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In recent years, community health workers (CHWs) have gained recognition as an important part of the health care system. At the same time, it has become increasingly clear that a person’s environment has a far greater impact on their health and wellbeing than access to health care or use of health care services. Individuals with low income communities of color are more likely to experience environmental burdens that lead to poor health outcomes. Over the past two years, a coalition of partners has developed a program in which CHWs in Hispanic/Latino communities take a leading role in organizing them to impact policies, systems and environments that affect community health. CHWs, are in fact, ideally suited to organize communities to increase health equity as catalysts for social change that improve community health and wellbeing.
Hispanic/Latino communities in the U.S. experience significant disparities in health and health care. In addition to having the highest uninsured rate of any racial or ethnic group, they are disproportionately affected by health conditions such as asthma, obesity, hypertension, diabetes and HIV/AIDS. Hispanic/Latinos also experience lower educational levels, higher rates of poverty, and the highest rate of food insecurity of any racial or ethnic group, all of which can negatively impact health.
The Centers for Disease Control and Prevention (CDC) administers a program called the Racial and Ethnic Approaches to Community Health program (REACH) to address racial and ethnic health inequities. Started in 1999, it is the first federal public health program in the U.S. designed to help communities of color take control over the health disparities affecting them the most. REACH grantees across the country have mobilized their communities, creating multi-sectorial coalitions that have developed innovative approaches for advancing health equity. The REACH model “goes beyond health care and seeks to fully integrate health considerations in economic regeneration, community development, and environmental efforts,” says Lark Galloway-Gilliam, Chair of the National REACH Coalition.
In 2012, with funding from a REACH grant, a consortium of partners known as REACH Su Comunidad (RSC) 
demonstrated how CHW and community coalition-led initiatives focused on policy, systems, and environmental strategies that could advance health equity in Hispanic/Latino communities in the Southwestern and Northwestern U.S. The consortium, Hidalgo Medical Services in New Mexico; the Center of Excellence in Women’s Health at the University of Arizona Mel and Enid Zuckerman College of Public Health; the University of Texas, Health Science Center at Houston School of Public Health El Paso Regional Campus; and Northwest Regional Primary Care Association in Washington state, worked with ten communities in five states: Arizona, New Mexico, Oregon, Texas, and Washington. In each community CHWs played a central role to address inequities in access to healthy food and safe physical activity environments in Hispanic/Latino communities.
CHWs were instrumental in convening multi-sectorial community coalitions, referred to as community leadership teams (CLTs). Together CHWs and CLTs conducted community needs assessments and policy scans to identify community priorities and policies that either restrict or promote healthy eating and active living. To better understand their capacities, each CLT also completed a coalition capacity assessment to help identify strengths and weaknesses, with a particular emphasis on the CLT’s capacity to address health equity. Based on the data, each CLT developed a community action plan in cooperation with CHWs. CLT activities were diverse: working with schools on recess before lunch policies and joint-use agreements so that school recreational facilities can be used after hours by the community at-large for physical activity; engaging local farmers’ markets to create greater access for Latino community members; and partnering with Departments of Parks and Recreation to ensure that all programs and facilities are culturally and linguistically accessible for Hispanic/Latino community members. While there isn’t data to report specific changes in health outcomes, CHWs and CLTs have had success in creating changes at the policy, systems, and environmental levels that, over time, will have the potential to positively impact health outcomes.
The key lesson from the RSC experience is that CHWs, as trusted and knowledgeable community members, are well suited to engage their community in coalitions to advance health equity. While the Affordable Care Act and related health care reform provisions currently being implemented in the U.S. have created new possibilities for CHWs, many are related to increasing access to care and the coordination of health care services. As CHWs are increasingly integrated into the health care delivery system, we should not lose sight of CHWs’ ability to act as agents of social change and community organization to improve the social determinants of health.
Authors:
- Seth Doyle, Northwest Regional Primary Care Association
- Jorge Ibarra, University of Texas, Health Science Center at Houston School of Public Health El Paso Regional Campus
- Martha Monroy, Center of Excellence in Women’s Health at the University of Arizona Mel and Enid Zuckerman College of Public Health
- Saskia Van Hecke, Hidalgo Medical Services – Center for Health Innovation
- Susan Wilger, Hidalgo Medical Services – Center for Health Innovation
Photo 1 courtesy of Sea Mar Community Health Centers.
Photo 2 courtesy of La Familia Medical Center
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