By Ramona Schindelheim for WorkingNation.
Broadcast version by Isobel Charle for Oregon News Service reporting for the WorkingNation-Public News Service Collaboration

From a translator helping a neighbor navigate health services or locate a food bank, a doula assisting a mother during childbirth, or a former inmate working with people exiting prison to reach healthier outcomes, community health workers have a wide range of roles.

They are frontline public health workers who usually live in the communities they serve and include volunteers. Research shows they have positive impacts by helping people access preventive care resulting in things like an increase in cancer screenings and reducing the risk of cardiovascular disease.

Community health workers (CHWs), also called promotores in Spanish-speaking communities, have existed for generations and have largely been under the radar. But their importance was thrust into the spotlight when COVID hit, sparking growing efforts to bring more structure to their workforce and ensure their jobs are sustainable.

Community Health Workers: Trusted Voices

"Because of the pandemic, there was the awareness that a lot of people didn't have trusted information. There are a lot of barriers for communities and accessing health care resources and getting trusted information, specifically looking at Black, Brown, Indigenous communities, immigrant, refugee communities," explains Jennine Smart, executive director, Oregon Community Health Workers Association.

"Being able to have a workforce that's already connected in community-based space to provide reliable, trusted, and honest information has been pivotal.

"It really amplified the recognition of this workforce and the value that CHWs bring more broadly to communities and really serving as a liaison and a bridge between health settings, health systems, and communities," adds Smart.

Those settings can include hospitals, clinics and community organizations. And CHWs are in demand.

The Bureau of Labor Statistics counts 63,400 CHWs in the United States, although that may be an undercount since there are different job titles for CHWs, especially in community health organizations.

It's estimated that jobs for CHWs will grow 13% between 2023 and 2033.

The median salary is $48,200, according to the BLS , with a high school diploma or equivalent required.

Empowering Through Technology

Among the latest efforts to create sustainable jobs for CHWs is the work of Pear Suite, a digital health company launched in 2021.

I spoke with the co-founder and CEO Colby Takeda at CES 2025 in January.

"Our company is all about empowering them, supporting them with technology, with software system that allows them to document all their activities, track the needs of individuals, track how they're getting support, whether it's through organizations or health care system or social services," says Takeda, who has personal experience with caregiver support as well as the nonprofit sector.

The company counts more than 175 partners in community-based organizations and health care companies and says it's had an impact on more than 100,000 lives.

Takeda explains the Pear Suite is providing accessible training in different languages to convert a community health worker's lived experience and help them with credentials and certifications since there is no standardization process across the country.

States have their own certification process and reimbursement process. Grants had funded much of this work, but 29 states now allow services by CHW to be reimbursed by Medicaid, according to a 2022 KFF survey.

Pear Suite, says Takeda, is helping CHWs utilize their technology to track their work. "It's really infrastructure for them to get more revenue, whether it's through reimbursement, through the new Medicaid or Medicare policies that allow for community health workers to now get paid or for them to secure more funding through grants with better data," stresses Takeda.

And it comes with hurdles.

"These organizations and these workers have been on paper and spreadsheets for many years. For them to transition to now a system for them to document and do claims and maintain compliance with health plans has been really challenging," he adds.

Takeda explains that the company provides wraparound support teams to better understand contracts with health plans and things like compliance and how to do claims.

The result, he says, is that community based organizations that can range from a small community center to a barbershop now have a formal structure.

"These are people that are providing screenings or resources to early young mothers to individuals who are facing homelessness or health sickness. These are organizations that have been doing this work for decades but never got paid by the health care system. We're now helping them get paid sometimes the average of $15,000 a month additional, which is huge for them," says Takeda.

Using Skills From Lived Experiences for a Living

One community health worker who credits Takeda's technology with helping his work become more sustainable is Joe Calderon, a former inmate who served 17 years in prison who has made it his mission to build better outcomes for people in his California community while supporting his family.

"Now I can change my life, my family's life, and my community's life, by slowly making a little bit more money by creating my own organization" says Calderon, a manager of recruiting and training for Urban Alchemy, based in San Francisco with a mission to "heal neighborhoods by employing the unique talents of returning citizens to transform communities and spaces."

Calderon has a Community Health Worker certificate from San Francisco City College and started out as a community health worker after exiting prison.

"I found my voice for advocacy as I watched so many men die in prison of treatable diseases," he explains. And he says it made him think more about health care when he had to take medicine for high blood pressure at the age of 29years old while behind bars. It's his lived experience that has spurred him to change outcomes of the communities he knows.

"No one ever taught me to go to the doctor. I already knew, when I started to see about health care, that the communities that I came from, in my perspective, took better care of our cars. Our cars had tinted windows, rims and beat. But nobody was talking about going to the dentist. Nobody was talking about going to the doctor regularly," adds Calderon.

Building a Sustainable Workforce

On a wider scale, Oregon, where a statewide professional workforce association for community health workers was established in 2011 and has an 80 training requirement for CHWs is aiming to take its new partnership with Pear Suite to a new level.

"We really want to support the sustainability of the workforce, right, and that we don't want to just get everybody trained as a CHW. We want to make sure that folks are able to be employed, and that we have a sustainable workforce," explains the Oregon Community Health Workers Association's Jennine Smart.

To do that, Smart explains, the organization is looking to use the platform to build a network that will take over the administrative burden of billing management while at the same time creating a system to get a more comprehensive view of the work done by community health workers.

"So we're looking at building a community based organization network. And so it'd be community based organizations that are employing community health workers and providing community health worker services. And then we'd hold a contract with Medicaid" explains Smart.

In short, it would provide structure not just for billing but case management. She describes the goal as building a more comprehensive payment system that hasn't always included all the work they do in an effort to recognize the key roles CHWs play.

She adds, "Those are the folks who are out there. They're getting their feet wet. They're in the dirt, they're really doing that connected hard work that is so meaningful."


Ramona Schindelheim wrote this article for WorkingNation.

Support for this reporting was provided by Lumina Foundation.


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Mother's Day is fast approaching and an Arizona mom wants women of all ages to make sure they are prioritizing their heart health.

Nearly 45% of women age 20 and older are living with some form of heart disease and do not know it.

Sharla Fisher was in her late 30s when she received her first pacemaker. She said she always lived an active and healthy lifestyle but would experience occasional blackouts. It was not until she sought medical attention experts determined she had an abnormally low heart rate and blood pressure and was later diagnosed with neurocardiogenic syncope, also known as vasovagal syncope.

"It is not a fatal condition by any means," Fisher explained. "But what becomes fatal is this happened to me while I was driving with my children on the freeway. This has happened to me when I'm flying cross-country, in a cab in the middle of a city I don't know at one o'clock in the morning."

Fisher added in talking with her doctor, they determined a pacemaker would help regulate her cardiovascular system. Fisher shares her story to inspire other women to take heart health seriously. This year's American Heart Association Go Red for Women Luncheon will celebrate women like Fisher and share vital information to keep women healthy. The event will be on May 8 at the Westin Kierland Resort and Spa in Scottsdale.

Fisher pointed out after receiving her pacemaker, things still did not feel right. She wound up in the emergency room while traveling and was diagnosed with cardiac tamponade, which is when there is excess fluid in the sac surrounding the heart. Doctors informed her she would need open-heart surgery, prompting Fisher to call her children and say goodbye.

"Because I didn't know how we would make it out of this procedure, and, like I said, my organs had already started shutting down," Fisher recounted. "Obviously I am here, so there is a good story that comes out of all of this, but it was then that it really opened my eyes to women and heart disease."

Megan Stuff is this year's Phoenix Go Red for Women chair and said she has been having discussions about heart health with her young daughters who are 8 and 12 years old.

"We have to start these discussions so that we really can break some of those statistics," Stuff stressed. "That is my goal for the luncheon is to just bring awareness and advocacy for cardiovascular disease in women and just start the conversation as early as possible."

Many residents of West Virginia are at risk of losing health care under a federal proposal to cut Medicaid funding by $880 billion.

Sen. Jim Justice, R-W.Va., and Sen. Shelley Moore Capito, R-W.Va., voted for the cuts.

Ellen Allen, executive director of West Virginians for Affordable Healthcare, said more than 500,000 Mountain State residents rely on Medicaid for health coverage.

"We've seen no interest in our legislators trying to make up the difference so they can keep health care intact for over a half a million West Virginians," Allen pointed out.

Allen added other states are also preparing for potential cuts and looking for solutions to fill in the gaps. More than 200,000 West Virginians lost Medicaid coverage after the end of pandemic era continuous coverage rules.

Allen explained 72,000 residents in skilled nursing facilities need Medicaid to pay for housing and care. She believes some facilities will shut down when faced with budget cuts.

"These are people who couldn't afford long-term care and policies," Allen explained. "Their families don't have the resources to support them. So what are you going to do with 72,000 people in skilled nursing facilities when Medicaid is not there to support it?"

State-supported home care for people with disabilities could also be at risk. According to the National Rural Health Association, slightly under half of the nation's rural hospitals are operating at a loss. Cuts to Medicaid would likely mean more rural hospital closures statewide.

The Alaska branch of the American Heart Association is helping save lives by teaching the use of cardiopulmonary resuscitation and automated external defibrillators in rural communities.

In a medical emergency, such as a heart attack, time and distance can be a formidable obstacle in rural Alaska for getting a patient to a hospital. The association said only about 10% of people who suffer a cardiac arrest outside a hospital will survive but access to CPR or a defibrillator can triple those odds.

Kristin George, executive director of the American Heart Association of Alaska, said it is all about keeping the blood flowing.

"The benefit of having CPR and AED education is restarting the heart," George explained. "If we can keep the blood flowing to the heart, then we're not losing any of the parts we need. The reason we do the education is to continue to keep that heart beating."

George noted by 2030, the association plans to visit more than 220 rural Alaskan villages. Each visit will include a hands-only CPR and AED skills session led by a LifeMed Alaska expert. Each town will get a CPR Anytime Training Kit, so residents can practice their skills and teach others.

George pointed out the goal is to increase the number of residents in Alaska's rural communities trained to provide chest compressions or apply an external defibrillator to restart a heart. She emphasized many remote villages in Alaska are detached from the state's road system, meaning it can take a long time for medical help to arrive.

"Any village that's out on the coast or anything like that is going to be pretty much unable to get there without a plane," George observed. "Or if you wanted to take the longest trek of your life and do it sled dog or by snow machine."

George added the Association has set a goal of doubling the survival rate from cardiac arrests in Alaska by 2030. The Foss Family Foundation and LifeMed Alaska are sponsoring the rural Alaska effort.