Overview

Community Health Workers (CHWs) are frontline public health workers who are trusted members of and/or have an unusually close understanding of the community they serve. This trusting relationship enables CHWs 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. 

CHWs also build 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. (American Public Health Association, 2008)

In January 2009, the Office of Management and Budget officially published the 2010 Standard Occupational Classifications (SOC) listing in the Federal Register.  The 2010 SOC includes a unique occupational classification for Community Health Worker (SOC 21-1094).

Community health workers are dedicated individuals who function along a continuum ranging from individual and community development to service delivery promoting community empowerment and social justice. They often help link people to needed health care information and services.

CHWs work in all geographic settings, including rural, urban and metropolitan areas, border regions (colonias), and the Native American nations.  Although CHW roles vary depending on locale and cultural setting, they are most often found working in underprivileged marginalized communities where people may have limited resources, lack access to quality health care, lack the means to pay for health care, do not speak English fluently, or have cultural beliefs, values and behaviors different from those of the dominant western health care system. In these communities, CHWs play an integral role in helping systems become more culturally appropriate and relevant to the people they are to serve.

CHWs typically have deep roots or shared life experiences in the communities they serve. They share similar values, ethnic background and socio-economic status, and they often speak the same language as the people they serve.

The CHW serves as a bridge between the community and the health care, government and social service systems.

The CHW’s responsibilities can include:

• helping individuals, families, groups and communities develop their capacity and access to resources including health insurance, food, housing, quality care and health information
• facilitating communication and client empowerment in interactions with health care/social service systems
• helping health care and social service systems become culturally relevant and responsive to their service population
• helping people understand their health condition(s) and develop strategies to improve their health and well being
• helping build understanding and social capital to support healthier behaviors and lifestyle choices among people
• delivering health information using culturally appropriate terms and concepts
• linking people to health care/social service resources
• providing informal counseling, support and follow-up
• advocating for local health needs
• providing health services, such as monitoring blood pressure and providing first aid
• making home visits to chronically ill patients, pregnant women and nursing mothers, individuals at high risk of health problems, and the elderly
• translating and interpreting for clients and health care/social service providers.

CHWs go by many titles, depending on where they work, who they work for and what they do. Common titles include community health advisor, family advocate, health educator, liaison, promoter, outreach worker, peer counselor, patient navigator, health interpreter, and public health aide. In Spanish-speaking communities, CHWs are often referred to as health promoters or promotores(as) de salud.

The role of the CHW started as a societal position, appointed by and responsible to members of community. Advocates and activists dedicated their time and talents to ensuring that local people received the health information, resources and health care services they needed. The success of their efforts has caused many government agencies, non-profit organizations, faith-based groups and health care providers to create paid positions for CHWs to help reduce, and in some cases eliminate, the persistent disparities in health care and health outcomes in underprivileged communities. The organizations benefit by gaining access to information about health care needs in these communities, which they can use to improve the design of health services.

You can download, save and print a PDF of this career profile:

Community Health Worker Overview 14 Sep 2009 [pdf, 216 KB]

Working Conditions

Community health workers (CHWs) often live in the community they serve. They spend much of their time traveling within the community, speaking to groups, visiting homes and health care facilities, distributing information and otherwise connecting with local people.

Some CHWs work in health facilities, providing case management, client education, interpretation and follow up care. Others are employed by government agencies and non-profit groups to provide community organizing, health education, Medicaid enrollment and preventive care services “in the field.” These CHWs may staff tables at community events, provide health screenings, referrals, and information, and help people complete applications to access health benefits. They may also visit homes to check on individuals with specific health conditions, drive clients to medical appointments, or deliver health education presentations to schoolchildren and their parents and teachers.

CHWs hired by health care agencies often have a disease or population-based focus, such as promoting the health of pregnant women or children, improving nutrition, promoting immunization, or providing education around a specific health issue, such as diabetes or HIV/AIDS.

CHWs are defined by the trust they receive from the communities they work in.  To be effective, CHWs must secure, preserve and develop that trust.  This can put the CHW in a difficult position, particularly when there is disconnect between program goals and community priorities. For example, communities that rely on their own traditional medical practitioners (such as native healers) may resist efforts by a CHW to refer patients to “Western” health care resources. The CHW must be able to balance their responsibilities to the community with their employer’s agenda.

Outlook & Salary Range

Throughout the United States, the CHW field is burgeoning, both in interest and demand, yet the practice lacks definition, standards, and openly available training opportunities. The field is also rapidly expanding into new areas of health and community wellness as CHWs continue to improve chronic disease management programs, health insurance enrollment, immunization drives, HIV/AIDS treatment, access to mental health services and maternal-child health interventions.

Becoming a CHW is almost an idiosyncratic process, involving individuals seeking opportunities to help their community through a patchwork of employment opportunities, often known only by word of mouth and with highly varied job requirements and situations.  This is unfortunate in that the lack of CHW identity and standards of practice has led employers to contribute to the confusion about who CHWs are and what they do.

CHW salaries vary depending on local economies, wage scales and demand.  In major metropolitan areas recommended starting CHW annual salaries range from $35,000 to $42,000, while Senior CHWs can earn $42,000 to $52,000 and supervising CHWs may earn $52,000 to $60,000.  Manager CHWs generally earn salaries above $60,000.

CHWs often are hired to support a specific health initiative, which may depend on short-term funding sources. As a result, CHWs may have to move from job to job to obtain steady income.  This short-term categorical funding of health services is a challenge to the stability and sustainability of the CHW practice.