They are women and men, young adults and middle-aged, from neighborhoods across the area.

Some have been homeless or known hunger. Others have witnessed or have been victims of physical violence. And still others have survived life-threatening illnesses. What links them together across gender and generations is the desire to give back to society -- to their neighbors -- as trained Community Health Workers (CHW).

CHWs can help their neighbors, many of whom are wary of the health care system, adopt healthy behaviors and gain access to quality medical care and social services.

Community Health Workers have been around in America in one form or another for at least 70 years. The U.S. Bureau of Labor Statistics estimates that there are currently 60,000 to 100,000 CHWs in America. A number of them practice in Northwest neighborhoods including Chestnut Hill, Mt. Airy, and Germantown, as well as Montgomery County.

The CHW title is a broad umbrella that, according to the National Association of Community Health Workers, covers “promotores and promotoras de salud, community health representatives, as well as aunties, peers, and outreach workers … who share lived experience, trust, compassion, and culture with communities where they live and serve.”

But it wasn’t until the passage of the Affordable Care Act in 2010 that interest in CHWs as a profession really picked up. A year later, the U.S. Department of Labor officially recognized CHW as a labor category.

It did so, the Labor Department explained, because CHWs were shifting from community-based organizations to hospitals and health systems that “value education and training more highly than traditional characteristics, such as peer status.”

Training to become a CHW usually takes more than a year. In Philadelphia, for example, Temple University has a Community Health Worker training program. Jefferson Health’s Community Health Worker Academy is a 13-month course. And Penn has a Center for Community Health Workers that it estimates has served nearly 25,000 people in this region. In general, these programs include training on communication styles, outreach and advocacy methods, and legal/ethical issues, according to the Bureau of Labor Statistics.

“Research shows that this program is highly effective at enhancing patient satisfaction, improving mental health and chronic disease management, and reducing health-care costs by shortening hospital stays,” Penn said in a statement.

But it is their peer status that is every CHW’s super power. CHWs live in the community. People know them as family, friends, and neighbors. They see the CHW in the neighborhood and know they have led similar lives. From that comes trust.

Several studies have shown that CHWs produce better health outcomes in their communities. CHWs also save the system money by focusing on prevention, chronic disease management, and social needs navigation, according to the findings of other studies.

Sinai Urban Health Institute, part of the Sinai Health System in Chicago, has 25 years of experience training and embedding CHWs. Its consulting arm, the Center for CHW Research, Outcome, and Workforce Development, has trained more than 2,000 CHWs nationwide and consulted with 70 organizations.

In 2012, doctors at Sinai enrolled 70 Black children in a pilot program to improve asthma management. Over a six-month period, CHWs conducted asthma education sessions during three to four home visits. They also served as a liaison between families and the medical system.

The results found that “symptom frequency was reduced by 35% and urgent health resources utilization by 75% between the pre-and post-intervention periods.” And the return on investment was $5.58 for every dollar spent.

In 2020, an article in Health Affairs cited a number of studies that showed CHWs netted an annual savings of $2,500 per patient, per year in America.

“Overall, a team of community health workers saved Medicaid $1,401,307.99,” wrote lead author Dr. Shreya Kangovi.

CHWs can work in almost every health care setting imaginable, from emergency departments and inpatient and outpatient trauma units, to primary care and specialty practices like maternal health, pediatrics, oncology, chronic diseases, and addiction clinics.

A new CHW’s first assignment is often their hardest. Being immediately accepted as a teammate into a field that until now has been made up primarily of doctors, nurses, and social workers, is not automatic.

In fact, many doctors and nurses don’t know anything about CHWs. They have no idea what a CHW does or where they fit into a practice. A CHW is not a nurse. They are not a social worker. And they most certainly are not a secretary. So, it takes time and education to understand the CHW’s role and get things running smoothly. But the message seems to be getting through. In an email, the American Nursing Association called CHWs “essential interprofessional collaborators.”

“A key way to move health care further upstream is by collaborating with CHWs as they are trusted stakeholders in their communities,” the association concluded.

CHWs have proven their value on the impact on health outcomes and savings. But CHW programs are faced with finding a sustainable source of funding. Many programs are an expiring grant or depleted gift away from shutting down.