Why Community Health Workers Deserve More Than Recognition

NATIONAL COMMUNITY HEALTH WORKER AWARENESS WEEK

Why Community Health Workers Deserve More Than Recognition

By M.E. Avila

Trust is not a soft outcome of community health work. It is the infrastructure that makes every other outcome possible.

Every year, National Community Health Worker Awareness Week gives institutions an opportunity to celebrate the people who connect communities to health care, public health, social services, emergency response, and other systems that shape daily life. The recognition matters. Community Health Workers deserve to be named, thanked, and seen. But awareness cannot become a substitute for accountability.

Too often, institutions praise CHWs for building trust while failing to examine what that trust requires, who carries the burden of producing it, and whether the workforce is being compensated, supported, and included in decisions accordingly. Trust is treated as if it simply appears whenever a familiar face enters the room. It does not. Trust is built through skill, consistency, cultural knowledge, shared experience, ethical presence, and the willingness to remain accountable to people even when the system is not. That work deserves more than a week of appreciation. It deserves structural investment.

Trust Is Infrastructure

We often describe CHWs as bridges. The image is useful, but incomplete. A bridge does not simply connect two fixed points. CHWs are often required to interpret both sides, anticipate where communication may break down, and help people cross systems marked by unequal power, unfamiliar language, and previous harm.

A referral may look complete in a database and still fail in real life. A patient may receive instructions and still not understand what will happen next. A family may qualify for support and still be unable to access it. A community may be invited to participate and still know that its knowledge will not influence the final decision. CHWs recognize the distance between what a system says it offers and what people actually experience.

They close that distance through relationships. They remember the family context that does not fit inside a required field. They notice hesitation that others mistake for noncompliance. They understand when silence reflects respect, fear, uncertainty, or a history of not being heard. They know that access is not merely the existence of a service. Access requires a person to feel safe enough to ask a question, respected enough to return, and confident enough to believe that the system will respond.

This is why trust should be understood as infrastructure. Programs, policies, and services may exist on paper, but trust is what allows people to use them. When institutions rely on CHWs to create that trust, they are relying on a form of expertise that is both relational and operational.

The Invisible Labor of Code Switching

My research with Community Health Workers examined the reflective practices they use while moving across community and institutional spaces. Again and again, code switching emerged as more than a change in vocabulary, tone, or language. It was a way of reading the room, interpreting power, protecting dignity, and deciding how to communicate without losing accountability to the community.

CHWs often know how a message will be received before it is delivered. They may translate clinical language into words that make sense within a family’s lived reality. They may also translate community concerns into institutional language that leaders are more likely to recognize as evidence. They adjust how they speak, what they reveal, and how directly they challenge a decision. They do this while knowing that one space may question their professionalism and another may question whether they have become too aligned with the system.

This is not indecision. It is sophisticated boundary spanning. It requires cultural awareness, emotional intelligence, discernment, and constant reflection. It can also be exhausting.

The emotional labor of code switching is rarely captured in productivity measures. A spreadsheet may count encounters, referrals, and completed forms. It does not show the preparation required to enter a room where community knowledge has historically been dismissed. It does not capture the strain of making an institution understandable to people who have been harmed by it. It does not measure what it costs to repeatedly prove that lived experience is not the absence of expertise, but a form of expertise that systems urgently need.

Recognition Without Power Is Not Enough

During awareness week, organizations often share photographs, proclamations, and messages of gratitude. Those gestures can be meaningful, particularly in a workforce whose contributions have long been overlooked. But celebration becomes hollow when CHWs remain the least powerful people in conversations about the programs they make possible.

If institutions truly value CHWs, then CHWs must be included before strategies are finalized, not invited after decisions have already been made. Their insight should shape program design, outreach, evaluation, emergency planning, and policy. They should be compensated for consultation, leadership, training, and the community relationships that organizations depend upon. Their advancement should not require abandoning the very lived experience and community connection that made their work effective.

We must also resist the habit of treating CHWs as an inexpensive substitute for other professionals. CHWs are not valuable because they can absorb more duties at a lower cost. They are valuable because they bring a distinct body of knowledge and practice.

Their role may complement clinicians, social workers, educators, emergency managers, and public administrators, but it should not be flattened into whichever gap an organization needs filled that day.

Respecting the workforce means protecting role clarity, providing supportive supervision, investing in continuing education, creating pathways to leadership, and paying wages that allow CHWs to care for their own families. It also means recognizing that self care cannot solve structural neglect. Breathing exercises and gratitude practices may help an individual recover in the moment, but they cannot compensate for understaffing, low pay, unclear expectations, or the constant demand to carry a system’s failures with a smile.

Community Knowledge Must Move in Both Directions

The deepest value of CHW practice is not simply that CHWs help communities understand institutions. It is that they can help institutions understand communities. Yet many systems embrace only the first half of that exchange.

When information moves in only one direction, CHWs become messengers for decisions they did not shape. When knowledge moves in both directions, they become partners in building programs that are more relevant, ethical, and effective. This distinction matters. Community engagement is not achieved because an organization distributes information in familiar language. It is achieved when community knowledge has the power to change what the organization does.

That requires institutions to listen differently. It requires leaders to examine whose language is treated as professional, whose evidence is considered credible, and whose discomfort is interpreted as resistance. It requires room for reflection, disagreement, and cultural affirmation. Most of all, it requires humility from systems that have often expected communities to adapt without asking how the system itself must change.

A Week of Awareness Should Lead to a Year of Action

National Community Health Worker Awareness Week should be a celebration. CHWs deserve joy, gratitude, visibility, and pride in a profession rooted in service and community strength. But the week should also be a challenge to every organization that benefits from their labor.

Do CHWs have a meaningful voice in decisions? Are they paid in proportion to the expertise and responsibility they carry? Are supervisors prepared to support a relational workforce? Are programs measuring trust, cultural responsiveness, and community influence, or only the outputs easiest to count? Are CHWs being asked to repair relationships that institutional practices continue to damage? These questions move us from appreciation to accountability.

Community Health Workers do not merely help systems work better. They reveal where systems are failing and show us what a more human response can look like. They carry knowledge formed through proximity, history, culture, reflection, and lived experience.

They create access where a door technically exists but does not yet feel open. This week, we should tell CHWs that their work is seen. Then we should prove it through investment, inclusion, protection, and power. Because trust is not an extra benefit that CHWs bring to the work. Trust is the work. And without it, the rest of the system cannot do what it was built to do.