Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud

Authors: Logan R and Castañeda H
Year: 2020
State: NatDoc: National Document
Website link:
Publicly Available: Yes
Certification: CHW role scope of practice, Competencies
Evidence Generation: Documentation of how CHWs can work within care teams, General other, Surveys and assessment tools to define and develop workforce, White papers
Sustainable Financing: Including community-based CHWs, Documentation of how CHWs can work within care teams, Results from pilots studies etc. that aren't published in formal literature
Workforce Development: CDC expand CHW work into SDOH, Data sharing between social services and clinical teams, General other (including mention of “employment practices”), Outreach education and TA to employers on CHW generally, Promotores

Rural populations in the United States are faced with a variety of health disparities that complicate access to care. Community health workers (CHWs) and their Spanish-speaking counterparts, promotores de salud, are well-equipped to address rural health access issues, provide education, and ultimately assuage these disparities. In this article, we compare community health workers in the states of Indiana and Texas, based on the results of two separate research studies, in order to (1) investigate the unique role of CHWs in rural communities and (2) understand how their advocacy efforts represent a central form of caregiving. Drawing on ethnographic, qualitative data—including interviews, photovoice, and participant observation—we analyze how CHWs connect structurally vulnerable clients in rural areas to resources, health education, and health and social services. Our primary contribution to existing scholarship on CHWs is the elaboration of advocacy as a form of caregiving to improve individual health outcomes as well as provoke structural change in the form of policy development. Finally, we describe how CHWs became especially critical in addressing disparities among rural populations in the wake of COVID-19, using their advocacy-as-caregiving role that was developed and well-established before the pandemic. These frontline workers are more vital than ever to address disparities and are a critical force in overcoming structural vulnerability and inequities in health in the United States.

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