A Community Health Worker’s Pandemic Perspective

May 6th, 2022 | Viewpoint


As the world realized that the coronavirus had grown into a pandemic, Durrell Fox was celebrating his wedding anniversary and sailing on a Caribbean cruise ship out of New Orleans. Taking a long-planned break from his work as a JSI community health worker (CHW) consultant, he was blissfully unaware.

By the time the ship returned to port, however, it was clear that Fox and his spouse would not continue celebrating during Mardi Gras, as they had planned. Instead, they drove straight home to Georgia and immediately into quarantine, which wound up lasting almost 2 years.

Pandemic Parallels

As the COVID-19 crisis unfolded, Fox saw echoes of another pandemic. “Just as with HIV, there were so many questions. There were so many myths and so much misinformation,” he recalls. Both pandemics highlighted deep disparities and inequities in health and access to information, testing, and treatment. Low-income urban neighborhoods and rural communities have the fewest resources, and initial responses weren’t designed to serve them. With COVID-19, disease rates were higher among those with low incomes, partly because they were more likely to have jobs where they had no option but to continue working outside the home, increasing the chances of exposure. Nor are people in these jobs likely to have paid sick time, including for medical appointments, forcing them to work untested and unwell, exposing others, Fox explains.

Further, testing and treatment rates were lower in some communities, in part because much of the outreach and scheduling was online, which made it difficult for people without computers or limited Wi-Fi. These inequities were compounded by the lack of transportation to testing and vaccination sites and led not only to increased incidence of COVID-19 cases, but also to increased severity of illness and deaths.

Who are Community Health Workers?

The APHA defines a community health worker as a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the worker to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. A community health worker also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy.

Perhaps most importantly, CHWs address the social determinants of health, and can see beyond a specific challenge to the broader health and wellness concerns that affect treatment and recovery, such as housing, food, and job insecurity.

It’s really about connecting people to resources and having someone who is knowledgeable about the disease/virus and able to debunk those myths and misinformation,” Fox says. “CHWs have shared lived experience and are trusted members of the community. They speak in a culturally appropriate language that community members understand.”

Many funders are aware of CHWs’ value and effectiveness, demonstrated through decades of evaluation, publications, and studies. As health care/public health institutions, agencies, and companies sought to support communities during the Covid-19 pandemic, they provided CHW programs with millions in funding.

Increasing Support for CHWs Strengthens Communities

Funding continues to be allocated across the country to support CHWs as they help communities become more resilient in the face of COVID-19 and future outbreaks and pandemics. Fox and a leadership team of evaluators and CHWs are now working with JSI, leading one of two national centers charged with evaluating the CDC’s COVID Response and Resilient Communities (CCR) project. The project is engaging, training and deploying CHWs at 68 funded organizations, to build and strengthen communities capacity to be resilient against COVID-19 and future pandemics by improving the overall health of communities. Fox is hopeful that the CCR project will inform and lead to sustained support for CHWs across the country. Fox is hopeful that the CCR project will inform and lead to sustained support for CHWs across the country.

This pandemic has proved again that CHWs, when funded and equipped with tools and other resources, improve health outcomes by providing accurate information and increasing access to testing, treatment, and a host of auxiliary services. Most importantly, they do this while working to mitigate the social determinants of health and other root causes of poor individual and public health outcomes. In this way, Fox notes, “You can not only reduce the amount of disease burden, you can improve the quality of life for everyone and increase life expectancy.”

Read the other Pandemic Perspectives in the series.

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