Jul. 14 2015

Community Health Workers: Allies for Immigrant Health

The life of an immigrant is a tough road—especially when it comes to health. Immigrants in the United States have limited familiarity with chronic diseases, yet their risk of developing them shoots up once they settle in a country saturated with fast food. At the same time, they are short on time and money for basic preventive health care. Even when immigrants are able to go to a clinic, language and cultural barriers restrict their ability to follow medical recommendations. Bridging the Gap, a new book co-authored by researcher Sally Findley at Columbia University’s Mailman School, identifies a unique ally to help immigrants thrive in their adopted home—the community health worker.

Findley, professor of Population & Family Health and Sociomedical Sciences at Columbia University’s Mailman School of Public Health, and co-author Sergio Matos, president of Health Innovation Associates and Executive Director of the Community Health Worker Network of New York City, show how community health workers, often immigrants themselves, can help immigrant communities improve their health.

Transmission sat down with Findley to find out more.

What is a community health worker?

Community health workers promote the health of the community within the community. They are members of the communities in which they work, and are thus able to communicate directly without linguistic or cultural barriers. Their primary function is educational, but you can think of them as health coaches. They use an informal, conversational approach rather than being didactic. They might say, “I see you’re having trouble taking your medications regularly. Let’s see if we can figure out a better to get to where you want to be.”

Your book tells the story of the immigrant Marilena who didn’t know she had asthma. Is that situation commonplace?

Health is a low priority for most immigrants. They’re busy getting jobs, going to school, learning English, finding a home, and finding a partner. If they have a chronic illness, they ignore it rather than skipping a day of work. Eventually it catches up with them, and they get so sick they finally seek medical care. But when they go to the emergency room, they don’t always understand what the problem is or how to use medicines to manage it. Sooner or later they’re back in emergency room. The hospital might tell them talk to their doctor, but many immigrants don’t have insurance or a primary care physician. That’s where the community health worker comes in.

How do immigrants like Marilena encounter a community health worker?

Community health workers go where the people are, whether it’s a parent meeting at Head Start or school or their community church. At such meetings, the community health worker explains that many kids in the community have asthma, explains the symptoms, and that the disease is controllable. That’s when the light bulbs go on. Unlike doctors, community health workers take time to explain what asthma is and translate medical jargon like “controller” and “quick relief ” into terms that the immigrants understand.    

Another example is the importance of healthy eating.  When immigrants come to the U.S. they see fast food outlets only blocks away, and they take their kids there as a big treat. While fast food may be seen as truly American, that does not mean it is healthy. The community health worker helps immigrants find alternatives by teaching them how to shop for and prepare fresh vegetables and fruit.   

Many community health workers are immigrants themselves. Why is this important?

If you’re an immigrant, your survival strategy depends on networking with other immigrants. They show you the ropes whether it’s where you go for your driver’s license or how to enroll your child in school. When a community health worker also is an immigrant, they can talk about these shared experiences, so it is easier for the community health worker to share advice on how to access and use the resources of the U.S. health system. 
What’s does research tell us about the efficacy of community health workers?  

Community health workers are the most cost-effective addition to a health team whether the goal is healthy children, balanced nutrition, or development of health lifestyles to prevent or manage chronic disease. The net result is a reduction in urgent care or hospitalizations, which saves everyone money.  For every dollar that’s invested in the community health worker, the savings is as much as $7. Not a bad return!