Community health workers build trust and improve health in West Philadelphia

An elderly woman can’t afford a ride to her doctor’s appointment, so Norma Gerald picks up the phone to help get her there. If an individual is seeking ways to stay motivated with an exercise plan, she’ll be their gym buddy for the day. If people are gathered at the scene of a violent crime, she’s on the scene with a sympathetic ear and the name of a good counselor.

The entire nation knows West Philadelphia as a wellspring of Black history and culture but generations of gentrification, mass incarceration, and other factors in the heavily Black community have created persistent barriers to good health and well-being. As a West Philly resident herself, Gerald knows these challenges well — and how to tap into the strengths and resources of the community and its people to overcome them.

The tools may not be splashy, but they are powerful forces for good in West Philly. It’s where Gerald not only lives but guides some of the city’s most at-risk people toward longer, happier, healthier lives. Gerald is a senior community health worker at Penn Medicine, and it’s all in a day’s work.

“At any given moment there could be an emergency,” she said. “What I had planned for the day doesn’t always go that way. But I love every moment of it. I just seem to gravitate toward this type of work.”

Community health workers like Gerald, 63, perform a range of functions including social support, patient advocacy, and health system navigation, all with the goal of improving health. More broadly, they form a bridge between the health care delivery system and people with limited resources, like those in West Philly, who struggle against deep health inequities, not to mention profound mistrust of a system that has often not had their best interests at heart.

Put succinctly, there are a lot of unmet health care needs in West Philly. Gerald spends her days trying to meet them.

“A community health worker is someone who has shared experiences with patients, who is able to connect and to understand some of the experiences they have had,” Gerald said. “We’re always following up and making sure that people are on track to meet their health goals.”

As a member of West Philly’s large Black community, and in working with patients referred to her by four Penn Medicine clinics in the area, Gerald is not just aware of but immersed in the myriad challenges that worsen health there and stymie access to care.

As part of the Penn Medicine at Home enterprise, community health workers are one element of Penn’s initiatives to deliver quality care and improve health outside hospital walls. According to Gerald, most of the patients she sees are laboring with chronic health problems including diabetes, kidney disease, and high blood pressure. Risky lifestyle behaviors like unhealthy weight management and smoking are common. This is the front line along which community health workers operate.

“We ask simple questions,” Gerald said. “We interview the patient to get a sense of who they are and what their health needs are, but also their likes and dislikes. We’re just trying to build a relationship so we can better understand where the problem is stemming from.”

Once patients feel heard, they are more likely to hear important messages themselves, Gerald said. This can mean being more receptive to health interventions tailored to them and their health—the epitome of patient-centered care.

“There are a lot of things that we know can be changed if a patient puts forth the effort,” Gerald said. “We try to work on that with them. For example, if a patient is looking to reach a healthier weight, we help them consider other options for snacks, such as replacing potato chips with rice cakes, which are about half the calories of chips. If they feel like they are more in control of their health, then they’re more likely to make some of these changes. And if they’re not, we adjust the goal to fit their needs. Everything is based around what the patient is willing to do.”

When it comes time to visit the doctor, community health workers facilitate the process by scheduling the visit, assisting with insurance matters, arranging transportation if needed, and even attending visits to help patients ask questions and understand advice.

“A lot of times when patients go to the doctor, they say the doctors talk ‘at’ them,” Gerald said. “A doctor may come in and want to immediately put them on medication but not really ask how they feel about it. We’ve been able to collaborate with doctors and be present at doctor appointments to make sure our patients have a say and then understand what follow-up might be needed.”

Gerald is well-versed in more than just the ins and outs of insurance and doctor appointments. Sadly, gun violence continues to wage a deadly toll in Philly. When bad news breaks, Gerald does her best to ease grief and stress the same way she facilitates doctor visits from wary patients—one word, one phone call at a time.

“With all the violence in the city, sometimes bereavement and social support are needed,” Gerald said. “If people want to talk, they tell you they just don’t understand how all the young people are killing each other, talking about how things were in the past and how we dealt with things. If they want to talk more I set up a call with a counselor, and I can stay on the line with them. I think just being a listening ear is important. We can listen and hear people out and let them know we understand what they’re going through, that we see it as well, and that we are here to support them.”

Community health workers are a valuable part of the health care continuum in West Philly and beyond—and the data bear that out. As a result, these unique professionals are eliciting trust not just from patients or physicians but community leaders and government officials.

“I think community health workers have come a long way,” Gerald said. “We were at one time not seen as valuable to the health system. But I think as doctors have started referring people to us over the years, they see patient health improves over the course of time.”

Penn Medicine has long been a champion for community health workers. According to Penn Medicine data, community health workers in Philly have helped make improvements in chronic disease control, mental health, and the overall quality of care while reducing total hospital days by 65 percent. What’s more, research found that every dollar spent on patients receiving support from Penn Medicine’s community health worker program resulted in an annual return on investment of $2.47 for every dollar invested annually by Medicaid.

Other studies have yielded similar results. And the nation is taking notice. The Biden administration recently announced $226 million to launch a community health worker training program, and congressional efforts are underway to support funding for community health workers.

As a further demonstration of their importance and the trust they’ve earned in the Penn Medicine system, community health workers are at the center of an innovative mentoring program designed to foster greater empathy and cultural humility among top executives within the health system.

“When we talk about health inequity, we talk about ‘those vulnerable people’ that are affected by inequities, but in reality, health inequity originates with privileged people,” said Shreya Kangovi, MD, MS, founding executive director of the Penn Center for Community Health Workers. “In this mentoring program, community health workers, who are lived experts of injustice, get to work with privileged leaders to help them gain awareness of their privilege.”

As community health workers continue their essential work, they help to remind all sides how trust is built — and how health is improved.

“The small changes are important, and it’s important for patients just to know they have that extra support,” Gerald said. “For me, it’s very fulfilling to be able to help somebody feel better about themselves and get their health a little better, as well as being able to support them and help them navigate all these different systems.”