Community health workers can fight COVID and historic inequities

As the Biden administration begins implementation of its strategy to address the COVID-19 pandemic, attention is being given to the need for a rapidly scaled workforce that can meet this emergency. But speed must be combined with care — as we hire workers who will be able to fill gaps in our current public health and community workforce and meet the needs of the communities most adversely affected by the pandemic.

Indeed, the President’s executive order on a sustainable public health workforce recognizes this.  He directs the secretaries of Health and Human Services, Homeland Security, Labor, and Education along with the CEO of AmeriCorps to develop a plan with “five-year targets and budget requirements for achieving a sustainable public health workforce, as well as options for expanding HHS capacity, such as by expanding the U.S. Public Health Service Commissioned Corps and Epidemic Intelligence Service, so that the department can better respond to future pandemics and other biological threats.” 

In the context of the executive order, what constitutes public health functions are narrowly described, usually referencing testing and contact tracing along with vaccination outreach and delivery. But as the President’s overall pandemic strategy recognizes, building a stronger system that can prevent or reduce the impact of a future pandemic means much more than this. It means building a public health system that has a workforce that can:

• Reduce the inequities in our society that have resulted in a disproportionate impact of this pandemic on communities of color;
• Assure that every community is served by a public health system with certain foundational capabilities that give real time capacity to understand and respond to public health threats;
• Address the health-related social needs of individuals and the social determinants at the community level that can mitigate the impact of a pandemic and make communities more resilient during a pandemic; and
• Empower communities to be active participants in their public and community health systems so they trust them during an emergency.

Thus, as this workforce plan is developed, the designated federal officials need to think more broadly so we make a long-term plan to support the institutions and individuals who will comprise a workforce that:

• Fills gaps in critical public health capabilities that have been found missing during the pandemic in state and local health departments by expanding the professionally trained public health workforce. This can be accomplished through existing programs as well as creating new pathways to public health positions through service and training programs.
• Builds community capacity to address social determinants of health by, as the national pandemic strategy notes, “expanding community-based, multi-sector partnerships that can align health and social interventions.” To build trust, this must be community driven and reflective of the variety of challenges and opportunities different communities face — and can build from existing models throughout the nation.  
• Represents a health workforce that builds from models such as community health workers and promotores in Spanish speaking communities that can perform important public health functions (like contact tracing or testing and vaccination outreach) and serve as a bridge in meeting the full range of health and social needs individuals and communities at risk may face. There are existing organizational, training and certification models that have been supported by various federal agencies on which this effort could build.

While the pandemic has certainly highlighted many weaknesses in our public health and social services systems, there are assets throughout the nation from which to build. 

To cite just two examples, we have the capacity to expand the size and role of the Public Health Service Commissioned Corps to address public health workforce needs or expand funding and training for community health workers through Medicaid reimbursement or Departments of Labor and Health and Human Services programs. 

That said, a significant new investment will be needed. One example would be passage of the Public Health Infrastructure Saves Lives Act, which would provide permanent funding to state and local health departments to build a workforce that could deliver all of the critical foundational capabilities for those who reside in health workers’ communities.

In short, as we urge expansion of the health workforce to meet immediate needs, we should also “build back better” so those mobilized during the emergency can be a part of strengthening our public health system in the longer term — with appropriate training, career ladders and sustainable funding for their positions.

Jeffrey Levi, PhD, is professor of health policy and management at the George Washington University, where he leads the Funders Forum on Accountable Health which focuses on improving population and community health through multi-sector partnerships.