The Health Equity Blog’s mission is to contribute to the discussion of health policy using evidence and research, to explore the opportunities for health equity through policy change, to raise awareness about health disparities, and to increase public advocacy for health equality.

According to the CDC, “Health equity is achieved when every person has the opportunity to ‘attain his or her full health potential’ and no one is ‘disadvantaged from achieving this potential because of social position or other socially determined circumstances.’”

Achievement of full health potential is necessary in all aspects of life – from running errands to relationships with loved ones. Some people are born into environments that limit their ability to achieve their full health potential. We believe that because society created many health inequalities, society can also fix them.

Monday, March 10, 2014

Community Health Workers

Who are Community Health Workers?

According to the U.S. Health Resources and Services Administration (HRSA), Community Health Workers (CHW) are “lay members of communities who work either for pay or as volunteers in association with the local health care system…and usually share ethnicity, language, socioeconomic status, and life experiences with the community they serve” (HRSA CHW tool kit).
While the concept of CHW is not new, the Affordable Care Act brought a new buzz to the topic. The Affordable Care Act (Section 5313) gives the Centers for Disease Control and Prevention (the CDC) the responsibility to award grants to public or nonprofit private entities to promote health behaviors in underserved communities through the use of CHWs.
CHWs go by several names including community health advisor, outreach worker, community health representative, promotora, promotores de salud, patient navigator, navigator promotores, peer counselor, and lay health worker. In 2012, there were 38,020 CHWs employed in the United States.
What do Community Health Workers do?
The Labor Bureau of Labor Statistics has an occupation code for CHWs that defines a CHW as someone who:

  • Assists individuals and communities to adopt health behaviors through education
  • Conducts outreach for medical personnel or health organizations to implement programs
  • Links the community to available resources
  • Provides social support, informal counseling and basic health screening
  • Advocates on behalf of the community’s health needs

Benefits of Community Health Workers
There are several benefits to using CHWs, including:
  1. Elimination of language barriers. One of the main criteria to be a CHW is that he/she must speak the same language as the community in which he/she serves. This is especially beneficial for newly immigrated populations.  An example is  increased screening rates for hepatitis B virus within the Hmong population.
  2. Trust. There is a strong distrust of medical and government officials within some communities in the United States. For example, individuals that are undocumented immigrants or have undocumented immigrants in their family may be nervous to seek traditional medical care. CHWs usually have similar experiences and can relate to the people they serve. 
  3. Cultural relevance. Many cultures have unique ways to improve health. For example, addressing obesity is highly cultural. It would not be helpful to completely ignore the cultural part of diet or the cultural barriers to exercise.
  4. Traveling to the community. CHWs can go to the people, instead of relying on people to seek services. This is especially needed in isolated (either physically or culturally) communities. For example, Kentucky Homeplace employs community health workers to deliver services in rural counties and improve health outcomes in those communities.
  5. Quick training. Unlike public health educators, an individual can be trained quickly. For non-profits with quick grant cycle turn around, this is helpful because a CHW can get out into the community delivery services with only a couple weeks of training.
  6. Cost-effective. Much of CHW’s work is preventative - for example prevention of ER visits, prevention of low-birth weight, or prevention of obesity. The Christus Spohn Health System links CHW activities to reductions inappropriate emergency department usage translating into a substantial cost saving as well as better health for the patient. Prevention, in general, is hard to do cost-benefit analysis for because of the challenging calculation of the amount saved by preventing a disease. However, in the simplest of terms, we know that chronic conditions, like obesity, are expensive for families and society and with fewer obese people, dollars would be saved. Unfortunately, there is little published research on the effectiveness of outcomes of CHW interventions.

Challenges of Community Health Workers.
While there are many benefits and success stories, there are also many challenges:
  1. Recruitment. Finding the right person in the community can be difficult. Ideally, the CHW should already have personal connections with neighbors and a history of casual relationships. For tight-knit communities with high distrust of others, it could be challenging to find a person for a CHW role. Not only is it challenging to find the right person to be a CHW, it is difficult to find the right person to supervise CHWs.
  2. Training. There isn’t one definitive CHW training. Training, evaluation, and outcome deliverables vary widely, so it is hard to compare programs and develop best practices.
  3. Low education levels. What is a benefit of CHW programs (no need for advanced degrees) is also a challenge. Unlike public health educators, CHWs do not have the educational background that might be necessary in all situations. It is a challenge to make sure CHWs know what they need to be effective with the community.
  4. Accountability. Since there is a wide variation in CHW’s tasks, it is hard to track their impact. Traditional models of employee accountability (also used for grant reporting) focus on measures such as number of people talked to. This might not always be a good measure since this is an individual approach and sometimes some families need more than others. CHWs are also out in the field and working alone, which makes it difficult to audit the authenticity of service delivery.

The future for CHWs

CHWs can be effective to improve health within the community, especially within communities that face barriers to health. The opportunities to improve health using CHWs outweigh the challenges. Some people will scoff at promoting CHWs without extensive research on cost-effectiveness or randomized control trials. The research, in someway, does need to be done but in the meantime innovate programs have improved health and that alone is exciting.


  1. For example, addressing obesity is highly cultural. It would not be helpful to completely ignore the cultural part of diet or the cultural barriers to exercise.cambogia garcinia safety