By: Hector Carrasco, MD, MPH Jessica Hinshaw, MPH, Harriet Napier, MSc, Stephanie Kang, MSc, Sandy Hoar, PGDip, MPAS, PA-C
In 1920, almost one hundred years ago, the first community health worker (CHW) program was established in China. The Farmer Scholars, later called Barefoot Doctors, were illiterate farmers trained to take vital statistics, deliver vaccines, provide first aid, and give health talks. The program became famous for its marked successes in reducing mortality and improving lives. It served as an example of community-based primary health care at the Alma Ata conference in 1978 which called for access to health care for all peoples around the world.
In the 21st century we are still working towards Alma Ata’s call for health equity. Today, we face immense challenges such as climate change, the expanding wealth gap, aging populations, non-communicable chronic diseases (NCDs), depression, and new or emerging diseases such Ebola, Zika, opioid addiction, and mental health disorders brought on by new technologies such as social media anxiety disorder and screen addiction. Due to the complex nature of these challenges and their root causes, holistic approaches that work in concert to tackle clinical treatments, community health, and policies are necessary for a healthier world.
In this feature series for CHW Central, we will share case studies from the United States and around the globe that are working to do just that! The six case studies presented in this series call attention to and invite dialogue on the critical role CHWs play in helping achieve health equity at the community, clinical and policy levels. They were presented at the 2018 pre-APHA session: “Community Health Workers as Transformative Agents for Health Equity: Global Models, Tools and Lessons Learned From Across Borders.” This international session was organized by the Community Based Primary Health Care (CBPHC) group of the American Public Health Association to explore the role of CHWs in achieving health equity.
The case studies in this series illustrate how different CHW programs achieve impact in diverse contexts, from rural Maharastra, India to Orange County California, US. Every case study presents a CHW program whose positive impact highlights an aspect of the health equity movement, followed by actionable strategies to help program designers or implementers approach similar situations around the world.
Our series answers central questions about the role of CHWs in improving health equity such as: Is it possible to create a CHW program using students or formerly incarcerated individuals? How effective are CHWs at doing advocacy work in environmental health? How do we implement a CHW program in a refugee camp in conflict zones? And how do we provide the best care to those forgotten completely by the system because they have a rare disorder?
CHW Central will feature a new case study every two weeks over the next three months culminating with a webinar with the case study authors. We hope you will join this exploration of health equity through reading and discussing the cases with your peers. It is our belief that enlighted CHW programs, like the ones presented in this series, are an answer to the most pressing equity challenges of this century.
Hector Carrasco, MD, MPH
Jessica Hinshaw, MPH
Harriet Napier, MSc
Stephanie Kang, MSc
Sandy Hoar, PGDip, MPAS, PA-C
Hector Carrasco is a physician and public health professional with degrees from the Tecnológico de Monterrey (ITESM) and Johns Hopkins University. Dr. Carrasco has a strong interest in health systems strengthening and biopolitics (politics for life) through community engagement. After finishing his MD, Hector went to work as a physician for Partners In Health (PIH) in a mountainous region of the poorest state of Mexico, Chiapas. There, he co-created and implemented community health worker programs to tackle child malnutrition and non-communicable diseases. Currently, Hector is a second year Doctor of Public Health candidate at Harvard T.H. Chan School of Public Health. His research focuses on social preferences for health policies and community organizing as a tool to improve health and promote wellbeing.
Jessica Hinshaw, MPH is the Monitoring, Evaluation and Learning Director of AMOS Health and Hope, a public health non-profit working to achieve health equity in the poorest, most remote communities of Nicaragua by working alongside community health workers and community leaders. She uses participatory evaluation techniques to assist community members and non-profit staff to take action to improve health and well-being based on real-time results from their own communities.
Harriet Napier began her career in community health in 2009 serving as a community case manager for homeless populations in rural Vermont. Since that time, Harriet has studied, supported, and advocated for community health systems across the globe, focusing specifically on community health policy, design, implementation, and financing. In her current role on the global malaria team at Clinton Health Access Initiative (CHAI), Harriet supports countries across sub-Saharan Africa, the Greater Mekong Sub-region, and Mesoamerica to holistically understand and optimally engage community health worker networks as key partners in the fight to eliminate malaria. Harriet holds a Master of Science in Public Health with a focus on community health systems, and a BA in anthropology.
Stephanie Kang is currently a second-year Doctor of Public Health student at the Harvard T.H. Chan School of Public Health. She received her BS in Behavioral Neuroscience at Northeastern University. Since then, she has worked with a medical organization working in hospitals across East Africa, performed drug discovery research for neurodegenerative diseases, and coordinated clinical research and quality improvement programs in hospital settings. Prior to starting her doctoral program, she was the Program Director for two non-profits: one an innovative education program at Harvard Medical School for underserved Boston youth and the other, a global health organization implementing community-based health projects in rural Haiti. She also received her MS in Global Health at Northwestern University. Currently, she is the Medicare For All Fellow in Congresswoman Jayapal’s office and the Congressional Progressive Caucus Center.
Sandy Hoar is a Physician Assistant. She sees patients in a primary care clinic for the uninsured and is a Clinical Assistant Professor in the School of Public Health and the School of Medicine at the George Washington University. She has more than 30 years experience with domestic and international public health projects and is currently completing a Doctor of Medical Science degree.