Racial and ethnic minorities that live in or around cities represent about two-thirds of individuals with diabetes globally.7 While social and cultural factors still play a role in the prevalence of diabetes in urban areas, the convenience of travel (think mass public transportation), the reduced physical demand required to provide food, and the increased availability of low-cost, highly processed foods contribute to the promotion of diabetes in this setting.7 This is why CHWs expertise in outreach and health education is crucial. CHWs know where and how community members purchase their foods and build relationships with these establishments to collaborate on initiatives.
For example, a study of the program, Vida Sana Hoy y Mañana (Healthy Life Today and Tomorrow), used Community Health Workers to promote the consumption of fruits and vegetables inside local Hispanic focused grocery stores often referred to as bodegas. The study found that individuals in this store reported an increase in fruit and vegetable consumption by about one additional serving per day.16
Community Health Workers are also great at group facilitation which allows them to educate large groups of people at once, on topics that have implications for diabetes and other chronic conditions. An example of this is the Harlem Health Advocacy program in New York City. CHWs conducted outreach and provided health coaching to individuals that lived in public housing complexes and senior centers. The results of the program found that 94% of participants continued to stay active for at least 6 months and blood pressure control increased significantly.15
Affordable Health Care Coverage
In the U.S., overall, residents in rural populations are less likely to have private health insurance than those in urban areas.11 However, factors such as affordability, unemployment, and misconceptions about the health care system still leave many individuals who live in urban settings without coverage. In many cities in America, the unemployment rates are higher for blacks and Hispanics that live in and around large cities.8 This means that a large part of this population is without employer-based coverage or cannot afford private insurance.
Because Community Health Workers serve as a bridge between health care systems and the communities they come from, they know what low-cost or free services are available at a local and federal level. They can provide education to individuals in the language they are comfortable with which is a big help when it comes time to dispel myths on the health care process. These skills also allow CHWs to help individuals with the application process. They can promote open enrollment periods, deadlines, and requirements in a way that their population can understand.
Access to Services
Like in rural areas, urban populations face challenges when trying to locate and access services they can identify with culturally. African Americans, Hispanics, and Native Americans account for nearly one-third of the population but only represent 9% of physicians, 7% dentists, 10% of pharmacists, and 6% of registered nurses.5,12 This is why CHWs use their trusting relationships with community members to build stronger connections between individuals and their health care providers. This trust allows for a more effective exchange of information between provider and client.
Further, CHWs consider more than just an individual’s medical needs. They work with community partners to address the social and economic barriers that prevent people from getting the help they need. For example, a CHW will know if an individual does not have bus or train fare to make it to a medical appointment and can connect them to organizations that cover these fares for qualifying individuals. Understanding small details such as this is what sets CHWs apart from other health professionals and what allows them to minimize barriers individuals face when seeking services.