Health Department Community Health Workers: The Greatest Potential for Improving Population Health
CHWs are quickly becoming recognized as critical to improving population health, which is where health departments are shifting their focus as they strive to achieve the strategies laid out in the Public Health 3.0 model.
Community health workers (CHWs) are an umbrella term that include community health representatives, promotoras, outreach educators, community health representatives, peer health promoters, and peer health educators, among other titles. Typically, a CHW is defined as someone who has a close relationship with the community they serve, enabling them to act as a link between health/social services and the community to help build individual and community capacity (the enabling of all community members, including the poorest and most disadvantaged, to develop knowledge, skills, and abilities and take greater control of their lives). One of the ways CHWs build individual and community capacity is by working to improve social determinants of health (SDOH) and equity within the community. SDOH are the environmental conditions where people are born, live, learn, work, play, worship, and age that affect their health, functioning, risks, and quality-of-life outcomes. They are often grouped into five domains: (1) economic stability, (2) education access and quality, (3) health care access and quality, (4) neighborhood and built environment, and (5) social and community context. Equity is the recognition that each person has different circumstances and needs and involves meeting communities and their members where they are, allocating resources and opportunities to achieve equal outcomes for all community members.
CHWs are quickly becoming recognized as critical to improving population health, which is where health departments are shifting their focus as they strive to achieve the strategies laid out in the Public Health 3.0 model. Evidence is significantly increasing for the value of CHW-driven population health outcome interventions (from about 15 studies from 1964-1973 to almost 600 studies from 2014-2016). A few notable research findings include:
- CHW interventions are more often effective when compared with alternatives.
- CHW interventions are more cost-effective for some chronic disease management among underserved communities.
- CHW interventions have a high return on investment.
Therefore, as local and state health departments consider strategies to tackling population health, they should consider hiring CHWs as part of their workforce. As of May 2021, the US Bureau of Labor Statistics estimates that there are about 61,000 CHWs across the United States. Data from the Public Health Workforce Interest Needs Survey (PH WINS) found that only about 1,000 CHWs currently work in state and local health departments (about 2% of the overall public health workforce). Though both of these are likely underestimates, the data still demonstrate a need for a larger CHW workforce within the United States and within state and local health departments specifically. Furthermore, an increased number of CHWs within the workforce may improve public health workforce diversity since they are often indigenous to the communities in which they work and the communities being served are often historically marginalized and minority populations. Together these strategies may position public health agencies to implement targeted approaches in needed communities, create systems to support community needs, supply more effective solutions to address health disparities, create more innovative public health approaches, and facilitate improvements in overall public health outcomes.
When considering hiring CHWs within health departments, here are some key considerations:
- Learn more about CHWs on the national and state level.
- Get to know your state’s CHW laws and education model.
- Use previously created tools and reports to understand the impact CHWs could have in the community your agency serves.
- These data should drive conversations with agency decision makers about the best way to incorporate CHWs into your agency.
- Incorporate mental health and burnout prevention measures for your workforce, especially for CHWs.
- CHWs are at a high risk for burnout due to experiencing the same traumas and challenges as the community they serve, increasing employee turnover. Mitigating burnout can increase retention and, therefore, the impact CHWs have on the community.
- To recruit the most effective CHWs, consider non-traditional avenues such as advertising in community-based settings (eg, churches, barber shops, community groups, recreational centers) and employing word-of-mouth strategies (eg, talking with CHW associations or groups, community and church leaders), in addition to traditional routes (eg, Indeed).
- Consider placing a higher emphasis on life experience than a candidate’s education as the former will likely increase their ability to connect with and have meaningful impacts on priority populations. Sometimes the least traditionally qualified person on paper may have the best community connections.
- When hiring, ensure equity is incorporated throughout the position, beginning with a livable wage. Employing CHWs is an investment in the community and one way to increase potential success is by providing CHWs with the support they need from day one.
Chelsey Kirkland, PhD (c), MPH, CHW (she/her) is a researcher within the Center for Public Health Systems at University of Minnesota, School of Public. During her time there, she has collaborated on numerous nation-wide, mixed-methods research projects working to support and build-up the public health workforce. Her background is in a variety of public health issues including health equity, health disparities, social determinants of health, community health workers, and physical activity. When not working, she enjoys being outside with her family and two dogs. Her favorite activities include running, water-skiing, and playing violin.
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