Community Health Workers Will Reduce Disparities & Improve Outcomes-The HSB Blog 4/19/21

Our Take:

According to the article, “America’s Health Literacy: Why We Need Accessible Health Information”, only 12% of adult Americans demonstrate limited (proficient) health literacy. This impacts overall health outcomes and healthcare expenditures due to a fragmented education system in the US where health education is not standardized. The cycle of poor health literacy contributes to the prevalence of preventable diseases. Integrating Community Health Workers (CHW) into the healthcare system will reduce the burden placed on strained resources and overworked clinicians. It will also help improve health outcomes when used for addressing chronic health conditions (chronic conditions are usually preventable).

Key Takeaways:

Community Health Workers will:

Cost-effectively address the need for healthcare professionals
Implement preventative care more closely, reducing the burden on healthcare services
Efficiently improve health outcomes, especially for chronic conditions
Close gaps between doctors and patient, acting as a mediator
Explain medical shorthand to patients while supporting them with potential social services
Improve health literacy in a sustainable manner

The Problem:

Social determinants of health allude to which populations often face extraneous barriers when accessing healthcare. We often overlook the barriers to receiving and complying with treatment plans even when, finally, inside the hospital room. It often starts with the rigid communication between healthcare providers and patients who often do not correctly understand the medical jargon given the poor health literacy in America. In addition to the poor health literacy noted above, in many communities, the formal medical community itself is not the primary means by which healthcare information is dispersed and providers may not be those most trusted to deliver that information. Moreover, even in communities where health literacy may be strong, they may not have good access to services or supports based on their geographic location.

The Backdrop

CHW’s are defined by the American Public Health Association as frontline public health workers who are trusted members of a community and who have an unusually close understanding of the community served. This relationship allows CHWs to serve as a liaison with 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. CHWs also function as cultural translators. For example, if English is not the patient’s first language or if Western medicine is not commonly practiced in their culture; patients are less likely to comply with or adhere to their treatment plans. Language is an extension of a culture where the semantics of certain words are accessible to in-group native speakers and where the meanings of certain words get lost in translation. In situations like this, CHWs can step in and improve communication. As patients often interpret symptoms and share information according to how they understand the question and their health, doctors may not end up with an accurate picture or truthful assessment of a patient’s health. As a result, there is a need for certain interventions and clarifications to bridge this gap. In addition, at times, healthcare professionals may not have the skills, personality, or luxury of time when presenting highly complex information to demonstrate cultural competence as their focus is the medical problem itself. No matter what the cause, as demonstrated during the Coronavirus pandemic, health inequities exist across demographics and geographic populations. Moreover, telehealth and digital tools allow providers to leverage services like these. For example, telehealth comes with supportive data infrastructure and can help make access easier for the rural population. The data infrastructure, often in the form of digital health tracking devices or applications supported by smartphones can now be leveraged to tackle poor health outcomes on a larger scale. More importantly, these tools can be programmed to give us sustainable positive health outcomes. (Example: Ginger, telemental health)

Implications:

CHWs will help make healthcare more accessible for consumers while promoting health literacy and fostering trust in the healthcare system. Medical mistrust is a cultural phenomenon that is shared within groups. As consumers of healthcare services, patients are often at the risk of mistreatment, mismanagement, or a simple lack of understanding in terms of clinical care and disease prevention. This can result in underutilization or poor application of healthcare services. Add in the historical implications of hospital malpractices and lack of general equity and the medical mistrust is likely to follow amongst consumers. Small interventions like these can ultimately improve health literacy and have big impacts. For example, the Mississippi Delta Center implemented CHWs in a program aimed at helping treat heart disease in 18 BIPOC neighborhoods. Studies of the program reported that patients with hypertension who were enrolled in this program reported a decrease in both systolic and diastolic blood pressure as well as an improvement in cholesterol levels. The studies also found a median change in health care costs, post CHW intervention of $82 per person/per year (with the range being -$415 to $14). In addition, health education and health literacy must be comprehensive because health is a multidimensional subject where all aspects of health are interconnected. The lack of health literacy and self-efficacy across populations is one of the main drivers behind America’s high mortality rates, low life expectancy, and the highest rates of preventable deaths. Ultimately, persistence and effective health interventions will lead to less adverse health outcomes.

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