Community Health Workers as Accelerators of Community Engagement and Structural Competency in Health

Abstract

Asian Americans are the fastest growing minority population in the United States. Asian Americans are portrayed as uniformly hardworking, affluent, and healthy, leading to the “model minority” stereotype that is often promoted in the American culture and media. However, there are substantial differences in language, migration, and social experiences across more than 30 Asian subgroups; and their health concerns and risks vary across and within these communities. From our personal experiences as refugees and immigrants, we know firsthand the cultural, linguistic, and social barriers that Asian Americans face in navigating the healthcare system. The trauma associated with war, migration, and social isolation, as well as cultural differences and language barriers, make it challenging to seek preventive and timely healthcare services. Similarly, providers also have poor understanding of the stress and mental health concerns associated with migration and displacement, and how that is manifested in health outcomes. These issues are complicated in miscommunication due to language differences and misconceptions of the experience of pain or symptoms among their Asian American patients. Decades later, we have learned from our research that our families’ experiences were not unusual; doctors are less likely to follow evidence-based guidelines and meet standards of care with their Asian American patients compared with other racial groups in preventing and managing chronic conditions. We have also learned that times have not changed dramatically in the care of Asian American patients even though there is now increasing recognition that Asian Americans face just as many health challenges, including an increasing rate of diabetes and certain cancers. Community health workers (CHW) can play an important role in bridging the communication gap, engaging low income Asian immigrant and refugee communities, helping them navigate a complex healthcare system, and, ultimately, improve health outcomes. CHWs are the frontline health workers who are indigenous and trusted members of the community. With the right balance of training and guidance, CHWs can be effective leaders and change agents in empowering and helping Asian American communities develop meaningful solutions for healthful behavior change.