Community health workers (CHWs), known in Latino communities as promotoras, are community members who provide health education and linkage to health services in their communities. CHWs deliver these services through a cultural lens representative of their community. They help to bridge the gap between the medical providers and communities suffering from poor health outcomes.
To provide a brief history of community health workers or promotoras, during the mid-20th century, promotoras in Latin America helped expand healthcare access to the poor. This model was replicated in the United States during the 1980s, focusing on the migrant farm working communities. Since then, promotoras (community health workers) have provided health education and health services navigation to disadvantaged communities throughout the country.
They have provided health education and navigation to medical services for many needs, including, but not limited to, chronic disease, health maintenance, infectious diseases, and maternal health. These are many issues of concern for disadvantaged communities in Los Angeles.
Over the past decade, many Los Angeles residents have experienced a series of health challenges that not only affect an individual’s well-being, but also can place an avoidable strain on their families, friends, and communities. For example, Los Angeles residents are experiencing poor health outcomes in three categories: sexually transmitted diseases/infections, chronic health conditions, and substance use disorders. Leading up to 2020, Los Angeles-born infants experienced a significant increase in exposure to syphilis. Further, Los Angeles adult residents have experienced increased diagnoses of syphilis, chlamydia, and gonorrhea.
Concerning chronic disease, we have observed increased deaths due to diabetes, with obesity in 27.4% of the adult population in 2020. Also, teen obesity has increased from 13.2% in 2016 to 20.8% in 20202.
Finally, concerning substance abuse, opioid deaths increased from 3.51 per 100,000 residents in 2016 to 10.9 per 100,000 residents in 20202. Overall, drug overdose deaths have increased from 8.88% to 18.28% of all deaths in the same period.
Community health workers can help address these poor health outcomes in three ways: health education, preventative services or health maintenance, and linkage to emergency services. CHWs can use health education as the foundation for improving community health outcomes. Through health education, CHWs can build trust in communities, help families make healthier lifestyle choices, and increase awareness regarding crucial health topics such as the environmental impact on health.
Organizations such as SHIELDS for Families, which has been working to improve the health of infants and families in South Los Angeles for over 30 years are important community resources. For example, Iris Cantor- UCLA Women’s Health Center runs a California Environmental Protection Agency-funded Promotora training program, which SHIELDS for Families assists in an advisory capacity.
For this program, the health center and their partner Worksite Wellness LA are training Latina women in disadvantaged communities on environmental toxins and their impact on breast cancer and maternal health. Through these education topics, women in the program can teach their communities about environmental toxins that negatively influence breast cancer and maternal health outcomes.
Further, preventative or health maintenance services influence positive lifestyle choices and improve health outcomes through screenings such as mammograms and routine blood work. Focusing on screenings and health maintenance can help individuals reduce poor lifestyle choices that, over time, lead to chronic illness and reduce the risk of individuals receiving a late diagnosis for diseases such as breast cancer and sexually transmitted infections (STIs). Finally,
CHWs can have a substantial impact on linking community members to emergency health services. For example, CHWs can become a bridge between an individual suffering from a substance use disorder and the inpatient or residential treatment provider that will help put them on track to living a drug-free life.
CHWs are crucial figures that can help build trust with community members weary of medical providers, helping people make better lifestyle choices and obtain services that can improve health outcomes.
Cameron Lewis, MPA, is the SHIELDS for Families project administrator.
