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Community Health Workers—An Effective Strategy to Help Address Health Disparities in Marginalized Populations

Programs such as the Penn Center for Community Health Workers are improving health outcomes and helping to reduce healthcare costs
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About four and a half years ago, Ernest Gardner struck up a conversation with a fellow juror serving jury duty. She happened to be Jill Feldstein, Chief Operating Officer of Penn Center for Community Health Workers, a community health worker (CHW) program serving more than 13,000 high-risk clients in the Philadelphia region.

“We had a really good conversation and she just thought I had a lot of the qualities they look for in CHWs,” says Gardner. “I’m a good listener and I have a heart for people. When she told me about the position I felt like, wow I want to use my God-given gifts to help people, and that's what made me really go for it and it completely changed my life.”

Gardner quit his job in property management and real estate and went through the rigorous application process and month-long training to become a full-time CHW with the program.

A life-long Philadelphia native who was raised by a single mother, Gardner is acutely aware of the social and systemic problems that plague residents of the poorest big city in the US. As a CHW, Ernest says his goal is to address the underlying real-life issues that make it hard for people from low-income and marginalized communities to stay healthy. “When I meet with clients, I try to get to know them as people and understand their life story and background, their hopes and fears, and then go into what their needs are.”

Addressing Social Determinants of Health Through Culturally Competent Care

CHWs like Gardner are trusted members of local communities hired and trained to be part of healthcare teams as a way to bridge the formal health system to the day-to-day realities of people’s lives. This can include anything from helping clients navigate the complexities of the healthcare system to battling eviction notices and connecting them to resources like affordable childcare, urban gardens or transportation to get to medical appointments.

Getting clients what they need to improve their lives makes his job worthwhile, says Gardner. He recounts helping an elderly gentleman, living alone with several health conditions, get a home health aide. “He had been running around for three years but kept hitting many different roadblocks. We discovered the issue was something as simple as submitting his documents to the county assistance office and we worked with the county assistant to make that happen for him.”

Another challenge is that many Black Americans distrust the health system, he adds. “Our clients relate to us and in many cases actually trust us more than their healthcare providers. They may be put off by the physician’s bedside manner or feel intimidated by them, that’s when we can come in and make the connection. We also help providers understand why a patient may not be adhering to their treatment regimen. Maybe they cannot afford the medication, or they can’t plug in their oxygen concentrator because they don’t have electricity, or they don’t have heat in their homes. When we work on rectifying some of those issues, their health also improves. Because we are integrated with the care team, we can actually help both sides understand each other better.”

COVID 19 was worse on those who were already disadvantaged, says Gardner, and CHWs were the social first responders providing remote support to high-risk, low-income patients in greater Philadelphia—from delivering face masks and cleaning supplies and arranging food deliveries to reinforcing public health messaging, contract tracing, and helping reduce social isolation through telephonic outreach and virtual support groups.

Improving Health Outcomes and Lowering Health System Costs

Studies have shown that the Penn Center for CHWs’ program model improves chronic disease control, mental health and quality of care while reducing total hospital days by 65% and generating Medicaid savings of $4,200 per beneficiary. Policy makers have also noticed the program’s impact.

The Johnson & Johnson Center for Health Worker Innovation, with support from the Johnson & Johnson Foundation, has partnered with Penn Center for CHWs to scale up this critical frontline workforce during COVID-19 and expand the program’s geographic reach in Philadelphia as well as to help healthcare organizations in other cities transform and improve how they care for their highest-risk patients.

As for Gardner, he is currently wrapping up his last semester of graduate studies in Public Administration and hopes to grow into a leadership role in this field and perhaps enter into local government or politics to affect his community on a broader scale by helping to shape laws and policies.

“It is especially meaningful when I can help people in my community, people who look like me, who are underserved,” says Gardner. His faith plays a huge role in his life and Gardner believes God placed an innate quality in him to care for people. Sharing a story from childhood, he recalls how his aunt, a single mother struggling with four children was once in tears after being reprimanded during a family meeting. “I felt so bad that I followed her and gave her a hug and told her everything would be okay. I remember vividly how that lifted her spirits, and I always think about that moment.”

Gardner wishes there were CHW programs when he was younger that could have helped people like his aunt. “We have similar experiences like our clients and CHWs make a huge difference in helping them and improving health outcomes especially in our underserved Black and Brown communities. Whether it is diabetes or substance abuse or mental illness, addressing basic needs can prevent treatable conditions from turning into chronic conditions.”