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Financial constraints, limited access to safe outdoor space, food insecurity, and lack of transportation are just a few of the many social factors that impact people’s health. These non-medical factors that impact health and wellbeing are called the social determinants of health. The problems that arise from the social determinants of health are often driven by systems outside the control of affected communities. Further, these problems tend to appear outside the walls of clinics and hospitals, so healthcare workers are usually not in a position to help.
The roadblocks presented by the social determinants of health prevent access to social services and health care, which can make whole communities less healthy. Black, Asian, Latinx, immigrant, and refugee communities are often the groups most negatively affected, along with those experiencing homelessness or substance use disorder. The effects of these barriers are also costly, incurring an estimated $93 billion in excess medical costs and $42 billion in lost productivity in the United States annually. These issues can also damage relationships between healthcare professionals and communities. Healthcare providers who do not understand the social determinants of health may dismiss affected groups as simply noncompliant.
Community health workers provide a promising solution to these problems. Community health workers are nonclinical healthcare professionals who serve their own communities. With intimate knowledge of the community and often a shared identity (race, ethnicity, education, and socioeconomic status), community health workers are keenly aware of the various issues that impede clients’ access to care. Many community health workers even face the same barriers to care as their clients. These workers are well-positioned to advocate for better access to health care and to help address the social issues that negatively impact the health of their community.
Community Health Workers in the Community
Policymakers, public health program administrators, social service providers, and health care employers should recognize community health workers as an essential piece of the health care system. Community health workers educate and empower clients and communities to take their health and wellbeing into their own hands. These workers also facilitate access to health and social services outside clinics and hospitals, which can dramatically improve the health of vulnerable populations. To build individual and community capacities, community health workers draw on a variety of skills including health education, informal counseling, and advocacy.
As advocates, community health workers teach clients how to navigate the health care system and to articulate their needs to other healthcare workers. For example, community health workers often advocate for clients in doctor appointments and to insurance company representatives. These interactions provide examples for clients to learn how to advocate for themselves.
Community health workers can also partner with community members to target specific social determinants. These workers can support other community members as they arrange town hall meetings to educate peers or work with policymakers to implement the changes needed to improve health and wellbeing.
Incorporating Community Health Workers as "Specialists"
Community health workers are not, for the most part, integrated into the health and social services workforce in the United States. This is a problem. To be most effective, these workers should be viewed as complementary members of health care teams who can help patients overcome structural barriers to care that undermine the care they are already receiving. To encourage this, policymakers, insurance providers, and other healthcare providers should work to ensure community health workers are paid for their work through hard funding.
There are a variety of opportunities for health and social services employers to consider when integrating community health worker programs. Organizations such as the American Journal of Managed Care, has put together a site advocating the financial benefits of addressing social determinants of health through community initiatives. Community health workers can be viewed as “specialists” at addressing the aforementioned social determinants of health. Investing in these workers will ensure that the broader community and workforce can remain healthy, something which can be difficult for individuals to attain due to the impact of social determinants of health.
In considering community health workers as specialists at addressing social determinants of health within the broader economic development paradigm, various streams of funding may emerge for this workforce. As a result, this will not only provide funding community health worker programs but also improving the health and wellbeing of all.
There are several ways forward that will be vital to address the social determinants of health through the work of community health workers. Policymakers should listen to and work closely with community advocacy groups and community health workers to fully understand how the social determinants of health impact communities. In doing so, policymakers can craft new legislation aimed at addressing these issues. Healthcare organizations who might employ community health workers should understand the unique facets of these workers and what makes them effective in addressing social determinants of health.
Lastly, protecting community health workers’ role in advocacy is as crucial as is employing them in stable, long term positions. Members of the established health care team (e.g., doctors, nurses, medical assistants, etc.) should understand the complementary role played by community health workers and the need for their work which is carried out most often outside of the clinic walls. Ultimately, community health workers are crucial and underutilized health care workers who can address social determinants of health and move communities toward increased health equity.
Co-authored with Margarita Hart, INCHWA, Esperanza Ministries.