Community health workers perform a vital role in advocating for underserved populations, and with advocacy and leadership training they can effectively combat health inequality across demographic lines, according to a new paper from University of Arizona public health researchers.
Published in the American Journal of Public Health, the research found that community health workers – members of a community who are chosen by fellow community members or organizations to provide basic public health and medical care – are in a unique position to make what are typically difficult-to-achieve advances in the quality of health for low-income and otherwise underserved communities.
The paper's lead author, Samantha Sabo, a researcher with the Mel & Enid Zuckerman College of Public Health's Arizona Prevention Research Center, says the paper's conclusion emphasizes both the close ties these health workers have with their communities and how with the proper support, their leadership can make a substantial difference in health outcomes.
"In public health, we think in terms of what things determine health, like access to healthy foods or safe neighborhoods where you could be physically active," Sabo said. "Community health workers have a particularly close relationship with community members. They have the pulse of the community and really understand what's happening, the underlying root causes of heath or disease."
The study, funded by the Centers for Disease Control and Prevention, collected data from 22 different states, examining the disparities in how different populations access health services and the roles community health workers played not only in health-care delivery, but in how they advocated for improvements in care or in mitigating the underlying causes of health problems.
"This study was exciting because we found that community health workers are very aware of where those structural issues or policy issues occur and they're helping their communities voice their opinion," Sabo said.
For example, community health workers can speak with elected officials about safety, work with clients to make their voices heard at school board meetings, make sure the proper medications are being taken and help navigate difficult health insurance situations.
"We think that community health workers, because they're from the community and they live and share the same life experience as their neighbors are uniquely positioned to see health inequities clearly and have the passion for changing them," Sabo said. "If you're not of the community, it becomes difficult for you to be as committed or engage the community members in the same trusting way as CHWs."
However, without the proper training and environment, those benefits can't be achieved.
"We're saying that when community health workers had leadership training and advocacy training, that determines their likelihood of advocating for community change," Sabo said. "They have intrinsic leadership qualities to advocate, but if you have the right work environment that lets you advocate, you are more likely to do it. If you have the autonomy and the ability to act, you're going to foster those changes."
Sabo said the various training and environmental characteristics that may contribute to community health worker engagement in community advocacy need to be adopted as policy. Two recent developments in Arizona – the newly formed Arizona Communtiy Health Worker Workforce Coalition and a new office of Community Health Workers within the state Department of Health Services dedicated to supporting community health workers – are making strides toward that goal.
"No longer is it OK to work only with the individual and expect that that individual has all the resources to be healthy," Sabo says. "You have to think about those broader determinants that make or break our health."