Community health worker Hawa Abraham (L) at Montefiore Comprehensive Health Care Center in the Bronx helping a patient. Photo: Ambar Castillo

It’s the end of the first ever National Community Health Worker Awareness Week. This campaign celebrates the work and impact of community health workers (CHWs) — frontline workers whose shared experiences and deep knowledge of the communities they serve often help patients navigate health and social service needs. At the peak of the pandemic, they took to the streets and were in clinics, churches and even barber shops educating neighbors about Covid-19 vaccines. Pre-pandemic, they were doing the same jobs but were likely better known under their official titles, such as case workers, outreach workers and nutrition educators.

What could CHWs do for you?

CHWs fill a critical role in educating people about how to improve and maintain good health. As Epicenter-NYC’s community reporter previously reported at STAT, CHWs at Montefiore Health System in the Bronx take a holistic approach to health care. They assist people from often underserved communities with a range of tasks that might involve understanding confusing policies and navigating never-ending processes.  

They also guide patients in applying for housing assistance and SNAP benefits and connect them to food pantries. They might help patients get legal assistance for immigration needs and child care or apply for jobs. One CHW at Montefiore, Hawa Abraham, went so far as to flag down buses in the street during her off-hours to ask school bus attendants how a patient could apply for that role (the patient ultimately got the job). And they have even been known to provide patients with doctor’s notes about the role of mold in their child’s worsening asthma to pressure reluctant landlords into managing outstanding and oftentimes detrimental housing issues.  

This diversity of identity and longtime lack of recognition at federal and state levels led the National Association of Community Health Workers to coordinate the awareness week. The source of momentum: a recent campaign for an accurate accounting of CHWs and fair compensation, among and other needs.  Local and national advocacy efforts have also called for a path for sustainability, including adequate professional development and broader Medicaid reimbursement for CHW services. The campaign comes on the heels of thousands of layoffs of CHW workers at the end of the Covid-19 public health emergency.  

To shed light on local efforts to raise awareness about the importance of CHWs, Epicenter-NYC spoke to Dr. Nadia S. Islam, the associate director of the Institute for Excellence on Health Equity at NYU Langone Health, over Zoom. Among other roles, Dr. Islam helps develop models to promote health equity that are culturally relevant and evaluates the impact of CHW interventions on chronic disease management and prevention in diverse communities. 

Excerpts from the conversation are below, lightly edited for clarity.

Epicenter-NYC: Could you speak about your experience and how it led you to this area of focus?

Dr. Islam: My research really focuses on how we can connect communities to health care systems and other systems of care in ways that are culturally and socially responsive. I’m the child of immigrants — my parents immigrated to the U.S. in 1968. They were [among] the first Bangladeshi immigrants in Dallas, Texas. They had to build a life for themselves here without the kind of social support, emotional support that family provides. So they really played a key role in community-building. 

That was an important part of my childhood — seeing and understanding how critical community is, especially for immigrants that can feel “other” or disconnected. In many ways, I grew up understanding community as being part of cultural events, or being in ethnic grocery stores or ethnic restaurants and faith-based organizations. I think that really informed my worldview growing up. 

So when I came to public health, I was really interested in thinking about how we engage communities in this process. And before I got my doctorate, I’d worked in grassroots, social service, immigrant advocacy types of organizations. One of my first jobs in New York City was at an HIV AIDS organization that served Asian American immigrant communities, and I ran what was called a bilingual peer advocates program. Reflecting back now I’m like, ‘Oh, that was a CHW model.’

Dr. Nadia Islam. Photo: NYU Langone Health

Epicenter-NYC: What was it about those experiences that reminded you of the CHW model?

Dr. Islam: They really helped me understand and see the kind of strength in assets and leaders that we have in the community. Also, just individuals who are trusted and have the shared life experience of community members, and how they can leverage that to build trust in settings where there’s a lot of very understandable distrust. And also just structural barriers, whether it’s language barriers, immigration-related barriers, even physical barriers. 

I often think about — many of my CHWs work in Bellevue Hospital [in Manhattan] — you enter that hospital, it’s huge. There’s signs everywhere. For an immigrant who’s new to this country, doesn’t speak the language, maybe has never been in a country where you have to have health insurance, it’s all very overwhelming. So having trusted individuals to help navigate that process — I saw from my work at Apicha [a community health center based in Jackson Heights with deep experience working with people of color], how impactful that could be. So I was really interested in thinking about building models like that. Like, how do we better connect communities to healthcare systems? 

Epicenter-NYC: Say more about this and other CHW-style programs you worked and currently work with — they are all local? 

Dr. Islam: Yes, [Apicha] is New York City-based and actually the country’s oldest HIV AIDS organization for Asian American communities. As I started to build my research career, I was very committed to doing that in partnership with communities. And being South Asian myself, I wanted to work in South Asian communities. So I partnered with many community-based organizations to identify key priority areas in South Asian communities —  we did a series of needs assessments and surveys and listening sessions with communities. Diabetes and cardiovascular disease came up again and again, as issues in the community where people were dying very young, dying from heart attacks or strokes very young, developing diabetes at very young ages. 

But I think it was really my community partners who encouraged me to think about, there are a lot of assets in our community. We have strong social support and social connections. And there are individuals who are leaders who really can be leveraged to play that bridging role. So now a lot of my research really focuses on testing community health worker models in a variety of different settings — community settings, healthcare settings, municipal agencies —  to really understand how CHWs can make an impact in improving health outcomes across diverse communities.

Epicenter-NYC: What kind of criteria do you use when evaluating these CHW programs?

Dr. Islam: A lot of my research has looked at the impact of CHW programs on specific health outcomes. For example, in my work with individuals with diabetes or hypertension, looking at the impact of being paired with a CHW on hemoglobin, A1C control or blood pressure control, or weight loss, for example, for individuals who might be at risk for diabetes. I think a lot of research has focused on that over the last 20 years. Because CHW advocates and people who believe in this model felt like we needed to make the case that this model really works, it really improves outcomes.

I actually think we’re at a point where we have enough [evidence]. We know that this works — we know that CHWs are skilled at connecting with individuals, and can have a major impact in terms of improving health outcomes. 

My research has also looked at how CHWs can enhance self-efficacy. Like, how do they work with community members to help them navigate the system, to help them feel like they can take control over their own health, to make them feel like they can manage their own chronic diseases? Because it’s not just getting your blood pressure under control once — it’s a lifelong disease. So you really have to be able to do that in a more sustainable way. And then increasingly, I think there’s a lot of interest in understanding how CHWs improve access to resources, whether it’s healthcare resources, but also social service resources, connect community members to resources, like food or housing or immigration services. 

Epicenter-NYC: Speaking of resources, are you concerned right now about CHW funds drying up now that there’s no longer a public health emergency?

Dr. Islam: I think there’s always a concern for that. I don’t think there’s enough systematic investment in the CHW workforce. We don’t have streamlined reimbursement mechanisms for CHWs. And once we see that, I think that’s when there’s going to be real potential for this workforce to grow and develop. There are a number of issues and challenges related to that — [for instance], credentialing challenges — that varies across states. But I really think there needs to be an investment from both health systems — from payers — and from the government and into this workforce.

This is part of a series of articles exploring health inequities in New York that is funded by a grant from the Commonwealth Fund.

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