Why the Current Interest in CHWs?

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Photo collage of a waiting room at a hospital and a dollar sign.

The current interest in CHWs can be attributed to:

  • Growing diversity of U.S. population
  • Growing prevalence of chronic diseases
  • Growing complexity of health care
  • Recognition of social/behavioral determinants of health
  • Commitment to reducing health inequities
  • Cost pressures on system
  • Shortages of clinical personnel limiting time with patients



Although CHWs have been around at least since the 1960s, interest has grown in the last 10 years, aided by two pivotal publications: the National Community Health Advisor Study, published by the University of Arizona in 1998, and the Community Health Worker National Workforce Study, published by Health Resources and Services Administration, or HRSA, in 2007. Links to both these studies are provided on the page of web references mentioned a few minutes ago.

Central to this new interest is the recognition that despite progress in treatment methods, pharmaceuticals and technology, and even disease prevention and management, the effectiveness and efficiency of our health care system are limited by deficiencies in relationships and communication.

With an increasingly diverse population, cultural differences can make providing quality health care more difficult, and can complicate prevention efforts. As chronic diseases consume more of our attention and resources, we see that clinical encounters alone are not sufficient to prevent and manage these conditions. And the increasingly complex health care system is challenging for everyone to understand, not just for those of different cultural backgrounds, limited education, or low health literacy.

Social and behavioral determinants influence health status, and these determinants are not affected by traditional efforts to improve the quality of health care. Improvement can take an entire community—or an entire society—and communities must be mobilized to make this improvement.

The effort to eliminate persistent health inequities will require multiple approaches, and various authorities, including the Institute of Medicine, have recommended that CHWs be engaged in these efforts.

CHWs also can contribute to efforts to contain health care costs—a priority in the U.S. because the cost of health care drives a good deal of decision making.

And finally, the debate over health care reform has brought into sharp focus the crisis in health care personnel, especially for primary care. If substantial numbers of previously uninsured individuals obtain coverage, providers must be available to serve them. Current clinical personnel, particularly physicians and nurses, will be hard-pressed to spend adequate time with patients in regular clinical encounters, let alone to participate significantly in important non-direct care activities, such as health education and follow-up contacts.