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Community Health Workers in Illinois – we ain’t seen nothin’ yet!

Guest Author
July 18, 2014
We’re pleased to share a guest post this week from Health & Medicine Board Vice President Steven K. Rothschild, M.D. Dr. Rothschild is a family physician and researcher in the Departments of Family Medicine and Preventive Medicine at Rush University Medical Center. You can follow Dr. Rothschild on twitter @comunidadysalud.

Advocates for Community Health Workers (CHWs) were cheered on May 29th of this year when HB5412 was passed by both house of the Illinois General Assembly.   Although CHWs have been working in the US for over forty years, this bill advanced the field in Illinois by creating an Advisory Board to advise the Department of Public Health, the Governor, and the General Assembly on matters concerning training, certification, and implementation of CHW programs. Health & Medicine was a leader in supporting this legislation, including the critical point that over half of the Board be composed of CHWs.
Of course, what happens next remains to be seen.   Professionalization and regulation can lead to unintended negative consequences such as excluding CHWs with low English literacy, disenfranchising undocumented CHWs, and disempowering the workers by drawing them into the more narrow medical model of care. All of us need to be vigilant in monitoring implementation to make sure that core values of empowering people to live healthier lives through community advocacy are preserved.
With that caveat, though, I am confident that in the next few years the health care community will be pleasantly surprised to see the impact of CHWs in our state. As a family physician, I first began working with CHWs in the early 1980s, in Cleveland. On the east side of the city, neighbors were trained to look in on frail elderly residents to make sure they were taking their medications and attending clinic appointments.  
Since then, here in Chicago, I have watched CHWs educate parents about asthma management, visit clients in their home to educate about diabetes, promote diet and physical activity to reduce the risk of diabetes in Humboldt Park, advocate for a safer environment in a CHA senior building, and establish an exercise program for seniors in Pilsen. In each and every setting, I saw community members provide education that was caring, creative, and effective. Visiting patients in their homes, CHWs often see things that doctors and nurses never see, and have to help patients in all kinds of innovative ways.    

I recall one CHW who visited a family who was getting their electricity from a wire strung directly to a street lamp – and who then helped them get safer affordable electricity through a public assistance program. In another case, a CHW visited an apartment, only to find her client lived with a brown bear in the bathroom (long story). Most often, though, the CHW's work has focused on helping neighbors overcome social barriers to health, including poverty, racism, lack of access to healthy foods, unsafe parks, low literacy, language barriers, transportation difficulties, and major stress and trauma. They have taught clients about their illnesses and how to adhere to their medications when the person's own doctor was too busy to do so. Some of the home situations they addressed were frustrating, sad, and on occasion even frightening – but the CHWs found ways to help their clients solve problems and live healthier lives.

Research evidence of effectiveness is growing as well;  the August 2014 issue of the American Journal of Public Health has a paper from my research group, demonstrating how a CHW program could result in sustained improvement in diabetes control over 2 years among Mexican-Americans here in the city.

What will happen next in Illinois, now that the legislature has recognized the field of Community Health Workers? I don’t know that anyone can say for sure, but I am confident that CHWs will exceed our expectations, awe us with their energy and creativity, and help reduce health disparities in our state.