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Healthy Equity: The Importance of Community Health Workers/Promotores

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The term Community Health Worker, or promotor(a) in Spanish, refers to health workers that work closely with the communities in which they live. They work with the primary aim of addressing a myriad of social determinants of health (SDOH) that result in poor health outcomes. Inherent to the power of CHWs/Ps is that Community Health Workers share the same culture, lived experience and background as the people in the community in which they serve. Research and evidence now support the integration of CHW/Ps as essential members of interdisciplinary clinical teams, including medical practitioners, who may not have rapport, trust or SDOH knowledge with and about the communities they serve.

“The work as Promotoras is not only about community’s health, but also about [community’s] wages, their working hours, how they can take care of themselves, it’s about immigration…housing.” Esperanza soleto - El Sol Neighborhood Educational Center Promotora

CHWs/Ps are proven to bring high value to many equity pursuits: climate action and environmental justice advocacy, school-based interventions, workforce development strategies, and more. This article will highlight the added value and importance of CHWs as integrated members of clinical healthcare teams:

1

    CHWs/Ps improve relationships with patients.

CHWs understand their community and their perceptions and wisdom make it easier for them to connect with the patients in ways that clinicians may not. CHWs act as cultural connectors, which makes it easier for patients to disclose circumstances and health issues without the fear of being judged or misunderstood. El Sol Neighborhood Educational Center trains its CHWs in emotional intelligence skills, empathetic motivational skills, and active listening skills to foster deep connections with community members and patients.

2

CHWs/Ps improve communication between health patients, insurance providers and physicians.

When people have access to health care that respects their cultural values and behaviors, delivered in language they can understand, they are more likely to have positive health outcomes. CHWs/Ps are often cultural workers in their community and when they are embedded into healthcare systems. This means that they understand cultural norms, taboos, and speak the language of the people in a particular community. They impart an ease that is vital when interacting with and serving patients. This ease of communication is critical to maximizing insurance goals, and proper access and usage of care, and to supporting California managed care plans’ Health Home Programs and Whole Person Care goals, which are current goals of the CalAIM program.

3

CHWs/Ps Improve Vaccine Equity and Pandemic Response Results

Research supports and the COVID-19 pandemic reminds us that CHWs/Ps who are equipped, trained, and paid as part of a well-functioning health system can help keep pandemics in check and maintain health service equity and access. 1 El Sol’s experience substantiates this. Amid healthcare labor shortages, CHWs/Ps are appropriate and effective solutions to ensure equitable testing and vaccination, especially in hard-to-reach populations, against COVID and other common illnesses

“At the beginning of the pandemic] the farm workers would come to us for help instead of the doctors. The clinics were closed and you could only get consultation via telephone. You could only be seen if it was a real emergency. Clinical staff almost left you to die, because they were scared even if you did not have COVID-19. I am still working on the COVID-19 project. Today, July 8, 2022, I worked an event were 104 people got tested an entire family tested positive.” - El Sol Riverside COVID Response CHW

4

HWs tailor outreach and education to specific community.

As trained, trusted members of their local communities, community health workers are in a unique position to fill health workforce gaps and boost COVID-19 vaccination rates in lower-to-middle income communities. CHWs have better access to rural and vulnerable populations, and they can serve as a powerful bridge between remote and hard-to- reach populations and the primary health care system. For example, when farm workers in Coachella Valley were identified as a difficult-to-reach population by Dessert Health Care District, El Sol and its partners organized COVID-19 testing and vaccination events onsite at Dessert ranches and farms

5

CHWs can excel when providing in-home services.

Home visitation programs have been used for decades as a means of effective intervention specifically among vulnerable, at-risk populations including: chronically ill, impoverished, rural, or homebound individuals. Home visit programs led by community health workers (CHWs) are becoming more common and pose specific benefits. El Sol’s Nurturing Parent and Home Visitation program led by CHWs, focused on fostering positive parenting skills to improve family functioning and resiliency among high-risk populations. The intervention included health education, referrals to health services, and provision of supplies and social support to Inland Empire families. Evaluations of our program highlight the importance of initial and ongoing CHW training, appropriate caseloads, effective communication, and sustainable funding, which can inform future CHW programs. As a result of our intervention, 78% of xxx participants improved their empathy towards their children’s needs by at least 65%.

Community health workers are ideal for in-home health services because they understand the environmental factors of the people they support, making it easier for them to intervene regarding the assets and challenges that a participant or patient faces.2

Final thoughts

One of the major advantages and values that CHWs/Ps have is their understanding of lower status, vulnerable populations, making it easier to address the SDOH and suggest appropriate solutions for people without medical homes, patients and managed care populations. Integrating CHWs/Ps into healthcare systems is crucial and practical for any community that wants to improve its population health outcomes. Contact Alex Fajardo, Executive Director of El Sol Neighborhood Educational Center at alexfajardo@elsolnec.org to learn more about the added value CHWs/Ps can bring to your work and practical integration steps.

[1]https://www.ghspjournal.org/content/10/2/e2100648
[2]https://pubmed.ncbi.nlm.nih.gov/32037337/

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