Holistic healthcare: The essential role of Community Health Workers
The World Health Organization (WHO) recently released their prediction of the ten threats to global health in 2019 [1]. The global health community is very familiar with many of the health challenges listed, including non-communicable diseases, weak primary health care, and HIV. Other threats, including climate change, vulnerable settings, and vaccine hesitancy, present challenges that have rapidly grown in urgency and are a complex mix of social, political, and equity-related issues. The clear message from the WHO is that these health challenges all require special attention in a patient-focused, holistic fashion.
Along with the announcement of these threats, the WHO released the 13th General Programme of Work; a plan to address these health challenges over the next 5 years [2]. Within the plan, the complex nature and interconnectedness of global health threats is addressed. Strengthening the health system and improving access to health services are emphasized as keys to tackling these threats. While an emphasis is also placed on community based-services and community engagement, there is no explicit mention of community health workers (CHWs). CHWs are ideally placed to help communities face health challenges in a holistic manner and are vital to addressing inequitable healthcare systems.
Who are CHWs?
The primary goal of CHWs is to provide culturally appropriate health services to their community [3]. They often receive healthcare training that may be shorter in duration than traditional health professionals and is paired with a more thorough understanding of the specific culture and language of their patient population [3]. CHWs may even be members of the communities that they serve [4]. Their expertise is therefore uniquely placed to fill a significant gap in communities where accessing traditional healthcare services is difficult due to distance, availability, or cost. Further, CHWs offer cultural competence and understanding that may be lacking from traditional healthcare services. CHWs address equity issues where social barriers, such as disease stigma, also prevent access to necessary services [4].
How do CHWs address serious threats to global health?
Due to their unique role in communities, CHWs are ideally placed to address interconnected health issues and their training often supports this. Partners in Health Canada, for instance, supports the strategic training of CHWs to accompany their patients on the journey through sickness and back to health [4]. This includes traditional health care practices, like ensuring adherence to a medication regime, but also offering moral support [4]. CHWs will treat their patient holistically — ensuring they have food, clean water, and adequate shelter. This approach, referred to as the syndemic approach, is noted in the literature as a common CHW practice [5]. Syndemic refers to “the clustering of two or more diseases within a population that contributes to, and results from, persistent social and economic inequalities” [6]. By taking a syndemic approach, a CHW would evaluate social and health conditions together, for instance coupling tuberculosis management with attention to nutrition, smoking habits, overcrowded living conditions, and the accessibility of social connections within the patient’s community [5]. By strengthening the role of CHWs, we will likely see a real effect on the complex, interconnected, equity-related health issues that threaten the global community not only in 2019, but well into the future as well.
The case for harnessing the strength of CHWs is very strong. The WHO is predicting a suite of complex health threats for 2019 and is calling for action that is community-focused. The syndemic approach to CHW practice, where health and social issues are treated together, will improve patient outcomes among the most socially and economically disadvantaged populations. CHWs are an important part of the health system and can ensure effective, safe, and efficient access to care. Of utmost importance, CHWs ensure respectful and compassionate relations between people and their healthcare providers.
REFERENCES:
1. World Health Organization. (2019). Ten health issues WHO will tackle this year. Retrieved from https://www.who.int/emergencies/ten-threats-to-global-health-in-2019
2. World Health Organization. (2018, November 08). Thirteenth general programme of work 2019−2023. Retrieved from https://www.who.int/about/what-we-do/gpw-thirteen-consultation/en/
3. Olaniran, A., Smith, H., Unkels, R., Bar-Zeev, S., & van den Broek, N. (2017). Who is a community health worker? — a systematic review of definitions. Global health action, 10(1), 1272223.
4. Partners in Health Canada. (n.d.). Community Health Workers. Retrieved from https://pihcanada.org/our-work/community-health-workers/
5. Mendenhall, E., Kohrt, B. A., Norris, S. A., Ndetei, D., & Prabhakaran, D. (2017). Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations. The Lancet, 389(10072), 951–963.
6. Singer, M. (2000). A dose of drugs, a touch of violence, a case of AIDS: conceptualizing the SAVA syndemic. Free Inquiry in Creative Sociology, 28(1), 13–24.
