Is a community health worker one solution to health care crisis?

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Seeing more TV commercials for glucometers and news stories about the diabetes drug, Avandia? It's not just by chance. Diabetes has become an epidemic in American society, but nowhere more than African-American and Hispanic communities.

About 6.6 percent of people who are white
have been diagnosed with diabetes, a number that's already disturbingly
high. But among black people, that percentage is almost double - 11.8
percent, and 10.4 percent among Latinos. People who are Latino are twice as likely as people who are white to be diagnosed with diabetes and 50 percent more likely to die from it.

Researchers from the University of Illinois at Chicago
have come up with a surprising solution to the epidemic: a friendly
neighbor who's not a doctor or a nurse, but knows a lot about the
disease, known as a "community health worker." A recent study from the university shows that these community health workers can do a lot
to educate people about their disease and change a person's behavior and
test results in ways doctors fail to do.

Here's how it
works: a community health worker is dispatched to a community to make inroads in different institutions, like schools,
churches and community centers. Once they meet people there, the worker arranges a series of classes on diabetes. Each week, the worker
educates people about what the disease really is, the
different ways they have to care for themselves and how to do that
well.

At the beginning, the workers tests participants' A1C - a blood glucose
test that reveals how well a patient has been taking care of themselves
for the prior three months. Then, after 10 weeks of classes,
the person is tested again. The results? The study shows a marked improvement
in almost all of the participants. New behavior, new information, and
better health - all without any nagging from a doctor.

Alicia
Lopez was one of those community health workers. She says the patients
she taught were able to get information from her that they couldn't get
from a doctor.

"They felt like the doctors did not have enough
time for them," said Lopez. "Some of them had a language barrier - they
weren't able to understand what the doctors were telling them or ask
the questions they wanted to."

Dr. Amparo Castillo,
lead author of the study, said communication problems with doctors and
nurses are common, particularly for patients who are Latino. She says
cultural norms make it unlikely that a Latino patient would question
a doctor persistently. If there's a language barrier, a patient might
be too embarrassed to admit it to a doctor.

"Many Hispanics
do not have good communication with physicians because they don't tend
to be very assertive in the way they communicate. We tend to avoid
conflict, to agree on the surface, but not engage in what they're
saying," said Castillo.

But a community health worker may not seem as intimidating. They're regular
people who have the time to listen and also have access to the
patient's real life - able to go into their homes, take them grocery
shopping, meet their family members.

"They can get into their
homes and help them figure out where to put the medication so they can
remember to take it, or how to take care of any environmental factors
that may be worsening the situation," said Castillo.

Community
health workers are not just for diabetes - they could help combat many
other chronic conditions and illnesses that communities are facing, including HIV-AIDS, asthma and obesity. They're much less expensive than doctors, nurses,
hospitals and tests, and may actually be more effective at getting a
patient to change their behavior long term.

Some of the
community health workers employed by the study have been kept on by
community organizations, but others had to be let go when the funding
ended. Both Castillo and Lopez would like to see more community health
workers dispatched to Chicago's toughest communities, where access to
good health care and information can often be scarce.

"There's
a real need for more community health workers," says Lopez. "It does
make a difference in the community.  People feel that they can come to
us, and we can really help them."

Photo credit: Alden Chadwick.

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  • In practice and theory it sounds very promising.Again we have people who are not very willing to change yet we'll cater to their needs.How do you make these people eat better? I travel all around Chicago on a daily basis and I see the way these communities operate.There are clinics everywhere just look for the line.One more program and presto changeo! Come on.Look,if this is a new program and I do pray that it works,cut the funding from a program that isn't showing any progress and I'm on board 100%.Mom and dad need to step up to or is that asking to much.

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