Expanding our health force can save lives and create jobs simultaneously
The pandemic is relentless. New cases of coronavirus are reported daily across the country, including states across the South, where COVID test positivity has exceeded 20 percent. Nearly 5 million Americans have been infected, and nearly 160,000 have died. COVID’s toll has extended beyond health. Businesses have closed, and 30 million have sought unemployment aid for the first time. And after being on lockdown for months, like other parents, we are desperate for our children’s schools to reopen.
We can shift from being on lockdown to putting the virus on lockdown. We lived through the Northeast surge in COVID-19 in the spring, but our states, Connecticut and Massachusetts, have managed to effectively respond. COVID-19 test positivity rates have fallen to less than 2 percent, suggesting enough testing to detect most new cases and prevent new outbreaks from spiraling out of control. Our small businesses are re-opening and our children have a higher chance of attending school in person — with safety measures in place.
How have our states done it? Social distancing, mask wearing mandates, and science-based communication have been vital. But one key factor has received less fanfare: the use of community-based strategies for testing, contact tracing and social support. In Chelsea, the coronavirus epicenter in Massachusetts, our clinic was flooded with COVID-19 patients in April, when rates of infection surged to 3,841 per 100,000 people, one of the highest in the country. Chelsea responded by bringing testing into the community at pop-up sites in the town square. It worked with the state to hire unemployed residents as contact tracers. Community health workers and community organizations organized to provide social support, like food aid, quarantine kits, and even shelter for those unable to safely isolate at home. Community-driven action helped slow the virus, save lives and reduce test positivity, allowing us to safely re-open the economy.
The foundation of community-driven strategies during this pandemic — and before it — are community health workers. Hired from their own communities, community health workers receive a few weeks of training in carrying out basic health and social tasks. Forming part of the health team with nurses and public health officers, community health workers have been a ‘human connection’ for some of the most vulnerable — delivering groceries, screening patients for COVID symptoms, ensuring patients with hypertension take their pills and offering dietary guidance to those with diabetes.
Now more than ever, community health workers are critical to America’s COVID-19 fight. In Baltimore, unemployed residents are being hired to conduct contact tracing and care coordination across the city, as part of the city’s Health Corps model. Hard-hit states like Texas and Arizona have community health programs that reach Medicaid patients and immigrant communities. But there are only 56,000 community health workers across America. To reduce transmission, prevent new outbreaks — and rapidly deploy a vaccine when ready — we must massively expand this vital workforce.
Congress has the power to change this before it goes on recess. The Health Force and Resilience Force Act of 2020, led by Sens. Kirsten Gillibrand (D-N.Y.) and Michael Bennet (D-Colo.), would invest approximately $50 billion in annual funding to support states and local community based organizations to recruit, train, and employ hundreds of thousands of Americans as community health workers. The Health Force bill would immediately bolster our fight against COVID-19, while expanding our public health workforce to respond to long-term needs — including the next epidemic.
By supporting Health Force, Congress can allocate federal funding to help states rapidly grow their rosters of community health workers — saving lives and creating jobs at the same time.
Organizations funded by the Health Force bill will be asked to prioritize hiring community health workers from low-income, minority, and historically marginalized groups. Health Force members, to the extent possible, will be recruited from and placed in their home communities — reinforcing trust and shared understanding. Health Force members will be asked to provide contact tracing, testing, and social support services.
The best programs show investing in community health workers pays for itself — many times over. Dr. Shreya Kangovi and the Penn Center for Community Health Workers found that community health workers improve health while reducing costly hospitalizations and readmissions, saving Medicaid $4,200 per beneficiary. If scaled to even a quarter of U.S. Medicaid beneficiaries, it’s been estimated that community health workers could save taxpayers $78 billion each year.
Health Force is gaining traction among leading health care organizations. Blue Cross Blue Shield Association supports the Health Force Bill, as do a growing chorus of national groups and experts, from a former FEMA administrator to professors at Johns Hopkins Bloomberg School of Public Health. Denise Smith of the National Association for Community Health Workers — who is helping lead a new ‘Community-Based Workforce Alliance,’ said this week, “The Health Force Bill promotes the kind of community-based workforce needed to increase access to COVID-19 testing and contact tracing and to coordinate social and mental health supports, making our communities healthier now and more resilient for the future.”
Investing in America’s community health workers has also become a factor in the presidential campaign. The Biden campaign made a proposal similar to the Health Force bill as part of his plan to ‘Build Back Better’ — calling for adding 150,000 community health workers who can be repurposed in a time of crisis to meet the urgent needs of vulnerable communities. Biden cited the tremendous impact of community health workers in places like North Carolina, where evaluations of the Community Care of North Carolina model have shown a return on investment of approximately $3 for every $1 invested in the community-based approach it utilizes.
Congress should act now to include the Health Force Bill in the next coronavirus relief package. This is an opportunity to equip America with the trusted community health workforce it needs to win the war against this invisible enemy. This is an opportunity to invest in the lives and livelihoods of all Americans.
Claire Qureshi leads U.S. initiatives for the Community Health Acceleration Partnership. Dr. Raj Panjabi is CEO of Last Mile Health, Assistant Professor at Harvard Medical School and a physician at MassGeneral Brigham. Follow him on Twitter @rajpanjabi.