Bridging the health divide: community health workers are helping eliminate costly health inequalities.

• Author: Tobler, Laura
• Position: HEALTH CARE

Lourdes Fernandez, a promotora, helps the people of Douglas, Ariz., learn how to prevent and manage chronic diseases. As a community health worker in this U.S.-Mexico border city, she's a trusted caregiver who helps her clients understand the resources available to them.

On any given day, she teaches, translates, directs clients to appropriate services, monitors blood glucose levels, measures blood pressure, helps arrange transportation and provides emotional and social support. More important, Fernandez teaches her clients that "they can prevent and control chronic disease." This is an important first step, she says, in her mission to reduce or even eliminate the disparities in health among people of different racial and ethnic groups in Douglas.

Studies show that members of white communities usually receive more health care and are in better health than members of racial and ethnic minorities, even when they have similar incomes and insurance coverage. A variety of factors are involved, including how easy it is to get appropriate health care services in the community; underlying genetic, ethnic and familial factors; and the physical and social environments of a community that may increase health risks.

The Costs of Disparities

Disparities in care result in costly inefficiencies, especially when preventive or primary care is missing. Without such care, a mild sickness may progress into a complicated condition that requires a trip to the emergency room, with a much higher price tag. Preventive care for minority populations is often inadequate for a variety of reasons, including a lack of transportation, poor English skills or a shortage of affordable primary care doctors in their communities.

Eliminating disparities, which includes expanding preventive care for minorities, could have reduced direct expenditures for medical care by $229.4 billion between 2003 and 2006, according to a 2009 study by the Joint Center for Political and Economic Studies, a think tank based in Washington, D.C.

Many state and federal policymakers, concerned about the high costs and widespread inequalities, are looking for answers. And research indicates community health workers may be part of the solution.

Although they go by a number of names--promotoras, village health workers, health aides, community health promoters and lay health advisers--community health workers have one main job, and that is helping patients in underserved communities navigate an...