Leaders in Reducing Racial Health Disparities: Community Health Workers

If health is a human right, how is it that someone who lives in Central Harlem or South Bronx can have a 30% higher death rate than someone who lives just a quick subway ride away in the Upper East Side of Manhattan? In a city deeply segregated by race and class, the evidence is clear that where you live influences your health and life outcomes. Residents in poor neighborhoods live four fewer years than those living in wealthier neighborhoods.

Black individuals who live in the poorest neighborhoods live shorter lives than all New Yorkers. Low-income neighborhoods and communities of color are hit hardest by the failures in our health care system and as a result, suffer from a vicious cycle of unequal access to resources, poorer quality health care, and the social determinants of health resulting from living in disinvested neighborhoods.

Community health worker programs can help address gaps in our health care system by training and enabling community members to lead public health initiatives in their own neighborhoods.            

Community health workers (CHWs) are uniquely positioned to address racial health disparities that disproportionately affect communities of color who live in residentially segregated communities. CHWs are trusted community members who work at the frontlines of public health by acting as liaisons between health, social services, and care coordination. Since CHWs are from the communities they serve, they play an important role in acting as a bridge between community members and health/social services while providing culturally competent health education, counseling, and support.

Community health worker programs as a solution to address health inequities is not a new concept. Research shows that when CHW programs are integrated into the health system, they can improve patients’ use of prevention services, medication adherence and chronic disease management, health behavior, and culturally competent care. A study of a CHW intervention on insurance coverage among Latino children in Boston found that those who received the CHW intervention were more likely to be insured than those who did not. CHW programs have been shown to significantly improve patients’ use of prevention services among low-income and immigrant women, in addition to improving health behaviors such as healthy food choices and physical activity among patients with diabetes. Furthermore, CHW programs can reduce healthcare spending by decreasing avoidable emergency department visits. In Denver, CO, CHW interventions shifted care from costly urgent care to primary care services, resulting in a savings of $95,941 per year.

Despite the evidence that CHWs can improve health outcomes in underserved communities, CHWs as a profession does not have a standardized scope of practice, steady funding, and is not fully integrated as part of the health care system. In order to address health disparities and build on the successes of existing community health worker programs, public health leaders at the local and national levels must address these challenges. Currently, the lack of standardization of CHW programs in New York State limits funding and a unified curriculum in the field. Standardizing CHW curriculum would create a system of training and certification requirements that would provide CHWs with a scope of practice and opportunities to be funded by third-parties such as Medicaid. In addition, federal and private insurance agencies should consider reimbursing CHWs directly for their work at competitive wages so that their pay reflects their valuable contributions to community public health. These new finance streams and standardization of practice would increase the much-deserved recognition and value of CHWs in the public health sphere.

Community Health Worker programs can bridge health disparities and address the gaps in a disconnected health care system that marginalizes the most vulnerable populations. As our country continues to be plagued by health disparities based on systemic racism and residential segregation, we must empower neighborhoods and build on community voices by advocating for community health worker programs. We cannot continue to be complacent in our current reality where the lives of low-income people of color continue to have worse health and life outcomes than everyone else. To address these gaps, we must take action by advocating for long-term solutions that build from communities, their contributions, and their wisdom.

Kiana Chan is a 2022 MPH candidate in the Department of Epidemiology. She is interested in the intersection between social epidemiology, determinants of health, and the built environment.