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A CHW speaking to an audience.The last of the major issues within the CHW workforce is that of self-determination.

  • Members of any occupation want and deserve a voice in defining themselves
  • Self-determination as part of community empowerment philosophy
  • Many CHWs leery of regulations imposed from “above”
  • Challenges in mobilizing CHW leadership


The last of the major issues within the CHW workforce is that of self-determination. Because of historic patterns of short-term, marginal employment and low levels of respect for CHWs among other professionals, some may presume that they can make decisions with only limited or token input from CHWs themselves. In most occupations, however, practitioners want to assert their right to define themselves, especially once they are well established. For CHWs, this philosophy of self- determination is also partly rooted in their historic values and beliefs based on their experience in empowering communities to solve their own problems.

CHWs appear to value their sense of unique local identity and tend to favor local and state-level solutions to major issues affecting them. In Texas, for example, local CHW networks are proceeding cautiously toward developing a statewide association, believing that regional cultures within Texas are too different to be brought together quickly. Because relatively few CHWs are actively involved in national policy development, making major policy decisions at that level may well be resisted.

We should not underestimate the challenge of mobilizing CHW leadership at the local, state, and national levels. Because of the current employment structure and fragmented loyalties of the CHW workforce, incentives for CHWs to come together for their common interests have been limited. Opportunity is also limited. For example, employers working under grants with specific deliverables are often reluctant to let CHWs attend meetings or even continuing education on “company time.” CHWs in most places have not developed some of the norms found in other professions, in which practitioners are expected to participate in association life and in advocacy on issues related to their profession.