Healthcare systems are using creative mechanisms to ensure there is fair access to care for all. As we saw during the COVID-19 pandemic, disenfranchised communities with low trust in healthcare systems were slow to respond to vaccine recommendations. Presentations from The Carol Emmott Foundation’s Christine Malcolm Symposium featured examples of these creative methods. Kenyatta Elliott, Carol Emmott Fellow (Class of 2021) and associate vice president, Duke University Health, described how the health system mobilized a variety of groups and organizations to take vaccine clinics to neighborhoods to address the crisis. Similarly, Johns Hopkins Health brought unlikely allies together to address the unique challenges the pandemic presented, according to Jennifer Nickoles, FACHE, president, Johns Hopkins Bayview Medical Center, and Carol Emmott Fellow (Class of 2020).
One of the most promising developments we’ve seen is the re-emergence of community health workers as a means of bridging societal gaps. Laura Markin, executive director, Transformation and Strategy, Urban Health Initiative, UChicago Medicine, and its representative in the Carol Emmott Collaborative, shared how her institution worked with 13 organization partners to help establish a network of community health workers, offering a wide range of services that make healthcare more accessible and easier to understand for the community.
Community health workers have played a vital role in advancing health equity in the United States, particularly among underserved populations. Early community health programs emerged in response to the growing need for culturally competent care in marginalized communities. Efforts such as the Neighborhood Health Center initiative, launched in 1965, recognized the importance of hiring local people—often without formal medical training—who understood the social, linguistic and cultural dynamics of their communities.
Community health workers were trained to provide health education, outreach and basic services. However, their role quickly proved invaluable, not only in navigating healthcare systems but also in building trust between medical institutions and communities that had long faced neglect or discrimination. They served as liaisons, advocates and educators—bridging the gap between patients and providers.
During the 1980s and 1990s, these professionals gained recognition as a key component in public health efforts related to maternal and child health, HIV/AIDS prevention, chronic disease management and immigrant health services. For example, programs such as the Promotores de Salud model in Latino communities and Native American health representatives demonstrated how community health workers could provide culturally grounded care and reduce barriers to access.
Despite their success, community health workers operated largely on the fringes of the formal healthcare system for decades, often working with limited funding and recognition. This began to change in the 2000s, as growing evidence highlighted their effectiveness in improving health outcomes and reducing costs. Studies showed that they contributed to improved medication adherence, reduced hospital readmissions and better chronic disease management among patients.
The passage of the Affordable Care Act in 2010 marked a turning point. The ACA explicitly acknowledged the role of community health workers (See Sec. 399V “Grants to Promote Positive Health Behaviors and Outcomes”) and encouraged their integration into team-based care models. States began to explore Medicaid reimbursement options for their services, while professional organizations advocated for standardized training and certification to support workforce development.
Markin describes community health workers as “bridges, advocates, translators and educators. They meet people where they are physically and emotionally, helping them navigate healthcare systems while addressing the social drivers of health” that can go overlooked in clinical settings. She tells the story of a young woman, eight weeks pregnant and living with HIV, who visited UChicago’s emergency department. Within days of being discharged, on a Sunday, her team collaborated with social workers to connect her with their clinic for comprehensive care including sexual health services, counseling and treatment. Their network of community health workers continued to provide social services, community-based primary care, high-risk obstetric care and community-based HIV treatment.
She notes that building this kind of system isn’t easy. It requires breaking down silos, co-designing workflows across sites and fostering a culture of collaboration that extends beyond organizational boundaries. It also requires institutional investment, mainly in the technology platforms that are shared between collaborative sites, but also in its people. This system differs from population health efforts in that it is “insurance agnostic,” and not necessarily focused on financial outcomes so much as public health outcomes—such as how patients access care and resources in the community.
Today, community health workers are increasingly recognized as an essential part of the public health workforce. Their deep ties to the communities they serve make them uniquely equipped to address social determinants of health, reduce health disparities and promote equity. As the healthcare system continues to evolve, ensuring the sustainable integration and support of these professionals will be critical in the journey toward a more just and equitable future.
Douglas Riddle, PhD, DMin, FAPA, is curriculum director, The Carol Emmott Foundation.