Sent by a community organization that works with the county, Santos listened to the cook’s concerns, discussed the matter with his employer and then referred him for covid-19 testing. The cook and his elderly mother tested positive; they both quarantined and recovered, and he went back to work a few weeks later.
As covid-19 continues to spread, many of the containment approaches that states have been taking — smartphone apps, call centers or case investigators — are struggling due to lack of public trust and engagement.
Yet most Americans have never heard of one approach that works. And we are concerned that our tendency to overlook community health workers stems from the same systemic racism that created many health disparities in the first place. We must not continue to ignore these often marginalized and underpaid heroes.
Who is a community health worker?
Community health workers are trusted individuals who come from within the communities they serve. For the past 80 years, public health departments, hospitals and outpatient clinics have hired community health workers to provide a broad range of services — advocacy, social support, navigation, health coaching — to improve health outcomes. Community health workers find and meet people where they are: They get to know their clients’ life stories; they ask each client what she thinks will improve her life and health. Community health workers then provide tailored support based on these needs and preferences.
Thus, community health workers do all sorts of work. Near Portland, Ore., Teresa Campos-Dominguez teaches the health department’s contact tracers how to build trust with an undocumented laundry worker who has tested positive for the coronavirus. Near Bristol, Tenn., Brea Burke collects masks for employees at her local food pantry. In Philadelphia, Cheryl Garfield grieves with her patient over the devastating loss of life that is all too common in our disadvantaged communities.
Unlike other health-care professionals who are defined by their training, community health workers are also defined by their identity. They share life experiences with their clients. They know what it’s like to face injustice and hardship, to be unheard or exploited. Thus, they enjoy an instant trust where it often does not exist. They are a diverse reflection of disadvantaged Americans: 65 percent are black or Latinx, 23 percent are white and 10 percent are Native American.
Randomized controlled trials have demonstrated that community health workers save each Medicaid beneficiary $4,200 by preventing costly hospitalizations. This proven, cost-effective workforce is exactly what is needed now to stem the tide of a public health crisis and repair the social fabric.
We just need more. There are 59,000 community health workers in the United States — one for every 5,500 Americans — but not nearly enough for the growing role we need them to play in disadvantaged communities in this crisis. One hundred thousand community health workers, embedded in the most disadvantaged communities across the country, could support covid-19 recovery efforts and help address the inequities that have created our health disparities — while providing employment in the communities that need it most. We estimate that the United States could double this workforce in six months.
How do we get there?
Along with the NAACP, the National Association for Community Health Workers and the American Public Health Association, we recommend that Congress and the Centers for Medicare and Medicaid Services act quickly to create sustainable financing for this workforce. A combination of short-term emergency supplemental funding for covid-19 response and recovery, along with longer-term funding, could ensure both rapid ramp-up and sustainability.
Black, brown, rural, poor and marginalized people are tired of dying of covid-19, chronic disease, police violence, hunger and despair. These health disparities are woven of many threads and are challenging to untangle. Acknowledging, hiring and empowering the people from within the communities most affected by these disparities is a vital first step to reducing them.