New APHA Policy Endorses Community Health Workers as Critical to Advancing Racial Equity

In November, the American Public Health Association (APHA)––the largest member-based public health organization in the United States––passed the policy statement A Strategy to Address Racism and Violence as Public Health Priorities: Community Health Workers Advancing Equity & Violence Prevention, acknowledging community health workers as a critical tool for addressing violence prevention and improving health equity. This comes on the heels of the APHA’s 2020 declaration that racism is a public health crisis.  

Public health advocates have long understood the link between structural violence in the United States and broader public health drivers like access to food, shelter, or employment. Beyond naming racism and violence as detrimental to public health, the new policy statement, written and prepared by the Community Health Worker section of APHA and endorsed by many organizations––including PIH-US––recognizes community health workers as a part of the solution to addressing these problems.  

Below, we summarize this statement and explain why it is important and what happens next.   

What does this new policy propose? 

The new APHA policy statement lays out a pathway to address violence and racism through a public health lens by partnering with community health workers. Community health workers, also known as promotoras de salud, as well as other members of the community-based workforce are frontline public health workers who are trusted members of and/or have a close understanding of the community that they serve. The authors of the policy statement recognize these community experts as integral to helping break through barriers left by systemic racism and structural violence in the United States.   

What gaps do the authors of the policy statement hope to address? 

The APHA’s new policy identifies gaps in past public health policies that have failed to address structural violence and have contributed to inequities in our public health and health care systems, including:  

• Partnerships that have prioritized (through funding, coordinated messaging, and staffing) large health care institutions over community-based organizations and trusted messengers in the community.  

• An over-emphasis on medical care, rather than addressing social drivers of health rooted in structural racism and structural violence.  

• Inequities in access to health care and financial resources.  

• Inequitable research practices that perpetuate racial biases through the research conducted, authors of that research, and, ultimately, programs funded and implemented. 

The new policy statement recognizes that although community health workers are equipped to respond to the social determinants of health, bring cost-savings to the health care system, and intervene both on structural racism and violence, as a workforce they face many barriers to success, including:  

• Lack of recognition or support from public health, health care, and other sectors addressing social determinants of health.  

• Lack of consistent, sustainable funding for community health worker programs and activities. 

• Chronically low salaries and inequitable pay.  

• Over-medicalized community health worker training, rather than training that emphasizes community knowledge. 

Why did PIH-US endorse this policy? 

The new policy statement from APHA acknowledges structural violence and identifies community health workers as a core part of the work to combat structural violence and deliver on health equity. Since 2020, PIH-US has applied lessons from our global work to lift up this critical workforce throughout the COVID-19 response and beyond.  

The statement directly supports the efforts PIH-US has been engaged in to expand the community health workforce across the country. Now, we plan to leverage the recommendations within the policy and to continue to advocate for sustainable investments in community health workers.  

In addition, some of PIH-US’s experts contributed to the author’s work. 

Why is the APHA’s passage of this policy significant?  

Though statements like this don’t change governmental policy, they do offer recommendations for policymakers, public health departments, and other actors. As one of the most influential organizations in public health in the United States, the APHA’s stance matters: when the organization takes a decisive policy position, it broadens the opportunity for research, advocacy, and more on the topic. This statement, voted on through the APHA’s democratic processes, added a new perspective to the conversation about community health workers, focusing on this workforce as a way to address structural racism, community violence, and health inequity in the United States.  

Now that this policy has been adopted by the APHA, what impact can it have on health?  

Now that this statement has been recognized by the APHA, it is on the shoulders of public health practitioners at the community, state, and federal level to put this plan into action.  

The APHA policy recommends that Congress pass legislation to support community-based organizations to hire community health workers and strengthen efforts to address racism and violence in communities across the country. APHA also recommends that state legislators follow suit. It calls for community health worker associations to implement trainings on violence prevention and structural racism, for philanthropic entities to help fund those trainings, and for higher education institutions to integrate into curriculums the importance of community health workers in addressing structural racism and violence prevention. 

PIH-US urges recipients of CDC funding for public health infrastructure to consider the importance of investing in community health workers, via partnership with community-based organizations, for long-term health equity.  

--------------

Authors, contributors, and endorsers of A Strategy to Address Racism and Violence as Public Health Priorities: Community Health Workers Advancing Equity & Violence Prevention:

• Authors: Rumana Shams Rabbani, CHW-VPP, MHA, PhD Student, RWJF HPRS; Abdul Hafeedh bin Abdullah, CHW-VPP; Dannie Ritchie, MPH, MD; Cynthia Williams, PhD; Keila Marlin, MPH; Noelle Wiggins (Advisor), EdD, MSPH
• Contributors:  Angie Kuzma, MPH, CHW; Evan Richardson, RN, MSN, CNM; Dina Ferrenti, RN, PhD; Charlie Bruner, PhD; Honey Estrada, MPH, CHW; Marcia Morales Villavicencio, CHW, MPH;  Jamie Santana, CHW; Maria Lemus, Promotora; Ashley Rodriguez, CHW; Justin Mendoza, MPH; Devin Worster, MD, MPH; Ali Bloomgarden, MA; Brenda Galloway, CHW-VPP; Vance Williams, CHW-VPP, Keshana Owens-Cody, HRM; Dwight Myrick, CHW-VPP; Juliette Jenkins, PhD, MSN; Teresa Campos-Dominguez, CHW; Jennifer Norville, BS; Mae-Gilene Begay, MSW, CHR; Maria Velasco, MA, CHW
• Governing Councilors: Mae-Gilene Begay, CHR; Maria Hererra, Promotora
• Special Acknowledgements: Betsy Rodriguez, RN, BSN, MSN, DCES and Refilwe Moeti, MA; Center for Disease Control & Prevention
• APHA Endorsements: Maternal Child Health Section, Public Health Social Work Section, Oral Health Section, Family Violence Prevention Caucus, Women’s Caucus, Men’s Caucus, Law Section
• External Endorsements (prior to policy being passed): Community Healing through Activism + Strategic Mobilization, NC Area Health Education Center, NC CHW Association, Partners In Health, Common Indicators Project, The University of Wisconsin Population Health Institute