Public health officials see a need for more people who help link people with public health services

If New Hampshire is going to win the Covid-19 war, it is going to need an army of community health workers, according to Dr. Trinidad Tellez, director of the Office of Health Equality for the Department of Health and Human Services.

“No matter what kind of culture, having a trusted member of that community is what the Community Health Worker brings,” Tellez said.

New Hampshire’s minority communities were hit hard by the Covid-19 outbreak in the spring, and a second wave anticipated for the fall has Tellez and other public health officials concerned.

“We have a pandemic, we have practically a state of emergency where the burden of illness is impacting some people more than others,” Tellez said.

Tellez said community health workers could be a key to keeping the state safe and healthy. They are considered lay medical workers, meaning they have no medical training. Instead, they are members of the community who help bridge the gap between people and the services they need.

“They offer a huge amount of support to the work that we do,” said Bobbie Bagley, Nashua’s public health director. “I’m hoping we can get quite a few more.”

State data shows that minorities are getting the illness at higher rates than the rest of the population. (More than 6,500 people have tested positive for Covid-19 since testing started earlier this year.)

Latinos make up 3.9% of the state’s population, but 719 Latinos have tested positive for the illness, making up 12.6% of all the Covid-19 cases in the state. Blacks, who are 1.4% of the state’s population, account for 337 cases, or 6% of all Covid cases.

Many of the more diverse communities in New Hampshire have a handful of community health workers. Unlike other states, where community health workers can be paid through health insurance, New Hampshire municipalities and organizations fund the positions through grants, said Paula Smith, director of the Southern New Hampshire Area Health Education Center.

“It’s hard to put a bunch of them out in the street if you don’t know how to pay for them,” Smith said.

Smith said that while the ranks of community health workers has grown since funding changes brought about in the Affordable Care Act, New Hampshire still lacks the infrastructure like education and certification for these workers.

“I think that if not for the reimbursement, people would use more community health workers because they are great cultural brokers, especially in the time of Covid,” Smith said.

Nashua’s two community health workers reach out to minority communities and assist with access to testing, treatment and education, Bagley said. They also help people get access to food stamps, food banks and other services as necessary. Covid-19 has been difficult on minority and immigrant communities partially because many cannot afford to take time off work in case of an exposure.

“Right now with Covid, there’s nothing that’s really typical,” Bagley said.

When her department communicates with a family that has to isolate or quarantine because of a positive test or exposure, that means the family is cut off from even grocery shopping. Bagley and her staff will get them food and necessities. She says the community health workers make connections with people who need help.

Nashua is home to Spanish speakers, Portuguese speakers and people from the Indian subcontinent where there are many different languages. Bagley, who would like to have someone who can relate to the communities they serve to be a trusted voice, says she would hire at least a half-dozen more community health workers if she could afford to fund the positions.

“You want to have someone who can speak the language (of the community) as a first language,” Bagley said.

Anna Thomas, Manchester’s public health director, said cities like hers are more vulnerable to the pandemic. That increases the need for community health workers who can be trusted by members of minority and immigrant communities.

“Urban centers are getting hit hard,” Thomas said.

Thomas said the city also is working with organizations to reach homeless people in the city.

Homeless people tend to have health issues that put them at great risk, Thomas said.

Manchester has one community health worker in the department, and two who are assigned to the schools. During the school year, the city funds another two community health workers to the school system, and they focus on schools in less advantaged neighborhoods, Thomas said.

“They gave us a whole other level of connection to the communities,” Thomas said.

Thomas said the city is adding two more community health workers to help with contact tracing and Covid-19 infection investigations. Smith said many of the workers have helped people get access to internet-connected devices to allow them to engage in telehealth appointments with their healthcare providers.

But, with Manchester employing, at most, five to seven community health workers during the school year, Thomas knows they could do more.

“There are some cities even smaller than us, and they will have 50 community health workers on the front lines,” Thomas said. “The pandemic really unearthed that for us.”

She added that there is an effort to bring together stakeholders to develop community health worker standards for education and some form of certification. This could help communities around the state build up the number of such workers.

“I would like to have as many as we can get,” Thomas said.

Smith said developing a certification for community health workers would likely lead to the positions becoming eligible for reimbursement through insurance companies and state insurance. Any certification program also should go along with a public awareness campaign to promote community health worker as a career option, Smith said.

“We have to figure out how we fund these positions,” Smith said.

This article is are being shared by partners in The Granite State News Collaborative. For more information, visit collaborativenh.org.