Health Department Public Health Workers: The greatest potential for improving the health of the population

HRDs are quickly becoming critical to improving the health of the population, which is where health departments are shifting their focus as they strive to achieve the strategies set out in the Public Health 3.0 model.

Community health workers (CHWs) are a general term that includes community health representatives, promoters, outreach trainers, community health representatives, peer health promoters and peer health educators, among other titles. CHW is usually defined as someone who has a close relationship with the community they serve, which allows them to act as a link between health / social services and the community to help build individual and community capacity (an opportunity for all community members, including the poorest and most disadvantaged in order to develop knowledge, skills and abilities and take greater control of their lives). One of the ways in which CHWs build individual and community capacity is by working to improve the social determinants of health (SDOH) and community justice. SDOHs are the environmental conditions in which people are born, live, study, work, play, honor and age, which affect their health, functioning, risks and quality of life outcomes. They are often grouped into five areas: (1) economic stability, (2) access to education and quality, (3) access to health and quality, (4) neighborhood and built environment, and (5) social and community context. Justice is the recognition that each person has different circumstances and needs and includes meeting communities and their members where they are, allocating resources and opportunities to achieve equal results for all members of the community.

HRDs are quickly becoming critical to improving the health of the population, which is where health departments are shifting their focus as they strive to achieve the strategies set out in the Public Health 3.0 model. The evidence increases significantly for the value of CHW-led interventions for population health outcomes (from about 15 studies from 1964-1973 to almost 600 studies from 2014-2016). Some notable research results include:

  • HV interventions are more often effective than alternatives.
  • CHW interventions are more cost-effective for managing some chronic diseases in underserved communities.
  • CHW interventions have a high return on investment.

Therefore, as local and state health departments are considering strategies to address the health of the population, they should consider hiring CHW as part of their workforce. As of May 2021, the U.S. Bureau of Labor Statistics estimates that there are about 61,000 CHW in the United States. Data from the Public Health Workforce Needs Survey (PH WINS) found that only about CHW 1,000 currently work in state and local health departments (about 2% of the total public health workforce). Although both are likely to be underestimated, the data still show a need for more CHW workforce in the United States, and specifically in state and local health departments. In addition, increasing the number of ARIs within the workforce can improve the diversity of the public health workforce, as they are often local to the communities in which they work and the communities served are often historically marginalized and minority. Together, these strategies can position public health agencies to apply targeted approaches to needed communities, create systems to support community needs, provide more effective solutions to address health disparities, and create more innovative approaches to public health. and to facilitate improvements in overall public health outcomes.

Here are some key considerations when considering hiring CHW in health departments:

  • Learn more about CHW nationally and nationally.
  • Familiarize yourself with the laws and educational model of your country.
  • Use pre-created tools and reports to understand the impact that CHW can have on the community that serves your agency.
    • This data should stimulate conversations with agency decision-makers about the best way to integrate CHW into your agency.
  • Include mental health and burn prevention measures for your workforce, especially for CHW.
    • CHWs are at high risk of burnout due to experiencing the same injuries and challenges as the community they serve, which increases employee turnover. Reducing burnout can increase retention and therefore the impact that CHWs have on the community.
  • To hire the most effective RIAs, consider non-traditional ways, such as advertising in community settings (eg churches, barbershops, community groups, leisure centers) and using word of mouth strategies (eg groups, community and church leaders) , in addition to traditional routes (eg Indeed).
    • Consider placing more emphasis on life experience than on the candidate’s education, as the former is likely to increase their ability to connect and have a significant impact on priority populations. Sometimes the least traditionally skilled person on paper can have the best connections in the community.
  • When hiring, make sure the capital is included in the entire position, starting with an acceptable salary. Hiring CHW is an investment in the community and one way to increase potential success is by providing CHW with the support they need from day one.

Author’s profile

Chelsea Kirkland

Chelsey Kirkland, PhD (c), MPH, CHW (she / she) is a researcher at the Center for Public Health Systems at the University of Minnesota, School of Public Affairs. During her stay there, she has collaborated on a number of national research projects with mixed methods working to support and build the public health workforce. Her experience is in a variety of public health issues, including health justice, health disparities, social determinants of health, community health workers, and physical activity. When she’s not working, she likes to be out with her family and two dogs. Her favorite activities include running, water skiing and violin playing.

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