1950s –1960s – Using community health workers to address basic health concerns has at least a 50-year history. 16 The most well-known of these earlier programs points to the Chinese barefoot doctor program18. These barefoot doctors acted as primary health-care providers in their rural communities but were perceived as peers because of their continued involvement in farming.
By the 1960s China had developed and institutionalized community health workers nationwide, prompting a boom of CHW-led programs in other countries, including the U.S.
By the 1970s, Community Health Workers became a rallying voice within the American Public Health Association (APHA). A Community Health Worker-led section was initially created within APHA called the New Professionals Special Primary Interest Group (SPIG). In 2000, the group changed its name to the Community Health Worker Section and continues to “to promote the community’s voice within the health care system.” 5
The Community Health Worker Section adopted the following definition for a Community Health Worker:
A Community Health Worker is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the Community Health Worker 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.
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.
1980s – MHP Salud
With a small grant from the United States Department of Health and Human Services, National Migrant Worker Council, Inc., an association of Catholic sisters, religious leaders and volunteers conducted a community assessment with farmworkers in the Midwest and designed the original Migrant Health Services Directory and the Camp Health Aide Program.
The council, which would come to be known as MHP Salud, officially launched its first Camp Health Aide Program in the mid-80s using a community-centered health worker model. With the success of this program, MHP Salud would go on to develop various successful Community Health Worker-led interventions throughout the mid-west, Texas and Florida.
June 1998– National Community Health Advisor Study
Completed in 1998, the National Community Health Advisor Study helped identify core roles, competencies, and qualities of Community Health Workers. With little existing literature on the role of CHWs on the health care system, this study helped provide guidance to policymakers and practitioners on a number of areas that could improve the status of the CHW field.6
March 2007– HRSA National Workforce Study
In 2007, the Health Resources and Services Administration provided a comprehensive, national report on the Community Health Worker workforce. Health care costs were high, and Community Health Workers were beginning to be seen as a cost-effective way to address health concerns in underserved communities. This study was vital in providing much needed missing information to private insurers, business enterprises and the Federal government to propose changes in health care delivery and financing3, with the inclusion of CHWs.
2010– Bureau of Labor Statistics
The Bureau of Labor Statistics assigned an occupational code to Community Health Workers:
Assist individuals and communities to adopt healthy behaviors. Conduct outreach for medical personnel or health organizations to implement programs in the community that promote, maintain, and improve individual and community health. May provide information on available resources, provide social support and informal counseling, advocate for individuals and community health needs, and provide services such as first aid and blood pressure screening. May collect data to help identify community health needs. Excludes “Health Educators” (21-1091).
As the interest in Community Health Worker programs grew, the demand to have more adequate information grew. Assignment of an occupational code made the exchange of accurate information more timely.
March 23, 2010– Patient Protection and Affordable Care Act
As health care in the U.S. enters an era of pivotal change, Community Health Workers have been identified as an important component in the “health care workforce”. Community Health Workers are cited in three sections of the Patient Protection and Affordable Care Act (PPACA):
With more funding available, health centers across the nation were able to seek federal funding for CHWs and CHW-led programs. This act also officially acknowledged Community Health Workers as legitimate health industry professionals which opened a variety of new employment pathways.