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Strengthening the Community Health Workforce Can Help Improve Healthcare Access for Communities of Color

CHWs play a key role in connecting communities with healthcare in a trusted and culturally competent way—they need to be fully recognized and integrated into health systems.
Community health workers distributing masks in their communities in Rochester, New York and Hartford, Connecticut.

The Johnson & Johnson Our Race to Health Equity platform, a $100 million commitment over the next five years, aspires to take on the inequities rooted in systemic racism that threaten health in communities of color across the United States. A key component of the platform focuses on supporting the work of Community Health Workers (CHWs) by partnering with organizations such as the National Association of Community Health Workers (NACHW).

As members of the communities they serve, CHWs play a key role in connecting their communities with the healthcare system in a trusted and culturally competent way. Yet they are not fully recognized and integrated into health systems. I sat down with Denise Octavia Smith, MBA, CHW, PN, Executive Director of NACHW to discuss the urgency and importance of the work in this area.

Jorge: How can CHWs help connect communities of color to health systems?

Denise: Disparities in healthcare access, quality, health status and outcomes have existed in the United States since its colonial period. Structural and institutional racism and prejudice experienced by generations of Indigenous, Black, Latino and Asian American, Pacific Islander and Alaska Native populations and other communities marginalized by citizenship status, disability and sexual orientation result in barriers to the social drivers of wellbeing. As a result of pervasive income inequality and limited access to housing, healthy food, healthcare coverage, mental health care, as well as high cost of prescription drugs, these communities have experienced significant excess morbidity and mortality from preventable chronic disease.

Community Health Workers (including promotores and other community health representatives) are critical leaders to transform community health and health services. We are a workforce of predominantly persons of color, who often share ethnicity, diagnosis, and lived experience with the families and communities where we live and serve.

These shared identities and experiences facilitate unique trusting relationships that help us build cultural, communication and navigation bridges that connect siloed medical, behavioral and social systems. We partner with patients and families to develop locally sourced and culturally relevant models of compassionate care by centering their preferences and building their capacity to achieve their health goals. This unique approach improves access and quality, reduces cost and increases performance across a wide range of diseases and conditions.

J: What are the primary challenges to incorporating CHWs into the healthcare system?

D: Despite nearly 60 years of research on CHW effectiveness, two decades of public health recognition, landmark workforce development studies, and a national labor classification, CHWs still lack a national identity, policies and models that sustain our integration into the systems that would benefit from our integration.

Funding to support our work is fragmented (disease focused instead of holistic and prevention centered) and supported by short-term grants and contracts. Sustainable financing of CHW services is challenging because there is no one size fits all financing model for long term employment of CHWs. Current barriers include:

  • Narrowly defined roles in health systems
  • Payment models focused on reimbursement of billable medically necessary services rather than holistic coverage and prevention
  • Limited funding for CHW community-based services and the social determinants of health
  • Few opportunities for CHW career advancement
  • Professional bias among health professionals who do not view CHWs as integral to the care team

J: How can CHWs help to address the important issue of racial health equity?

D: Equity driven legislators, payers, health systems and advocates know that the same communities experiencing health system barriers and poor health outcomes before the COVID-19 pandemic will continue in this burdened state in a post pandemic America unless we change course. For over 100 years now the U.S. has documented and considered the impact that racism and inequities have on the health of communities of color.
Now is the time to build on these lessons and commit to equitable access and outcomes – not just during this pandemic, but for all future generations and across all health systems and services. NACHW believes that the growing call from U.S. and global health leaders, health providers, legislators, policy makers and funders for increasing CHWs’ roles during COVID-19, should be the start of a movement toward CHW recognition and system integration and toward equity and social justice for all communities.

J: What are the goals outlined in the national policy platform?

D: NACHW developed the National CHW Policy Platform to promote national professional identity, leadership, and capacity of CHWs and to articulate policy recommendations for public and private institutions to respect, protect and partner with CHWs.
This was a year-long collaborative effort, created through over seven national town hall calls with over 30 CHW Associations, three national member polls, numerous partner meetings and gathering national input on President Biden's national plan to “build back better.” It centers many of the policies and best practices that are already nationally endorsed within our field and can be applied to COVID-19 response efforts as well as long term policy development.

J: Where can people learn more about NACHW and your new national policy platform?

D: To learn more about our mission to unify the voices of the CHWs and strengthen the profession’s capacity to promote healthy communities, including our newly published national policy platform, you can visit our website, www.nachw.org.