“Champions in Communities for Improving Health and Wellness” Community Health Worker Conference Louisville KY Sept. 27-28 2016 Vivian Lasley-Bibbs, MPH Acting Branch Manager and Epidemiologist Office of Health Equity Kentucky Department for Public Health

Health starts in our homes, schools, workplaces, neighborhoods, and communities.

World Health Organization What is Health ? “Health is a state of complete physical, mental, and social well being and not merely the absence of disease or infirmity.” World Health Organization The definition has not changed since 1948.... Foundation for Healthy Generations 2014

Community Health Workers Explore how programs, practices, and policies in these areas affect the health of individuals, families, and communities. Establish common goals, complementary roles, and ongoing constructive relationships between the health sector and these areas. Maximize opportunities for collaboration among Federal-, state-, and local-level partners related to social determinants of health.

CHW Core Competencies Communication Skills Interpersonal Skills Knowledge Base Service Coordination Skills Capacity-Building Skills Advocacy Skills Teaching Skills Organizational Skills National CHA Advisor Study

Who are they? We connect our friends, family, and neighbors to a comprehensive, integrated delivery network of health, human and social services resulting in improved access and removal of barriers to needed resources. Community Health Workers (CHWs) are frontline public health workers who are trusted members of and/or have an unusually close understanding of the community they serve. This trusting relationship enables CHWs to serve as a liaison/link/intermediary between health/social services and the community to facilitate access to services and improve the quality and cultural competence of service delivery.  CHWs also build individual and community capacity by increasing health knowledge and self-sufficiency through a range of activities such as outreach, community education, informal counseling, social support and advocacy. (American Public Health Association, 2008)

Community Health Workers must be of the people they serve They must live with them… Work with them… Rejoice with them… Suffer with them… Grieve with them… And decide with them… World Health Organization

Who are they? Sisters Mothers Daughters Aunts Grandmothers Nieces Friend Vital role in Health care system Wise investment Evidence based approach that works

What is their role? Provide/increase access: “the 5 rights” Right Care Right Time Right Place Right Provider Right Payer CHW’s afford a unique position to engage individuals and populations that professionals have difficulty reaching.

What do they do? Outreach Cultural mediation Navigation: help people get the services they need Create more effective linkages between communities and care systems Provide culturally appropriate health education and self-management support Advocate for underserved individuals and community needs Informal counseling and social support Build individual and community capacity in addressing health issues

How Do They Do What They Do….. They stay current on the issues They strategize … They take advantage of every learning/training opportunity or they create it Popular education Incorporating adult learning styles Most importantly they know how to reach the community they serve

Why does it work? Peer support Status within the community and identified as someone respected Contribution to community empowerment Successful referrals to health facilities Communities see visible changes CHWs also build individual and community capacity

“Trust is the conduit of influence” The trusting relationship enables the CHW to serve as a link between systems and the community to facilitate access to services and improve the quality and cultural competence of service delivery systems. (Amy Cuddy, social psychologist) Foundation for Healthy Generations 2014

Health Equity Exercise Equal ≠ Equity

Making Healthy Choices the Easy Choices Social Circumstances: Housing Education Employment Health Care Access to services Safety Sidewalks Availability of Healthy Food Systems and Policies Matters Foundation for Healthy Generations 2014

Examples of Social Determinants Availability of resources to meet daily needs (for example, safe housing and local food markets) Access to educational, economic, and job opportunities Access to health care services Quality of education and job training  Availability of community-based resources in support of community living and opportunities for recreational and leisure-time activities Transportation options  Public safety Social support Culture Social norms and attitudes (for instance, discrimination, racism, and distrust of government) Exposure to crime, violence, and social disorder, like the presence of trash and lack of cooperation in a community Socioeconomic conditions, such as concentrated poverty and the stressful conditions that accompany it Residential segregation Language/Literacy Access to mass media and emerging technologies, like cell phones, the Internet, and social media

Examples of Physical Determinants Natural environment, such as green space (e.g., trees and grass) or weather (e.g., climate change) Built environment, such as buildings, sidewalks, bike lanes, and roads Worksites, schools, and recreational settings Housing and community design Exposure to toxic substances and other physical hazards Physical barriers, especially for people with disabilities Aesthetic elements (e.g., good lighting, trees, and benches)

What I need to know WHAT YOU WILL NEED TO KNOW: Data Understanding community needs and assets Representation form all sectors of the community Impact of current policies and programs Level of support for an issue or action Tools and resources needed to take action Use of multiple approaches to reach diverse audience Share or develop the necessary resources for action and problem solving. Recruit participants from diverse backgrounds and with diverse experiences. Promote community-wide change through the use of multiple approaches proposed by representatives from different sectors of the community. Improve your chances of making meaningful changes in community conditions by gaining community members’ trust in a broad-based coalition of partners.

Partnerships and Collaborations Education Urban Planning and Built environment Faith-based Transportation Business Sector/Commerce Housing Law Enforcement Community based organizations State/Local/city government

Next Steps Obtain professional recognition for Promotores and Community Health Workers. Create certification process Can result in job availability for Promotores and Community Health Workers Utilize knowledge, experience and abilities of Promotores and Community Health Workers in the creation of policy. Increase Advocacy presence.

Thank You! Vivian Lasley-Bibbs, MPH Kentucky Department for Public Health Office of Health Equity 502-564-3970 ext. 4074 Vivian.lasley-bibbs@ky.gov