Community health work faces funding cliff
GRANITE CITY, Ill. — As a community health worker, Christina Scott, 46, is a professional red tape cutter, handstand, shoulder to cry on, and personal safety net, all rolled into one.
She works in an office in the shadow of the steel mill that employed her grandfather in this declining town in the Greater Saint-Louis region. Some of the region’s stability has disappeared with many steel jobs – almost a fifth of Granite City residents live in poverty, far more than the national average.
Then another destabilizer – covid-19 – struck. And so Scott stepped in: she knows how to access housing assistance for people out of work as they isolate themselves at home with covid. She can bring people cleaning supplies or food from a local food bank. She will stay on the phone with customers, helping them budget their finances to keep the lights on. And the calls keep coming because people know she understands.
” I was hungry. I didn’t have a car,” Scott said. “I’ve been through these things.”
Scott is one of more than 650 community health workers the Illinois Department of Public Health has hired through local community organizations starting last March. This Pandemic Health Navigator program workforce was made possible by a nearly $55 million grant from the Centers for Disease Control and Prevention through federal pandemic assistance passed by Congress. The team handled at least 45,000 requests for assistance, which were forwarded to them via contact tracing of covid cases.
As workers have gained the trust of the community, Scott said, new inquiries have poured in from people who have heard of the catch-all program, which does more than many people may consider a public health work.
But the money should run out at the end of June. Workers like Scott are uncertain about their future and that of the people they help every day. dr. George Benjaminexecutive director of the American Public Health Association, said it is the tragedy of the boom-bust nature of public health funding in the USA.
“As the dollars go, we’re going to see people falling off the cliff,” he said. The problem, according to Benjamin, is the lack of a systematic view of public health in the country. “If you did that with your army, with your army, you could never have a strong security system.”
Community health workers have been positioned as key to President Joe Biden’s public health agenda. Ideally, they are one with those they serve, like a neighbor who can be trusted in times of need. Popular in countries such as Costa Rica, Liberia and Brazilcommunity health workers have been difficult to sustain in the United States without consistent means of paying them.
Hundreds of millions of dollars were supposed to go towards building a community health workforce after the American Rescue Plan Act was enacted last March, said Denise Smith, founding executive director of the National Association of Community Health Workers. But, she said, much of the money is quickly spent on health services or national initiatives, not local and community organizations. And much of it has gone to AmeriCorps workers who may not be from the communities they work in — and earn poverty-level wages, Smith said.
“For bills and a car bill, rent or kids, it’s just not viable,” she said. “We can’t do it for free.”
In contrast, the Illinois program attempts to hire workers from within the communities. Two-thirds of its workers identify as Latino/Hispanic or Black. Around 40% were previously unemployed and hiring them injects money into the communities they serve. The jobs pay between $20 and $30 an hour, and nearly half include health insurance or a stipend.
It’s on purpose, said Tracey Smith, who oversees the Pandemic Health Navigator program for the Illinois Department of Public Health and is not related to Denise Smith. She believes paying for these workers is a necessity, not a luxury, to help people navigate the country’s failing health care system and disjointed government aid programs.
Angelia Gower, vice president of the NAACP in Madison, Ill., is now one of those paid community health workers. “They see you there week after week and month after month and you’re still there, they start to trust you,” she said. “You make a connection.”
But as covid cases have declined, the number of Illinois pandemic health workers has fallen by nearly a third, to around 450, in part because they have found other opportunities.
Smith is optimistic that the program will get money to keep about 300 community health workers on staff, then use the goodwill they have accumulated in communities to focus on disease prevention. America’s fragmented health care system — and its systemic inequities — won’t go away with covid, she said. More, millions of people are on the verge of losing their Medicaid coverage as the benefits of the pandemic run out, Benjamin said, creating a hole in their safety net.
Part of the long-term funding challenge is quantifying what workers like Scott do in a day, especially if it’s not directly related to covid or another communicable disease. How do you calculate the difference in a client’s life when you secure beds for their children, laptops for them to go to school, or tap into funds from the Federal emergencies to pay funeral expenses after a loved one dies from covid? How do you put a dollar amount on complementary services that can keep a family afloat, especially when a public health emergency isn’t happening?
As Scott likes to point out, most of the time she helps people use the resources already available to them.
Denise Smith of the National Association of Community Health Workers worries that even if programs like the one in Illinois do the work to help reduce health inequities, they could follow the same path. than many Affordable Care Act grants. In 2013, she was working as a community health worker in Connecticut, helping to reduce the rate of uninsured people in her area by 50%. But the money dried up and the program disappeared.
She said North Carolina is an example of a state that designed its pandemic-inspired community health worker program to be more permanent. But, nationally, Congress has yet to approve more money for covid tests and vaccines — much less for longer-term public health investments.
Meanwhile, Scott can’t help but worry about the likes of 40-year-old Christina Lewis.
As she leaves Lewis’ mobile home after dropping off a load of groceries, Scott reminds Lewis to keep wearing his mask even if other people lose theirs. Scott used his own family as an example, saying they all wear their masks in public even though people “look at me like I have five heads.”
Lewis said Scott’s help — bringing groceries, talking about budgeting — was invaluable. Lewis has stayed home throughout the pandemic to protect her 5-year-old daughter, Briella, who was born prematurely and suffers from chronic lung disease. The struggle to make ends meet is far from over amid rising inflation. Briella knows how to turn off the lights as soon as she leaves a room. And now they are considering rising gas prices.
“I already know I’m going to have to buy a bike,” Lewis said.
Over the past few months, Scott has listened and comforted Lewis as she grieved over the stress of staying afloat and losing family members to covid. Scott doesn’t know what will happen to all of his clients if his support disappears.
“What happens to people when it goes away?” Scott asked.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.
Comments are closed.