Learning from healthy community initiatives in Canada: CHW interventions addressing health inequities in a publicly funded health care system

Despite a publicly funded health care system, health inequities persist in Canada; there is new interest in how CHWs can mediate inequities for underserved populations. Emerging knowledge from recent research suggests that Canadian CHWs operate within a continuum of care, with models that may be categorized as informal, semi-formal and formal, depending on whether these are system-driven or community-driven. Informal models are usually independent initiatives run by volunteers with no formal ties to local health service organizations. Funding is ad-hoc and CHWs work part-time. Semi-formal models tend to be coordinated by community health centres or non-profit community based organizations. These initiatives are semi-permanent: sustainability depends on available funding. Formal models are either administered through public health departments or function independently, as community-based organizations. They receive core or regular funding, and the initiatives are integrated within the overall programming of the organization. In this model, CHWs may work full-time, part-time, on contract or as volunteers. We (CHWs and researchers) share findings from community-based and participatory research with CHWS about: 1) CHW contributions to improving health equity for underserved communities in each model; 2) how Canadian CHW models compares to the five models of care identified in the U.S. (HRSA 2007): a) Direct health service delivery; b) Navigator; c) Screening and health education provider; d) Outreach-enrolling-informing agent; e) Organizer. The presentation contributes to documenting the importance of CHW initiatives in reducing health inequities and improving overall health and well-being for marginalized populations within a publicly funded health care system.