Achieving Health Equity, One Community Health Worker at a Time

Community Health Workers are Playing a Critical Role in Efforts to Reduce COVID-19 Disparities.

For many years, people who work in public health have witnessed and often suffered the consequences of health disparities driven by inequities in major segments of our population. Now, as we respond to the COVID-19 pandemic, which reflects and exacerbates  such inequities, communities of color and the community health workers (CHWs) who support them are gaining the attention and resources they deserve.

CHWs are public health professionals who are trusted members of the communities they support, many of which are particularly affected by the pandemic. As bridges between clinical and community care, CHWs help to slow the spread of the virus by facilitating culturally responsive prevention education and advance health equity by linking people to testing, care, and other resources.

Many CHWs, like our own Durrell Fox, remember working during the height of the HIV epidemic with communities experiencing similar challenges from misinformation, stigma, and fear, perpetuated by health care services and public health policies embedded with systemic barriers, especially for people of color.

Like many federal institutions, the Centers for Disease Control and Prevention (CDC) understands the critical role that CHWs can play in integrating public health into clinical care. Launched in August 2021, CDC’s Community Health Workers for COVID Response and Resilient Communities (CCR) initiative provides financial support and technical assistance (TA) to 68 states, territories, urban Indian health organizations, and tribal nations, organizations, and health service providers.

CHWs are a part of the solution to the challenges in our health and public health systems and communities. Investing in and sustaining the CHW workforce is critical for responding to current and future pandemics and to achieving health equity.” Durrell Fox, CCR evaluation co-principal investigator.

One of the goals of the CCR initiative is to support the training, deployment and engagement of additional CHWs in the communities hardest hit by COVID-19 and among populations at high risk for COVID-19 exposure, infection, and illness. These CHWs are equipped with specialized training and provide ongoing TA to support their efforts to respond to the COVID-19 pandemic.

JSI is co-leading the strategic planning for and implementation of an equity-driven, multi-site (68 grantees) community-based participatory evaluation framework, in partnership with the Washington State Department of Health and the CHW Common Indicators Project, the CDC, Pillar Consulting, and Arizona State University. This framework will be used to explore CHWs role in expanding access to COVID-19 resources for the diverse communities served by the CCR grantees, particularly people of color, including many Tribal nations and U.S. territories.

Our CCR evaluation will also explore how CHWs address the underlying social determinants of health that contribute to higher rates of COVID-19 infection and death among people of color. Relying on the expertise of CHWs who will serve as project leads and subject-matter experts, JSI and our partners will use a mixed-methods approach to assess short-, intermediate-, and long-term outcomes of the CCR initiative. Evaluation results will inform improvement strategies and sustainable program design that respects and supports CHWs.

It is important that our evaluation approach, based on science, is driven by communities. CHWs will be part of our process as well as represent the communities this work will ultimately impact” – Rodolfo Vega, CCR evaluation co-principal investigator

Program evaluation is critical to improving program effectiveness and identifying training and TA needs. Our hope is that this work will strengthen the CHW workforce and reduce health inequities among and increase resilience of diverse communities during this and future pandemics.