Shreya Kangovi, MD MS is the founding Executive Director of the Penn Center for Community Health Workers, and an Associate Professor at the University of Pennsylvania Perelman School of Medicine. Rebekah E. Gee, MD, MPH is CEO of Healthcare Services for Louisiana State University and formerly served as Louisiana's Secretary of Health where she led the state's Medicaid expansion. Rear Admiral Susan Blumenthal, MD, MPA (ret), the Senior Medical Adviser at amfAR, The Foundation for AIDS Research, served as US Assistant Surgeon General, Deputy Assistant Secretary for Health, and a White House Health Adviser. The views expressed in this commentary belong to the authors. Read more opinion articles on CNN.
(CNN)In order to emerge stronger from the Covid-19 pandemic and a year of social and economic tumult, we need to focus on bolstering public health, re-building the economy and achieving racial justice. There is one often-overlooked workforce that will be critical on all three of these fronts: Community Health Workers (CHWs).
Shreya Kangovi
Rebekah E. Gee
Susan Blumenthal, MD
CHWs are trustworthy individuals who come from the communities they serve. They are part of a Department of Labor classified workforce and unlike many other professions -- such as social workers and nurses -- they are not defined by training or licensure, but rather by who they are and what they do. Throughout the pandemic, CHW have served on the front lines, engaged in public health messaging and contact tracing, addressed broader social and health needs within their communities and could inform policy and system changes. Many are now working on the ground to ensure that marginalized people have reliable Covid-19 vaccine information and access. However, the impact of CHWs could be much greater.
There are approximately 60,000 CHWs in the country, employed by grassroots organizations, hospitals, clinics or public health departments with funding from a patchwork of grants and pilot funding. Increasingly, policymakers have voiced support for investing in and mobilizing this workforce.
A bipartisan group of congressional leaders urged the US Department of Health and Human Services (HHS) to direct Covid-19 and Medicaid dollars to CHWs. In his campaign platform, President Joe Biden promised to create jobs for 150,000 CHWs from within some of America's hardest-hit urban and rural communities; Biden's recent pandemic response plan renews his commitment to including CHWs as part of a US Public Health Jobs Corps.
Despite growing policy momentum, many Americans have never heard of CHWs. This oversight may in part be due to the fact that the CHW workforce is commonly black, brown, or rural white and may not have graduate degree letters behind their name. Yet, it is a mistake to overlook this important workforce. Here is what Americans need to know about CHWs, and how they can guide us through public health, economic and moral recovery.
Public health
With the severe delays in delivering Covid-19 immunizations across the country, lower income, Black and Brown people continue to bear a disproportionate impact of the disease. And Americans are sick and dying at startling rates, not only of Covid-19, but its effects: unemployment, food insecurity, deferred preventive care, social isolation, alcohol and opiate use and suicidal ideation.
CHWs have a flexible, holistic approach that is well-suited to this range of challenges. Imagine Maggie, a 43-year-old who has lost hours at her retail job due to the pandemic and can't make rent. Her son has autism and is having a difficult time being out of school. She has concerns about the safety of a Covid-19 vaccine and her ability to even access one. A CHW would get to know Maggie as a whole person. She would ask Maggie what she thinks would improve her life and health. And then she would work with Maggie to do those things: battle an eviction notice, introduce her to an autism support group and connect her with a good primary care provider who can talk her through the risks and benefits of a Covid-19 vaccine, as well as help ensure that she gets immunized when eligible.
In the United States, we typically take a piecemeal approach to health that does little to connect the silos of public health, community-based organizations and health care. By investing in CHWs we can do more than build lamp posts; we can build a power grid that can shed light where needed for a given individual. Many developing nations have incorporated CHWs as integral players in their health systems with lifesaving dividends including reductions in childhood and maternal mortality, enhanced uptake of vaccinations as well as increased HIV testing and delivery of treatment services.
A large body of scientific evidence suggests that in the US CHWs may help improve chronic disease control and mental health outcomes, promote healthy behavior, and reduce hospitalization and health spending. And they could play a critical role in ensuring that people get vaccinated where they live. The National Committee for Quality Assurance is translating science-based best practices into national standards for CHW hiring, training and infrastructure on a national scale.
Economic recovery
America spends far more on sick care than every other developed country in the world. We tend to wait for people to get sick and then pay a fortune to treat them in hospitals and clinics with expensive drugs and high-tech medical devices. CHWs address the root causes of poor health such as racial discrimination, unstable housing, intimate partner violence, loneliness, or food insecurity. Their effect on health translates into cost savings: randomized controlled trials have shown that CHWs can prevent costly hospitalizations and save $4,246 per Medicaid beneficiary. We estimate that if scaled up to serve to even 15% of the Medicaid population, CHWs have the potential to save American taxpayers $46 billion annually.