Community Health Workers: Leading Alongside Communities to Advance Equitable Well-Being

What is your definition of a Community Health Worker?

Teresa:A Community Health Worker is a community member who is trained, has the skills needed, and goes back to my own community.

Sergio:The definition of a Community Health Worker caused confusion over the years and often depended on the health care institution employing the worker. As a community, we developed our own definition that was accepted by the Department of Labor in 2008.

Assist individuals and communities to adopt healthy behaviors. Conduct outreach for medical personnel or health organizations to implement programs in the community that promote, maintain, and improve individual and community health. May provide information on available resources, provide social support and informal counseling, advocate for individuals and community health needs, and provide services such as first aid and blood pressure screening. May collect data to help identify community health needs.

-US Bureau of Labor Statistics

Rumana:Lived experience is an essential component of what it means to be a Community Health Worker. Lived experience drives your empathy and in-depth knowledge that cannot be gained through formal training.

Community Health Workers (CHWs) are trusted community members who promote health in their own communities and have played a vital role in health systems around the world. While recognition of CHWs' role by the formal health system is a recent occurrence, the CHW profession has its roots in natural helping systems that have existed throughout history. These systems became formalized in areas where large sectors of the population lacked health care and the conditions for good health. As such, since its inception, the CHW profession has been dedicated to addressing and eliminating social and health inequities. Community Health Workers are frontline workers in addressing inequities.
-Community Health Workers and Allies for Systems Transformation

Bernice:Given that this is both a global and local team, it is important to recognize that Community Health Workers are defined differently in different countries, often with broader roles outside the U.S. At its core, Community Health Workers serve as a voice for the voiceless to address inequities.

Photo courtesy of TeresaCampos Dominguez

How do Community Health Workers work with communities to advance equitable well-being?

Sergio:I was invited to build Community Health Worker capacity in Tobago, a very underdeveloped island. It's a resort community and everything is imported from Trinidad. Economic opportunity is very limited in Tobago, with 80% of the population unemployed.I provided the training. I didn't tell people what to think or do--I helped to develop skills.

The Community Health Workers decided to create a micro-economy and set up a contract with one of the hotels to sell their produce. One health worker started a vegetable farm, another fruit trees.

We're community organizers. We use popular education techniques. We help build capacity and skills, but the Community Health Workers use their knowledge however they want to meet their needs.

Bernice:While working for the United Nations in Iraq, I was charged with trying to address gender inequities during the war. I needed to engage local and international nongovernmental organizations to help me with this work. When we weren't getting women from the community to engage in the process, I knew I needed to pull from my Community Health Worker background to meet people where they are.

I went to the first home and met with the women there. We spent three hours drinking tea--and not talking about gender inequities. I went back and met with them again. And again. On the fifth meeting, we began to come up with solutions to increase access to healthcare, to address food security.

I needed to let the community drive the agenda and drive the solutions. Taking the time to drink tea meant taking the time to build relationships and to understand what the community needed--not what we thought they needed.

What are you seeing that COVID is making visible?

Rumana:The Coronavirus has exposed the ways we have institutionalized racism in our communities--and in the way we think about health care. Community Health Workers are so essential to communities and can play a part in addressing legacies of trauma and exclusion.

Teresa:As Community Health Workers, this crisis has revealed what we already knew. People don't have access to what they need, the Internet, food--medical care that they understand.

What is giving you hope?

Bernice:We are all connected--and are weaving our experiences toward systems transformation. This crisis shows me the individual and collective power of voice to inform change.

Rumana:Our work, as the Community Health Workers and Allies for Systems Transformation team, gives me hope. We are making incremental changes that make a difference over time. This is a failing forward moment for our country. When you fail, you have to pick yourself up and try again.

Sergio:You can look at a crisis in two ways: you can be overwhelmed or see it as an opportunity. We know that we will need extensive contact tracing. We know that people are going through extreme experiences and that all our usual ways of grieving are interrupted. We know this crisis will have long-term mental health impacts on society at large. Community Health Workers can help with all of these challenges.

Teresa:After sharing our recently published paper with my colleagues and the health department, we are creating a Community Health Worker pilot. We will be hiring a Community Health Worker. It gives me hope to know that the work we are doing is making an impact and that we will have more Community Health Workers support community members.

Learn more from Community Health Workers and Allies for Systems Transformation, COVID-19 Writing Group. Bernice, Rumana, Sergio, and Teresa are authors of the recently published Global and Local CommunityHealth Workers as a lifeline for communities facing inequities in the midst of COVID-19 and beyond.

This white paper outlines the essential role of Community Health Workers (CHWs) in fighting the COVID-19 pandemic from a historical lens to present. It highlights the important role of Community Health Workers in serving as advocates for populations most impacted by inequities in the midst of the COVID-19 pandemic and beyond.