Roosevelt Institute | Cornell University

ACA supports Community Health Workers

By Elaine JaworskiPublished November 8, 2013

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Community Health Workers have been an integral part of health systems around the world for years. It is time the United States takes advantage of their power to fight obesity-related illnesses.
By Elaine Jaworski, published 11/08/2013


Community Health Workers (CHWs) are individuals who promote basic health within their community with minimal health care training. They have been at the center of preventative healthcare in rural countries for years, providing basic healthcare to areas where medical access is scarce. But now we will soon see how the U.S. can benefit from them. The role of the CHW, which goes by many other names as well, first took hold in China after the Chinese Revolution in 1949. Mao Zedong reorganized China's public health system to include "barefoot doctors", who were actually farmers with minimal medical training. These "barefoot doctors" worked in rural villages to bring preventative care and treatments for common illnesses, and in rural communities that before had restricted access to care to promote hygiene and family planning. The United States then used the model in 1968 when addressing the needs of the Native American tribes. However, beyond the Indian reservations CHWs have been used sparingly throughout the U.S. even though pilot programs have been promising.

Save our Sons was a six-week intervention study in 2010 that aimed at reducing obesity and diabetes in African American men with the use of CHWs. The study concluded that after the intervention the participants had an increased understanding of strategies for prevention and management of obesity and diabetes, increased levels of exercise, as well as decreased blood pressure and weight. The promising study is an anecdote of the effects CHWs can have on our communities.

Obama has decided to take advantage of this health model and is now funding the increased presence of CHWs to reduce obesity, diabetes, and related diseases in the Affordable Care Act (ACA). Although CHWs have primarily been used in rural areas because access to care in these areas is minimal, it is now evident that access to care is just as limited in poor, urban areas. CHWs are the solution to providing education and treatment to these communities that suffer from obesity related illnesses.

There are four primary reasons why CHWs benefit these communities. First, CHWs work in the communities they reside in and are therefore culturally sensitive to the needs of that community. CHWs can act as a liaison between the community and the health care system. This becomes extremely important in minority neighborhoods where many community members speak English as a second language.  Second, CHWs reach people who otherwise would not seek medical attention because of lack of money or resources. CHWS can help community members prevent the need for future treatment, but also direct people to the right resources if they are in immediate need of care. Third, CHWs are much less expensive to train and manage than other medical professionals. Finally, CHWs' focus on preventative care will reduce the amount of chronic and emergency cases in the future, reducing the cost of care.

The ACA has made countless grants available to states supporting CHWs. Ten states will receive a total of $85 million over the next 5 years for programs that incentivize Medicaid beneficiaries to participate in tobacco cessation, managing and preventing diabetes, and weight control programs. The National Diabetes Prevention Program has awarded $6.7 million to organizations that fund activities for lifestyle coaching programs within community organizations. The Community Health Center Fund will also provide $11 billion over the next 5 years for community health centers to open new clinics, expand facilities, and build up their CHW workforce. Look here for more information on funding for CHWs from the ACA. Fifteen states have also either established initiatives or have initiatives under way that increase the presence of CHWs in their state.

The ACA is steering the health care system in the right direction by awarding funds to focus on this holistic approach to health. Over the next 5 to 10 years we will see a huge increase in CHWs across the nation, accompanied by reduced obesity, diabetes and related illnesses, and consequently reduced Medicaid and Medicare costs.