Community Health Workers in a Post–Health Reform Era

Abstract

Most health care spending and deaths in the United States are related to costly, debilitating chronic diseases such as obesity, diabetes, high blood pressure, heart disease, and cancer (Centers for Disease Control and Prevention [CDC], National Center for Chronic Disease Prevention and Health Promotion, 2015b). Racial and ethnic minority populations and vulnerable groups are disproportionately impacted by certain chronic conditions due to barriers caused by lack of education, socioeconomic, geographic, or other sociocultural factors (Smedley, Stith, & Nelson, 2003). As The Patient Protection and Affordable Care Act (2010) seeks to improve access to and quality of health care as well as curb health care expenditures, we are presented with a new opportunity to focus on a more interdisciplinary, holistic team approach to facing these chronic conditions-an approach that includes community health workers (CHWs). Given CHW programs have existed for decades, what additional information or changes are needed in today's evolving health environment for CHWs to live up to their promise and potential? CHW is a standard occupational classification recognized by the U.S. Department of Labor and the World Health Organization (WHO) but in practice has been referred to under more than 150 different titles of paid and unpaid positions such as lay health advisors (LHAs), outreach workers, promotores(as) de salud (Spanish for "health promoters"), community health representatives, and patient navigators (Bureau of Labor Statistics, U.S.