‘A poverty in understanding’: Assessing the structural challenges experienced by community health workers and their clients

ABSTRACT

Community health workers (CHWs) are crucial intermediaries between marginalised populations and health and social services. Among their unique repertoire of services includes their commitment to advocacy, a crucial skill that aids clients in addressing the social determinants of health that deleteriously affect their wellbeing. However, a plethora of structural barriers encountered by their clients complicates the caregiving of these workers. Drawing on data from a year-long ethnographic research project situated in Indiana, I analyse the diverse structural challenges experienced by these workers and their clients and assess the parallels encountered by CHWs at the global scale. Among the key barriers encountered by CHWs included difficulty in accessing resources for clients, lack of effective public transportation, barriers within the professional workforce, and the overarching negative impact of structural violence on client motivation. In spite of these issues, CHWs can positively address these barriers through a wider adoption of a structural competency approach, which further elucidates and addresses the harmful effects of structural violence.

KEYWORDS:

• Community health workers
• structural violence
• structural competency
• social determinants of health
• Indiana

Acknowledgements

First and foremost, I would like to say thank you to all of the participants in this study. I also want to thank Dr. Heide Castañeda for her guidance, critique, and help throughout all facets of this project.

Disclosure statement

No potential conflict of interest was reported by the author.

Notes

1 All names are pseudonyms.

2 Hoosier is the demonym for residents of Indiana.