President BidenJoe BidenThe Hill’s Morning Report – Biden shifts on filibuster GOP looks to squeeze Biden, Democrats on border Sanders creates new headache for Biden on taxes MORE’s American Rescue Plan opens up a window of opportunity to reimagine how we can invest in public health, redress health inequities and save lives.
One way to exact an impactful change is by creating a permanent, adequately-resourced workforce of community health workers in neighborhoods across the country — a national Public Health Corps.
Over the past year, we have seen that, even in a city as large as New York, the best way to improve the public’s health, rooted in equity, is to meet people on their own terms, in the neighborhoods where they live.
We have also seen that mobilizing a rapid epidemic response often hinges upon staffing — whether for contact tracing or for vaccination. Community health workers embody these approaches, providing crucial public health services while emphasizing relationships and trust.
In New York City, community health workers have been essential to our COVID-19 response. For example, last summer in the Tremont section of the Bronx, COVID-19 rates were about twice as high as other parts of the city.
This disparity falls along racial lines — about 67 percent of residents in Tremont are Latino and 25 percent are Black, and just 1 percent are white. Thirty percent of Tremont residents live below the poverty line, and 22 percent do not have health insurance coverage.
In Tremont, we tapped into our network of community health workers, faith leaders, care providers and nonprofits who serve as trusted messengers in their neighborhoods. One community partner helped us pick the location of a testing center, recommending a site residents would know and feel comfortable in. Their staff — many from the neighborhood — helped with outreach by explaining the testing and directing people to the site. Other partners joined us to connect residents to resources including food pantries and food delivery, mental health services, and health insurance.
All our Tremont partners ensured that our efforts were focused on the needs of the community, helped us promote testing services, and lent credibility to the effort. Within weeks, testing rates went up and new cases started to decline.
The Public Health Corps is an extension of this model. It is a ready group of community health workers working in unison with a local health department. New York City is already getting started, with a plan to create a neighborhood-based Public Health Corps as part of Mayor de Blasio’s recovery agenda.
Community health workers use existing relationships with houses of worship, local businesses, and community groups to build a network committed to creating a healthier neighborhood. They help guide the health department as to what local services are most needed, such as pest remediation for asthma in children. They also serve as advocates, surfacing the deeper-rooted issues requiring policy change, whether related to affordable housing or criminal justice. And when another emergency strikes, the community will know whom to turn to.
Experiences from other countries show how a Public Health Corps in the U.S. can be successful. In Costa Rica, for example, community health workers are linked with primary care providers, educate residents on health issues, often make home visits, and enhance trust in medical care. They join the health ministry and clinical colleagues on governance boards to contribute local knowledge and intelligence.
Costa Rica implemented the model in the 1990s and rooted it in the Ministry of Health, which serves as the administrative backbone. There is now evidence of its positive impact — adult mortality, maternal and infant mortality and deaths from communicable diseases have all seen a decline.
Funding from the American Rescue Plan — which includes $7.7 billion allocated to the public health workforce — presents the chance to immediately move forward with a sustainable, diverse and community-centered Public Health Corps.
Yesterday, the Biden administration took another step in the right direction by announcing a $300 million investment in community health workers to expand access to COVID-19 vaccines.
This investment will accelerate the mass COVID-19 vaccination rollout, provide much-needed jobs and improve health in marginalized communities.
Importantly, this investment should augment — not substitute for — other elements of the public health workforce which are also in dire need of investment, such as laboratory professionals, epidemiologists, and sanitarians. According to the Trust for America’s Health, the public health workforce has shrunk by about 56,000 positions over the past decade, primarily due to funding issues.
Federal funding for public health is often temporarily available during emergencies, creating “feast or famine” cycles antithetical to sustainable workforce development. Currently in the U.S., community health worker programs are largely funded through grants, county and state budgets and (rarely) Medicaid waivers.
Instead, local health departments need stable and flexible initial federal funding — as well as the ability to draw upon health insurance reimbursement, starting with Medicaid and Medicare for community health worker services.
As the COVID-19 pandemic continues to shed light on health inequity, particular inequity linked to structural racism, it is clear that the solution lies in our communities. New York City’s experience during the COVID-19 pandemic has shown the power of a neighborhood-based approach.
A Public Health Corps will not only have immediate impact for our economic recovery, it would also be a bulwark against future emergencies and a leap forward for community health in the times in between.
Dr. Dave A. Chokshi is the New York City Health Commissioner.