Using community based participatory approaches to influence system support for community health workers : Lessons from REACH communities

The Centers for Disease Control and Prevention's Racial and Ethnic Approaches to Community Health (REACH US) has cooperative agreements with a range of institutions, from universities to health providers and CBOs, working towards health equity locally, regionally and nationally. Among the 40 funded sites, approximately 1/3 use community health workers (CHWs) in some capacity to drive the health equity agenda in their communities. CHW as a strategy aligns with and promotes CDC's mission to reduce health disparities while defining potential future initiatives. The CHW model has been used nationally and internationally and has demonstrated success in improving health in underserved communities. The conversation is no longer whether or not the evidence supports the practice, but how to sustain and support these change agents to create the infrastructure necessary for widespread impact. Cross-case analysis among a variety of projects, drawing from experience as a program officer, demonstrates that these projects use CHWs on multiple socio-ecological levels, from the individual to the broader community, to guide the transformation of social determinants of health. Furthermore, the coalitions driving these projects, composed of local, regional and national groups, are an integral part of the development of strategies for sustaining CHWs and their work. The 10 sites analyzed include projects based in both urban and rural settings, targeting African-Americans, Latinos, and/or Native Americans. This presentation will also include discussion with project representatives around what needs to occur to create a sustainable environment where CHWs can work, live and thrive in communities to achieve health equity.