Addressing Health Disparities in the Rural United States: Advocacy as Caregiving among Community Health Workers and Promotores de Salud

Abstract

Rural populations in the United States are faced with a variety of health disparities that complicate access to care. Community health workers (CHWs) and their Spanish-speaking counterparts, promotores de salud, are well-equipped to address rural health access issues, provide education, and ultimately assuage these disparities. In this article, we compare community health workers in the states of Indiana and Texas, based on the results of two separate research studies, in order to (1) investigate the unique role of CHWs in rural communities and (2) understand how their advocacy efforts represent a central form of caregiving. Drawing on ethnographic, qualitative data—including interviews, photovoice, and participant observation—we analyze how CHWs connect structurally vulnerable clients in rural areas to resources, health education, and health and social services. Our primary contribution to existing scholarship on CHWs is the elaboration of advocacy as a form of caregiving to improve individual health outcomes as well as provoke structural change in the form of policy development. Finally, we describe how CHWs became especially critical in addressing disparities among rural populations in the wake of COVID-19, using their advocacy-as-caregiving role that was developed and well-established before the pandemic. These frontline workers are more vital than ever to address disparities and are a critical force in overcoming structural vulnerability and inequities in health in the United States.

Time Trends in Racial/Ethnic Differences in COVID-19 Infection and Mortality

“…Healthcare systems and hospitals have engaged community health workers, who are trusted members of local communities with shared lived experience, to bridge medical distrust among racial/ethnic minority individuals. Community health workers have been instrumental in providing reliable health information, combatting misinformation, and helping racial/ethnic minority individuals navigate the healthcare system and social support resources [ 4 , 5 ]. Moreover, while COVID-19 infections were initially concentrated in urban areas, which typically had larger racial/ethnic minority populations, the pandemic is now widespread in the United States [ 6 ].…”

Toward Designs of Workplace Stress Management Mobile Apps for Frontline Health Workers During the COVID-19 Pandemic and Beyond: Mixed Methods Qualitative Study

“…Second, an important consideration in future research is how geographic location may affect the stressors, strategies, or user needs amid the pandemic. Research has shown that there are differences in health workers’ qualifications in urban versus rural areas [ 43 ]. These differentials directly impact the level of knowledge and willingness to work during crisis situations [ 44 ].…”

Village health workers as health diplomats: negotiating health and study participation in a malaria elimination trial in The Gambia

“…To serve as functional health diplomats who advocate to address health disparities, VHWs should be able to perform social and medical roles, such as mobilising local populations to receive antenatal care, vaccination, or malaria treatment [ 7 ]. Indeed, VHWs’ advocacy should be viewed as a form of caregiving within the existing primary health care [ 35 ]. To fulfil this multifaceted role, VHWs must be equipped with adequate tools [ 17 ], which in our case were malaria diagnostic and treatment tools.…”

“…Moreover, there is a lack of attention concerning lay health workers’ political role and status that may shape their social and medical roles. Only in the American context lay health workers have been described as social justice and policy advocates in addition to their role as health promoters and social agents [ 32 – 35 ]. In this instance, lay health workers who previously had leadership or advocacy training were likely to advocate at the political and civic level [ 32 , 33 ] and inform policies based on communities’ realities [ 34 ] as a ‘broker’ between the poor (in community) and the state [ 14 ].…”