The Institute of Medicine, in its 2003 report Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, recommended engaging CHWs as an effective way to reduce health disparities, and noted that a barrier to their involvement in health systems has been the lack of a consistent, widely accepted definition of who they are and what services they can provide, including scope of practice and qualifications. Defining the unique competencies and contributions of CHWs is essential to promoting the CHW profession. Here are several key definitions, which overlap significantly.
The Massachusetts Department of Public Health uses the following functional definition of CHWs in its community-based contracts and for policy development, including certification. DPH defines CHWs as public health workers who apply their unique understanding of the experience, language, and/or culture of the populations they serve in order to carry out one or more of the following roles:
- Providing culturally appropriate health education, information, and outreach in community-based settings, such as homes, schools, clinics, shelters, local businesses, and community centers;
- Bridging/culturally mediating between individuals, communities, and health and human services, including actively building individual and community capacity;
- Assuring that people access the services they need;
- Providing direct services, such as informal counseling, social support, care coordination, and health screenings; and
- Advocating for individual and community needs.
CHWs are distinguished from other health professionals because they:
- Are hired primarily for their understanding of the populations and communities they serve;
- Conduct outreach a significant portion of the time in one or more of the categories above;
- Have experience providing services in community settings.
American Public Health Association Definition (APHA CHW Section)
“A Community Health Worker (CHW) is a frontline public health worker who is a trusted member of and/or has an unusually close understanding of the community served. This trusting relationship enables the CHW to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery. A CHW also builds individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy.”
Bureau of Labor Statistics (Federal Department of Labor) Definition
In 2009 the federal Department of Labor created a distinct standard occupation classification (SOC) for CHWs. The definition is currently under revision.
“CHWs assist individuals and communities to adopt healthy behaviors. Conduct outreach for medical personnel or health organizations to implement programs in the community that promote, maintain, and improve individual and community health. May provide information on available resources, provide social support and informal counseling, advocate for individuals and community health needs, and provide services such as first aid and blood pressure screening. May collect data to help identify community health needs. Excludes ’Health Educators’” (21-1091).
Affordable Care Act Definition
In 2010, sections 5101 and 5313 of the Patient Protection and Affordable Care Act defined CHWs in its list of health professionals.
“An individual who promotes health or nutrition within the community in which the individual resides —
- by serving as a liaison between communities and healthcare agencies;
- by providing guidance and social assistance to community residents;
- by enhancing community residents’ ability to effectively communicate with healthcare providers;
- by providing culturally and linguistically appropriate health or nutrition education;
- by advocating for individual and community health;
- by providing referral and follow-up services or otherwise coordinating care; and
- by proactively identifying and enrolling eligible individuals in Federal, State, local, private or non-profit health and human services programs.”