Prabhjot Singh, MD, PhD, Director of The Arnhold Institute for Global Health, right, with, from left: Hilda Mejias, a Health Coach in Harlem, and Anna Stapleton, Program Manager for Policy at The Arnhold Institute for Global Health.
The United States spends more money on health care than any other country, yet has poorer outcomes with shorter average life expectancies (78.8 years, per capita) than peer nations, such as Japan and Spain, with 83.4 years and 83.2 years, respectively. Furthermore, a child born in poverty in Detroit has a life expectancy that is six years shorter than a child born in similar circumstances in New York City. And someone born on the Upper East Side of Manhattan has a life expectancy that is nine years longer than a person born ten blocks away in East Harlem.
Mending this uneven patchwork of U.S. health outcomes will require a new model of care that embraces the use of community health workers (CHWs), non-clinical workers who provide underserved patients with the continuum of care they need, according to a new report from The Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai and the Office of the UN Secretary General’s Special Envoy for Health in Agenda 2030 and for Malaria. The report recommends creating a pilot program in Newark, New Jersey, a city with many non-English speaking residents that lags behind the rest of the state in health outcomes.
CHWs come from the same communities as their patients and serve as the primary mechanism that enables patients to live healthier lives. They can serve as educators, for example, explaining the relationship between diabetes, blood sugar, high-sugar foods, and insulin in a way patients understand, or link patients to neighborhood exercise groups or food pantries that provide health-conscious meals. Such programs have been successful in South America, sub-Saharan Africa, and Southeast Asia.
“A growing body of evidence tells us that social, economic, genomic, and cultural factors can impact an individual’s ability to build and maintain health, and community health workers have the ability to help bridge that gap between medical advice and a patient’s ability to comply,” says Prabhjot Singh, MD, PhD, Director of The Arnhold Institute for Global Health, and the report’s senior author. Dr. Singh co-founded the One Million Community Health Worker Campaign with Jeffrey Sachs, an author and well-regarded sustainable development leader, whom The Arnhold Institute for Global Health is hosting as a visiting fellow through 2018.
Claire Qureshi, MBA, Vice President of Frontline Delivery, Office of the UN Special Envoy for Health in Agenda 2030 and for Malaria, co-wrote the report with Dr. Singh. “We’ve seen the health impact and economic value of CHWs in countries around the world and fundamentally believe that working with them as part of integrated primary care is a better way to practice medicine,” says Ms. Qureshi. “With careful construction of the right care models, including the organizational and financial infrastructure needed to support them, CHWs can contribute enormously to patients, communities, and health systems alike.”
While CHWs have existed in the United States for decades, they have struggled to gain widespread acceptance. The services they provide have not been reimbursed by public or private health insurance plans, which are based on traditional fee-for-service payments made to hospitals and clinics. In this old model of health care, there has been little incentive to pay for the preventive and maintenance support provided by CHWs, and little consideration given to the support patients need to comply with the medical advice they receive.
But that is changing. The country’s new emphasis on keeping populations healthy and out of the hospital is creating fertile ground for robust, sustainable CHW programs to emerge, according to the report.