Review of: Community Health Workers in Action: The Efforts of “Promotores de Salud” in Bringing Health Care to Marginalized Communities

Abstract

Community health workers in action:  The efforts of “Promotores de Salud” in bringing health care to marginalized communities.

Melvin Delgado’s latest publication relates to integration of faith in social work practice with an emphasis upon social justice topics.  The author focuses upon special populations which included persons confronted with their age, race, youth, addictions, homelessness, criminal justice, health challenges, gender issues, and LBGTQ identities.  As Christians, we are called to address societal needs in providing compassion and concern without judgement.  As social workers we are called to be advocates with the gospel providing that foundation.   

Social work practitioners will find Delgado’s publication relevant to social work practice but will want to note that it was published in 2020, before the COVID-19 pandemic.  When Delgado addresses health care topics, there is no mention of the 2020 global pandemic, but regardless, there is relevancy to ongoing health challenges faced in the United States.  For example, the author does a remarkable job addressing the challenges faced in immigration procedures that have become a major social justice issue.         

Delgado covers a wide area of topics starting with a firm foundation in recognition of the “close relationship between health and well-being across the life span” (p. 3) and carries this theme throughout.  He specifically addresses the “graying of the nation’s population” and how this necessitates “the development of initiatives to meet their complex health care needs that are increasingly financially costly” (p. 7).  Special attention is given to the Affordable Care Act (ACA), the historic legislation that increased health care with a special focus upon mental health services throughout the publication as it relates to specific groups.    Delgado discusses values as key principles that community health workers (CHW) should embrace in practice (p. 28).  He then refers to the importance of culture and addresses it extensively in chapter 2.  Reference is made to the effectiveness of CHW because of their focus on culture in association with values and practices found in communities.  This chapter also tackled the present-day struggles of Latinxs, and their fear and resistance to seek out health care because of a perceived risk of deportation.  Delgado also focuses upon medical personal who are bilingual and as a result enhance their role as a CHW.  The chapter closes with a solid definition of acculturation as it relates to the role of the CHW. 

Interestingly, Delgado addressed the impact of previous pandemics such as the Asian Flu, HIV/AIDS, and SARS without knowingly making a connection to how the United States would recover from the pandemic now known as COVID-19.   He discusses the social justice analysis that must be addressed during a pandemic as it presents a higher level of barriers to marginalized individuals who are already facing challenges.  Also, in this chapter, he addresses the term “US health care system” which is a misnomer as it is not an organized system but rather a system that has disparate parts and provides an inequal delivery of care across age and racial spectrums.  Work related injuries are addressed as well noting that “workers of color…. are often overrepresented in occupations with high rates of injuries” (p. 50). 

A unique phrase is found in chapter 4, in regard to addressing barriers in urban health care, “the nation is graying (getting older) and browning (diversifying ethnically and racially), setting the stage for a country that will look very different in the future from what it looks like today” (p 53).  The graying of America refers to not only senior citizens but also their families who are often the primary caregivers.  Awareness of the nation’s graying is critical to community health workers because it represents a growing population getting older and thus relating to healthcare services associated to the aging process.   The browning of America is related to the progression in the number of blacks, Hispanics, Asians, multiracial Americans and other non-white groups.  The impact is that we no longer view Europe as the primary origin of immigrants to the United States.   We are now transformed from a country with a majority of white people to a country of mixed peoples which presents a continued need for awareness on how health care challenges impact those who are marginalized due to race. 

Foundation of health care values in chapter 5 addresses social justice, empowerment, cultural competency, and participatory democracy which lays the framework for a listing of eight principles related to CHW initiatives.  Delgado touches upon the non-traditional environments in which communities can focus upon health care.  One such example provided is houses of worship initiating health programs by hosting community health workers offering a free health clinic, a screening site for common illnesses or a vaccination site.  Places of worship are viewed as ideal locations because community members have already established trust within these environments.    

Delgado addresses the need for community health workers to be a profession that has legitimacy in order to earn consumer trust.   This trust is acquired in a variety of ways, one in which is an academic degree and professional credentials acquired from a college education.  “Achieving professional status also serves a gatekeeping function, keeping people in and out” (p. 12).   This position relates to policies, guidelines, and standards that a community health worker brings with them to the position because these principles were learned in a formal education.   This reference to professional status is a critical element for academia to focus upon especially in the field of social work because one competency of those required by the Council on Social Work Education (CSWE) relates solely to policy. 

Peer support for CHW is also referenced as a focus upon “shared understanding, respect and mutual empowerment” (p. 16) between people in similar positions.   Addressing the need for peer support in practice is another critical factor that educators should address in their curriculum as way of preparing students for future roles. 

As social work educators strive to promote the work of community mental health, it is important to address the various titles and roles that are used in order to understand this field.   These descriptions are addressed in chapter 6.  Defining the roles of CHW is dependent upon who is defining them, but focus should also be made upon the critical role the Affordable Care Act (ACA) has played in fostering employment in this area. 

Christian foundational values of working with the poor and other oppressed populations continue to guide the social worker with a faith perspective.  This publication provides an introductory practice perspective whereby integration of faith in practice for the Christian social worker is at the forefront.  Strengths of this publication include the definitions, historical focus, and examples of community mental health workers and their role in reaching marginalized communities.  As noted above, since the book was written before the Covid-19 pandemic, future editions could include the ongoing challenges that have been presented to community health workers.    

Reviewed by Carla J. MacDonald, Ed.D., Social Work Program Director, Associate Professor of Social Work, Huntington University, Huntington, IN.  Email:  cmacdonald@huntingotn.edu.