摘要：Community health workers are resources to their communities and to the advocacy and policy world on several levels. Community health workers can connect people to health care and collect information relevant to policy. They are natural researchers who, as a result of direct interaction with the populations they serve, can recount the realities of exclusion and propose remedies for it. As natural researchers, they contribute to best practices while informing public policy with the information they can share. In this light, community health workers may also be advocates for social justice. COMMUNITY HEALTH WORKERS are the integral link that connects disenfranchised and medically underserved populations to the health and social service systems intended to serve them. 1 – 3 Worldwide, community health workers—also known as promotoras , natural helpers, doulas , lay health advisers, and frontline workers—increase access to care and provide health services ranging from health education and immunization to complex clinical procedures in remote areas where they are often the only source of health care. 4 Community health workers have appeared repeatedly throughout history as those who heal others and help communities thrive. 5 , 6 Although the central role of community health workers is to be outreach workers who help clients access health or social services, they do more than merely link individuals to a doctor’s office. Community health workers play a paramount role in connecting people to vital services and helping to address the economic, social, environmental, and political rights of individuals and communities. They are also “natural researchers”—they can observe and relay community realities to outsiders—placing them in a position to influence policies that affect public health. Their history and the breadth and scope of the roles they serve distinguish them as social justice and policy advocates for underserved communities across the world. Their work is linked to social justice precisely because it focuses on ensuring that individuals and communities share equally in the benefits society has to offer. 7 Likewise, as policy advocates with close relationships with the communities they serve, community health workers are in the position to inform policies based in reality. This role as social justice and policy advocates must be upheld in community health workers’ development and as they become critical figures in the integrated system of health care. Public health literature has examined the relationship between community health workers, community health work in general, and social justice. 8 – 10 Farmer et al. 11 espoused the value of community health workers as advocates for patients’ health. Their discussion focuses on the history and importance of community-based participation in health care and on the broader vision of health and human rights. Specifically, they see a practical benefit in community health work, not only in the connection of patients to care and services but also in community health workers demonstrating how the issues that people face in their lives, both those directly related to health and those that result from social, economic, cultural, or political exclusions, impact their life conditions, which may be the more relevant unit of analysis for an illness than illness itself. Others look at the subject from a broader community health lens, focusing on how community health work and partnerships in the community succeed in promoting better community health outcomes, including more-equitable environments and personal economies. 9 Politzer et al. 10 have discussed the importance of community health centers, specifically their efforts to reduce racial and ethnic health disparities in low-income communities. Along this theoretical construct of defining health and assessing outcomes in health is the following question: are diseases to blame for illness, or are established health and social policies and structures the more germane unit of analysis? 12 , 13 In other words, what are the perceptions, decisions, policies, and structures that determine one’s health before the disease? Considering this body of work and its significance in pointing to some of the root causes of poverty and ill health (broadly defined), we also ask what else is required to fill the gaps. Who else is necessary to raise consciousness about those most excluded and their needs and rights? In this context, the work of community health workers must be understood on 2 levels, as those who can connect people to care and as advocates who can attest to the realities of marginalization and how it must be remedied. The natural research component of community health work activities is critical to contributing to best practices in the field and also to influencing thoughts and paradigms. Those working on the front lines in the community are concerned about changing the social ills, institutions, and policies that contribute to disease. In this light, community health workers are natural helpers and researchers and advocates for social justice. Here, we share our thoughts about the importance of recognizing community health workers’ function and about their historical and current role as advocates for health, social justice, and human rights.
