Eduardo Sanchez: In Praise of Community Health Workers
“The time is right for community health workers to be even more [integrated] into the community health system to help achieve the triple aim of better care, better outcomes and lower cost,” said Eduardo Sanchez, MD, MPH, vice president for medical affairs at Blue Cross Blue Shield of Texas ,who previously served as health commissioner of Texas. Sanchez made his remarks via a recorded presentation at a standing room only session on community health workers this week at the American Public Health Association annual meeting. The session was hosted by the APHA section on community health workers established just two years ago.
The section defines community health workers, who number in the thousands across the U.S., as a frontline public health worker who is a trusted member of or has an unusually close understanding of the community served. At the session yesterday, speakers said that this trusting relationship enables a community health worker to serve as a liaison between health and social services and the community. They can also facilitate access to services and improve the quality and cultural competence of service delivery. Dr. Sanchez said that community health workers are also often able to build individual and community capacity by increasing health knowledge and self-sufficiency through activities such as outreach, community education, informal counseling, social support and advocacy.
In his presentation, Dr. Sanchez said that key reasons to expand the role of community health workers include an insufficiently and unevenly distributed primary care workforce, a shortage of primary care doctors and a nursing shortage and that fact that studies show that prevention recommendations are only followed up by individuals about 55 percent of the time.
“I believe the [primary care physician] shortage forces all of us to think about new and different ways to expand capacity, including health teams that include community health workers,” said Sanchez.
Sanchez said that model community health worker programs studied found improved outcomes including improvements in the birth weight of babies whose mothers had relationships with community health workers during the pregnancy. Texas has developed training programs for community health workers and the state’s most recent legislative session directed the legislature to study the feasibility of identifying payment and reimbursement for community health workers.
Sanchez said diabetes is another great example of a health condition that would benefit from community health workers to help manage glucose, blood pressure and blood lipids. In Holyoke, Mass., promotoras—community health workers in the Latino community—look after their own and patients’ diabetes.
And Sanchez cited a Medicaid study of community health workers that found a decrease in emergency room visits by 58 percent, a decrease in doctor visits by 42 percent, a 29 percent decrease in missed school days and a 42 percent decrease in missed work days by parents.
Sanchez says critical roles for community health workers include:
- Offering health education and health literacy skills
- Helping patients navigate the health system
- Connecting people with the services they need
- Providing informal counseling and social support
- Serving as advocates for individuals and communities
- Augmenting primary care capacity
Sanchez said the next steps include the need to raise awareness about community health workers’ roles; change attitudes about the workers where needed including through policy briefings; better define roles, responsibilities and accountability; make the business case for community health workers and grow the evidence base.
>>Bonus Link: Watch a video about Wyandotte County, Kansas and its efforts to improve the health of its community. Innovations include using promotoras, community health workers in the Latino community, to work with women on smoking cessation.