What Community Health Workers Can Teach Us

Recently I was invited to Washington, D.C. to work on a project called HealthRise. HealthRise aims to expand access to care for diabetes and heart disease in underserved parts of the U.S., Brazil, India and South Africa.

Community Health Workers (CHW) are a vital resource in this project. Minimally trained, they provide a number of essential and specialized services where health professionals are few. They also provide cost savings amid runaway global health care costs.

I think they also offer something that may too benefit the bottom line – healthier behaviors as a result of the human connection.

As CHWs are members of their community, they share their neighbors’ values and culture. This inclusion, along with their desire to serve their neighbors, typically fosters relationship and trust and feelings of well-being and self-regard in those they see.

These positive feelings can cause people to take better care of themselves. And here I think we have something to learn.

The Power of Relationship My invitation to work with the HealthRise participants — public health experts, government and community representatives of diabetes and health organizations, Medtronic Philanthropy grantees and diabetes patient advocates from all four countries — was to talk about patient-empowerment. But I didn’t. I spoke about the power of relationship.

These last few years the buzzword in health care has been to be “patient-centered.” But I don’t believe in it. I believe in being “relationship-centered.” And this is not semantics. This is a shift of mindset.

Being relationship-centered emphasizes partnership, support, union and compassion. It brings the expertise of both provider and patient to the interaction. It strengthens both their skill sets as they work together. And it aims for both to be more successful.

I’m not telling you anything new. You know this. By merely being human, you know the need you have for, and the power of, relationships in your life. You know how the good ones make you better, stronger, more complete, more confident and comfort you in times of need.

They also make you healthier. It should come as no surprise that social connectivity and relationships is one of the commonalities shared by people who live in the Blue Zones. Places across the globe where people are the healthiest and live the longest.

Psycholoist and Director of the Harvard Study of Adult Development, Robert Waldinger, discovered that it is not work nor fame but leaning in to relationships with family, friends and community that makes us happier — and healthier.

So why should that value of relationship not also apply to the patient/provider interaction? Yet medical training is almost exclusively disease-focused. Our health care system incentivizes speed and efficiency over care and relationship. Consequently many health professionals have learned to shed their empathy and compassion when they don their white coats.

Community Health Worker Visit in India Two years ago I volunteered at the Jnana Sanjeevini Medical Center, a diabetes clinic for the poor in Bangalore, India. I had the opportunity to go to a Community Health Worker’s home who was taking part in a pilot training program for CHWs.  

The health worker, Ratnamma, had spent weeks knocking on her neighbors’ doors in her village conducting a few simple, basic health checks in their home. She explained that doctors would be coming to her home from the clinic to give medicine, counseling and care. She would let them know what day to come to her home. We rode out to the village from the clinic, six of us in a minivan. It was a forty-mile two-hour drive over potholed streets. Upon arrival the clinicians unpacked their boxes of medicine and blood pressure and blood sugar monitoring equipment. Then we waited. Within fifteen minutes the first villagers crossed the main road from their home to receive their health check.

People crossed the road all afternoon. Young family members supported the old and infirm. The youngest were carried in the arms of parents and relatives. Their blood pressure was taken, they were poked for a blood sugar check, asked about their health and even the very old were lifted onto a scale still in its plastic cellophane.

What made almost an entire village come out for a health check that day? What made people cross the road and sit on Ratnamma’s stoop in the sun, waiting? Largely the relationship Ratnamma had, and had cultivated, with her neighbors. By knocking on their door, spending a bit of time and showing concern for their welfare.

Science Shows We’re Social In the book, Social: Why our brains are wired to connect, author Matthew Lieberman, a psychologist, explores the premise that our need to connect is as strong as our need for food and shelter. As infants we cannot receive food or be sheltered if we are not in relationship with someone who can do these things for us. Being social, Lieberman posits, is primal and it is a key driver behind much of our behavior.

A year prior to my work in India, I did a workshop with Community Health Workers and patients from the Pascua Yaqui tribe in Tucson, Arizona. The CHWs were diabetes educators, counselors and fitness professionals from the reservation.

I had asked them to invite a patient of theirs to the second day of our training. I had been told by fellow diabetes educators to expect the participants may not be open or emotive and that they might be uncomfortable both with me and each other. Yet nothing could be further from the truth.

As they worked together any walls that may have been there between providers and patients came down. They became so enthused and bonded, that on their own they decided they wanted to come up with ways everyone on the reservation could become healthier.

Community Health Workers are here, 1.3 million and growing. We will come to rely on them to fill the gaps in access to care and they will serve to lower healthcare costs.

But let’s not forget that one of the greatest values Community Health Workers may offer is relationship. And that may be the immeasurable currency that impacts communities’ health — and helps to prevent disease.

And let’s do remember that that same power of relationship influences the quality of our everyday visits with our health professionals. And, what someone with a chronic illness decides to do, and not do, when they leave their doctor’s office.