences and that all our usual ways of grieving are interrupted. We know this crisis will have long-term mental health impacts on society at large. Community Health Workers can help with all of these challenges.
Teresa: After sharing our recently published paper with my colleagues and the health department, we are creating a Community Health Worker pilot. We will be hiring a Community Health Worker. It gives me hope to know that the work we are doing is making an impact and that we will have more Community Health Workers support community members.
Learn more from Community Health Workers and Allies for Systems Transformation, Covid-19 Writing Group. Bernice, Rumana, Sergio, and Teresa are authors of the recently published Global and Local Community Health Workers as a lifeline for communities facing inequities in the midst of COVID-19 and beyond.
This white paper outlines the essential role of Community Health Workers (CHWs) in fighting the Covid-19 pandemic from a historical lens to present. It highlights the important role of Community Health Workers in serving as advocates for populations most impacted by inequities in the midst of the Covid-19 pandemic and beyond.