Mariam Merced, Director of Community Health at Robert Wood Johnson University Hospital in New Brunswick, New Jersey, began her journey in public health over 30 years ago and has been a trailblazer in forging critical ties between neighborhoods, their residents and health professionals.
“Community outreach isn’t what I started out to do,” says Merced. “I came to New Brunswick from Puerto Rico to earn a master's at Rutgers University.”
While she was attending college, she worked as a security guard at a senior center where she befriended a group of Spanish-speaking seniors. When the social worker at the senior center retired, her friends encouraged her to apply for the position. “I got the job,” Merced adds, “and wound up doing community outreach for the first time, connecting with seniors to make sure they had access to benefits.”
That was the beginning of the path that led to Merced training promotoras (community health workers) in the Latin American community of New Brunswick. The promotoras serve as trusted messengers that create a bridge between health systems and the people they serve. “They aren’t outsiders,” Merced explains. “They’re neighbors, family and friends.”
The Johnson & Johnson Center for Health Worker Innovation, with support from Johnson & Johnson Foundation, has been working with the Rutgers Robert Wood Johnson Medical School Office of Community Health on the Greater New Brunswick Community Health Improvement Project, a series of aligned initiatives seeking to improve the overall health of the greater New Brunswick community. This program continues Johnson & Johnson’s decades-long support for community health programming in New Brunswick, where the company is headquartered, and aligns with Our Race to Health Equity, an enterprise-wide initiative launched in 2020 that aspires to help eradicate racial and social injustice as a public health threat by eliminating health inequities for people of color.
“Communities are better served when health workers share similar backgrounds and when they look like those they are there to help,” says Silvia Cruz-Vargas, Senior Director, Global Community Impact at Johnson & Johnson. “Community Health Workers are a workforce who share ethnicity, diagnoses and lived experiences with the communities which they serve. It’s easier to build trust with people you can relate to, people you know.”
A bridge between diverse populations and health systems
Promotoras don’t just educate the community about health, they also teach the health sector about the needs of the Latino community—how the culture works, how they feel about being sick, end of life issues. For example, Merced explains, “Key to decision-making in the Latino community is the family, with each individual having a voice. The health system can’t put pressure on the family or the patient to make a decision quickly. They need to give them the time to experience emotions and make the right decisions for them.”
Merced was able to utilize these strengths offered by community health workers during the COVID-19 pandemic. When she surveyed the families they served, they learned that 89% did not know how they were going to pay rent. More than 90% had lost at least one income. Many faced food insecurity, had nowhere to quarantine or depended on others for their medication.
The promotoras worked fast and smart. They ensured people had information about COVID-19 and a place to get tested. They ran the hospital’s Spanish-language Facebook page, meaning 500 people would see a post in a matter of minutes. When Merced conducted a vaccine presentation in Spanish on Facebook Live, 1,500 people logged in.
“Those same promotoras,” Merced recalls, “were there with me on the street with a megaphone telling people ‘Get tested’ and then when the vaccine came, ‘Come and get the vaccine.’ Knocking on doors, talking to people, we were able to dramatically increase the number of people that we saw in the different vaccination clinics.”
With all of her success, Merced feels what’s most rewarding about her position has been the sense of community she’s gained over the years. “Those seniors that I met, they’ve been my family from the beginning. I’m still connected to their grandkids, to their great grandkids, who now participate in the programs that we have.”
As Merced points out, there is much more to public health than hospitals, medications and machines. Communities must be cared for by those familiar with them to fully engage individuals with the resources health systems can offer. Open, trusted communication between the health sector and the people they serve is critical to keeping communities healthy. “That’s what promotoras and community health workers can build,” she adds, “and that’s what makes me happy. That’s what makes me come here to work every day.”