Community health workers in Canada and the US: working from the margins to address health equity

Abstract

In this commentary, we address community health workers’ (CHWs) marginalized social location within the health care systems of Canada and the US. This marginalization is due, in part, to their being a workforce shaped by socio-structural factors, such as gender discrimination, racism, and poor socio-economic conditions. This marginalization challenges their ability to address health equity. We propose system-level and workforce-level policy changes that build toward an empowerment path for CHWs to realize their full potential to address health equity. Regarding the work they do and the populations they serve, system-level changes would allow CHWs to strengthen their intimate connection with, and commitment to, advancing health and well-being in their marginalized communities. Workforce-level changes would target their peripheral status by addressing multiple structural factors and altering organizational arrangements to remove their marginalization as a workforce. Together these system-level and workforce-level changes would greatly enhance the health and social services systems.

Keywords:

• Health equity
• community health worker
• marginalized communities
• social location
• empowerment

Acknowledgements

We thank community health workers for their commitment and dedication to their communities. We also thank Dr. Denise L. Spitzer and Carl H. Rush for their insightful comments.