As COVID-19 exposed cracks in our healthcare system and racial/ethnic health inequities, community health workers rose to the challenge to educate communities on virus prevention, dispel misinformation, and advocate for the vaccine.
Community health workers – called promotoras in Latino communities – are non-medical public health workers who connect people to healthcare and social services.
The U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH) is seeking public comments on the use of community health workers to increase “cultural competency in educational campaigns on public health vaccines and prevention, including but not limited to influenza and COVID-19.”
Submit this Salud America! model comment to tell HHS about the importance of using bilingual, bicultural promotoras to promote public health vaccines and prevention.
Public comment opened on June 12, 2024, and closes July 12, 2024.
Submit This Comment to Support the Use of Promotoras in Public Health Outreach
While Latinos are the largest racial/ethnic minority in the United States, they are also some of the most underserved and underrepresented when it comes to access to healthcare and health information.
The lack of representation and bilingual resources available, which includes literature and Spanish-speaking healthcare providers, has led to a deep seeded distrust of the healthcare system (https://bit.ly/47ZccYu).
This distrust has caused many to delay treatment, forgo life-saving screenings for diseases such as cancer, and decline vaccines, like the COVID-19 vaccine, contributing resulting into worse health outcomes than their white peers. In fact, the
The outlook of health opportunities for Latino adults is 34%, compared to 53% for white adults, and 85% for Latino children, compared to 93% for white children (https://bit.ly/3RmKEWX.).
Community health workers, known as promotoras in Latino communities, could be the key to restoring trust in the public healthcare system and vaccinations (https://bit.ly/47ZccYu).
Promotoras use their cultural, bilingual, and trusted community ties to disseminate health information, promote disease prevention, share resources, connect people to services, and educate about vaccines and other important health issues (https://bit.ly/49TR2LU).
Promotoras are a critical part of meeting the unique needs of the communities they serve.
On a wider scale, incorporating bilingual and bicultural promotoras into an organization that works with patients and communities’ normal operations will help reach harder to reach communities and improve community/patient health through better access to care, vaccines, and preventive services.
I firmly believe that bolstering these community relationships with promotoras can have a positive impact on the way Latinos view and receive healthcare information and health prevention, such as vaccines.
What is a Community Health Worker?
Many struggling with access to health resources and services live in rural and poverty-stricken communities, or areas with large ethnic minority populations.
Community health workers exist to promote health and wellness for these underserved populations and advocate for individuals who may not have equitable access to health resources and social services, according to HHS OMH.
Community health workers also work to identify and address barriers to equitable healthcare such as access to transportation medical insurance by providing resources to overcome some of those challenges.
To achieve this, community health workers partner with other healthcare and social service providers, such as nurses, social workers, and mental health counselors.
How Community Health Workers Serve Latinos
Language is one of the biggest to healthcare for Latinos and other ethnic minorities.
More than 68 million people living in the US speak a language other than English at home as of 2019, according to a United States Census Bureau article.
Of those who speak a language other than English, 62% of them speak Spanish making it the second most spoken language in the US.
However, there is a lack of health professionals who can communicate with Spanish– speaking individuals and few bilingual resources such as literature and informational posters, contributing to worse health outcomes.
“Language barriers can be a significant deterrent to health. People who don’t speak English well are less likely to seek health care or receive health information. This can lead to delays in care and missed health screenings for chronic disease and cancers. Language isolation is also linked to poor mental health,” according to a study from the University of Georgia.
Community health workers, also known as promotoras, have gained the trust of the Latino community, who are more receptive to receiving information from someone who looks like them and understands the cultural and ethnic challenges associated with healthcare.
Promotoras are also Spanish-speaking and can bridge the language gap by providing hard to find resources in Spanish.
Each encounter with a promotora works to slowly rebuild the trust of the healthcare system, leading to more life-saving screenings and timely medical care visits.
Promotoras en Acción
Lack of access to the COVID-19 vaccine and healthcare along with the spread of misinformation about virus prevention and the vaccine contributed to higher rates of COVID-related mortality in Latinos.
In fact, Dr. Marlene Martin, an associate professor of clinical medicine at the University of California, San Francisco (UCSF) and a hospitalist at San Francisco General Hospital (SFGH), witnessed the disproportionate impact COVID-19 had on the Spanish-speaking population and the need for intervention.
“At the very beginning of the pandemic, almost everyone who was coming into the hospital with COVID-19 was Latino and Spanish-speaking,” Marlene said. “Many Latinos couldn’t safely quarantine at home or isolate because they had to work. They didn’t have a financial safety net, and many were essential workers. These challenges that particularly impacted the Latino community made me feel like I needed to do more to prevent the spread of COVID-19.”
That’s when she partnered with community health workers, which became a vital health resource for Latino communities.
When mass media communications and vaccine campaigns struggled to reach some of these communities, promotoras stepped in to educate people about COVID-19 safety and prevention and direct them to vaccination sites.
Martha Castilla answered the call during the pandemic, using her community connections and ability to speak the language to reach Latino communities as a promotora de salud.
Seeing the impact COVID-19 on Latino communities first-hand, Castilla jumped into action with her fellow promotoras to supply residents with personal protective equipment, hand out food, register people for vaccines, and promote proper hand hygiene and the importance of getting vaccinated.
“Thankfully, we started getting masks and checked themselves to sites where they could go [for testing],” Castilla said. “That’s why I admire the community health workers, because while everybody was home scared, and all this, we were the ones out there.”
She even went as far as to get the vaccine herself to help ease the fears of community members and stop the spread of misinformation.
“I asked [doctors to come] to the community, at the school, and teach people from the school and CHWs on what’s going on, what are the facts, so that we can get rid of the misinformation and disinformation,” Castilla said.
Incorporating bilingual, bicultural promotoras into the normal operations of an organization that works directly with the community and patients can improve the health of those communities by granting them better access to care, vaccines, and preventative services.
Tailor Your Comment to the Needs of Your Community
HHS OMH is seeking comments to guide the creation of an educational campaign focused on increasing the cultural and linguistic competency efforts related to public health vaccines (e.g., influenza and COVID-19) and other prevention strategies.
They want comments from community health workers, individuals and communities using community health worker services, and organizations representing or communities using community health workers.
To aid those in writing a comment, HHS OMH crafted the following questions:
- What specific methods or practices ( i.e., discussing vaccines as part of a prevention program, prioritizing social determinants of health [SDOH], being a member of the cultural group being engaged, etc.) are required to build trust around vaccinations within the communities you serve?
- What innovative culturally competent practices have resulted in increasing vaccine uptake or vaccine confidence in your communities?
- What training programs have been effective in engaging community health workers to enhance cultural and linguistic competency to support vaccine confidence and other prevention efforts?
- What training, coaching, or learning collaborations would improve the ability of community health workers to improve vaccine confidence or vaccine uptake in their communities?
To supplement your comment use evidence, facts, and statistics pertaining to the communities you serve by downloading a free Salud America! Heath Equity Report Card.
The Health Equity Report Card gives you a broader look at the social determinants of health, such as housing, transportation, the impact of COVID-19, and access to healthy food, in your community.
Compare the information contained in the Health Equity Report Card to other cities and states across the country to support your recommendations for increasing cultural competency in public health vaccines and prevention campaigns.
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