Community Health Workers in the United States: Time to Expand a Critical Workforce

ABSTRACT

ommunity health workers (CHWs) have a long, rich global history of extending essential health services and helping address social determinants of health for underserved populations.1 The 1978 Declaration of Alma-Ata, which called for the achievement of "health for all," explicitly defined a role for CHWs as an integral member of primary health care teams.2 In the United States, CHWs have historically been patient health educators and advocates, particularly for patients who have limited health knowledge or whose first language is not English. Despite these efforts, the CHW workforce in the United States has been underrecognized and underutilized, and many have called for policy change to better integrate CHWs into the US health system.3,4 CHWs have been largely neglected in health workforce planning, with existing programs often led by multiple actors without coordination, with fragmented or diseasespecific foci, unclear links to the health system, and unclear identities because of wide-rangingjob titles.2 Small programs and demonstration projects have shown the efficacy and promise of CHWs to improve population health outcomes,5,6 but monitoring and evaluation systems for large-scale CHW programs have been weak, and evidence of their real-world effectiveness and cost-effectiveness has been limited. In many communities, CHWs have been instrumental in COVID-19 public health messaging and communication, contact tracing and monitoring in medically underserved communities, navigation to vaccine and testing appointments, and even in conducting rapid antigen testing with the proper training and personal protective equipment. Leveraging this current momentum and unique window of opportunity to strengthen and expand this critical workforce will require evidence-based practices8,11,12 for effective recruitment, training and certification, retention, evaluation, supervision, reimbursement, recognition, and remuneration of CHWs to ensure success and sustainability long beyond the COVID-19 pandemic. >4JPH CORRESPONDENCE Correspondence should be sent to Natalia M. Rodriguez, PhD, MPH, Department of Public Health, College of Health and Human Sciences, Purdue University, Matthews Hall 218, 812 W State St, West Lafayette, IN 47907 (e-mail natalia@purdue.edu).