This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

Many Michiganders haven't even heard of community health workers (CHWs), but these rarely recognized frontline workers have been integral to getting the word out about COVID-19 vaccine safety and effectiveness. 

A Michigan League for Public Policy (MLPP) presentation describes CHWs as patient advocates, health educators, enrollment assisters, and referral providers who help their clients navigate both health care systems and human services. Their job titles include peer support specialist, health navigator, outreach worker, promotor de salud, community health representative, recovery coach, or community-based doula. No matter what their title, they meet their clients where they are, in their homes, at food banks, in local health departments or human services agencies, and at health clinics.

As COVID-19 rates among unvaccinated Michiganders continue to result in deaths and hospitalizations, CHWs are taking on an increasingly important role.
Aleea Swinford.
"A lot of my role is education, giving them the reasons, the statistics, and knowledge as to why the vaccine could be successful, then giving them the empowerment to choose if they would want to get it or not," says Aleea Swinford, Ingham Health Plan CHW. "I do a lot of education. I do call a lot of people who don't have the vaccine and make them aware that I am here [and] I have the time to talk."

As members of the communities they serve, CHWs understand people's needs and often meet with folks face to face to link them to the health and social services resources they need. 

"We're all about advocacy and education, to empower people, to advocate for them," Swinford says. "I'm able to be more relatable and not strictly medical. I'm seen as a person that is more of an equal. I don't go in there thinking I'm better than they are. They don't have that feeling of separation like they do when they are talking to someone in the medical field, like a doctor."

CHWs lead Ottawa County to higher vaccination numbers

Ottawa County ranks among Michigan counties with a higher COVID-19 vaccination rate. As of Oct. 22, 2021, 61.3% of Ottawa County residents aged 12 and over had completed COVID-19 vaccination. Ottawa County Department of Public Health's (OCDPH) CHWs have developed a COVID-19 education pathway as part of the department's Pathways to Health program. 
Toni Bulthuis.
"The community health workers schedule appointments throughout our county, they help people link to Vaccinate West Michigan, and they've even driven clients to vaccine appointments if they need a ride," says Toni Bulthuis, OCDPH immunization team supervisor. "They are getting out there and sharing that education, making visits, and talking on the phone with them."

Bulthuis believes the county's success arises from the person-to-person conversations that its CHWs and other health department staff have with community members.

"[Because of] our presence in those neighborhoods, being out there, people feel a little more comfortable asking questions," she says. "It's good to be able to talk to a person instead of going online and not knowing what to believe. It's trust. A lot of people are not having that conversation with their doctors. When we have that conversation with them in person, we tell them there is a lot of information online that is confusing but this is what we know to be true. We have had good results with that. Some people walk away but we think that we plant a seed for them to get the vaccine later."

Bulthuis also credits community partners like Holland Hospital, North Ottawa Hospital, schools, churches, and local event organizers that have invited OCDPH to host vaccine clinics on their sites.

"They have kind of been our cheerleaders, going out into the community, making connections, and setting up dates for our off-site clinics," Bulthuis says. "They have encouraged people to come over to our tent and be vaccinated at festivals, block parties, and school open houses. We are out there and front-facing."

Bridging the health equity gap

Michigan's CHWs have made great contributions to educating Michiganders about COVID-19 and the safety and effectiveness of vaccines against it. But they serve numerous other functions as well. CHWs often focus on serving people without a health care connection and those with chronic health conditions like high blood pressure, substance use disorder, diabetes, or asthma. As liaisons between their clients and medical providers, CHWs connect folks to community resources that address social determinants of health, which impact both quality of life and, ultimately, mental and physical health.
Amber Bellazaire.
"Community health workers are uniquely effective at what they do. They so often share a peer connection with those they serve," says Amber Bellazaire, MLPP health policy analyst and member of the Protect Michigan Commission's Women and Children workgroup. "It's important for folks to know who community health workers are."

The state's 2022 budget requires the Michigan Department of Health and Human Services to consult with the federal government on ways to have Medicaid fund CHWs. And Michigan Gov. Gretchen Whitmer's MI Healthy Communities plan, proposed on Sept. 14, supports a CHW navigator program to connect Michiganders affected by COVID-19 to the care they need. 

"Community health workers help ensure that as many people as possible have what they need to be healthy," Bellazaire says. "They reach out to those who can benefit the most from holistic peer support. They can help close the loop and offer follow-up care, not just for clinical needs but other non-medical barriers to health." 

According to MLPP, CHWs are not only uniquely positioned to advocate for their individual clients, but also to advocate for communities as they come to understand what a community's persistent health needs are. This can help communities to overcome structural barriers that impact their residents' health and well-being. The personal relationships and trust that CHWs build also help dispel the misinformation that has been particularly virulent and damaging during the pandemic.

"Vaccines can be a sensitive issue," Swinford says. "I like to build rapport first. I definitely think that talking in person allows us to have that rapport and build that trust."

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Lead photo by Adobe Stock. All other photos courtesy of the subjects.