Community health workers bridge the gap between healthcare systems and the people those systems struggle to reach. They work directly with individuals and families in their own neighborhoods, helping them navigate everything from managing chronic illness to finding affordable food, housing, or insurance. Unlike doctors or nurses, community health workers connect with people outside clinical walls, often in homes, community centers, churches, and shelters.
Core Responsibilities
The day-to-day work of a community health worker (CHW) centers on making healthcare accessible and understandable. That means different things depending on the setting, but most CHWs spend their time on a mix of these tasks:
- Health education: Teaching individuals and groups about managing conditions like diabetes, asthma, or high blood pressure. This often involves explaining treatment plans in plain language, demonstrating how to use medical devices, or helping someone understand what their doctor told them.
- Connecting people to resources: Identifying and referring clients to services they need but may not know exist, including food assistance programs, mental health services, transportation to medical appointments, and insurance enrollment.
- Outreach: Going into communities to build trust and identify people who need help. This can involve door-to-door visits, attending community events, or partnering with faith-based organizations.
- Advocacy: Speaking up for clients within healthcare and social service systems, helping them get the care and support they’re entitled to.
- Follow-up and care coordination: Checking in with clients after hospital visits or new diagnoses to make sure they understand their next steps and are following through on treatment plans.
What makes CHWs distinct is their relationship to the community itself. They typically come from the neighborhoods they serve, share the same language and cultural background, and understand the practical barriers their clients face. That shared experience builds trust in a way that a clinician in a hospital setting often cannot.
Where Community Health Workers Work
CHWs are employed across a range of settings, both clinical and non-clinical. The largest share, about 21%, work in outpatient healthcare services like clinics and physician offices. Social assistance organizations employ another 20%, while local government agencies account for 18%. Hospitals employ about 11%, and religious, civic, and professional organizations make up roughly 9%.
Travel is a regular part of the job. Many CHWs visit clients in their homes, meet them at medical facilities, or hold group sessions at libraries, schools, and community centers. The work is rarely desk-bound. A single day might involve a home visit in the morning, a group diabetes education session at a church in the afternoon, and phone follow-ups with clients in between.
Impact on Chronic Disease
Some of the strongest evidence for the value of CHWs comes from chronic disease management, particularly diabetes. A CDC-published study of a CHW-based care model in rural Appalachia tracked 446 patients with diabetes over time. Among those patients, 63% lowered their blood sugar levels during the study period. The average starting blood sugar marker (HbA1c) was 10.2%, which signals poorly controlled diabetes. After 12 months, the average dropped to 8.5%.
For patients who improved, the average reduction was 2.4 percentage points, a meaningful shift that lowers the risk of serious complications like nerve damage and kidney disease. Among the sickest patients, those starting above 10%, 96 individuals brought their levels below that threshold with an average drop of 3.7 points. Emergency department visits in the program fell by 22%, and hospitalizations dropped by 30% from the first year to the second.
These outcomes illustrate what CHWs do that clinical visits alone often cannot: they stay in regular contact with patients, help them understand how to eat, take medication, and monitor their condition between appointments, and catch problems before they become emergencies.
Cost and Value of CHW Programs
CHW interventions are relatively inexpensive. The median cost runs about $329 per person per year, with most of that going toward the CHW’s time, training, and supervision. Healthcare cost reductions after a CHW intervention have a median of $82 per person per year, meaning the direct savings don’t always fully offset the program cost in the short term. One well-designed study found a return on investment of 1.8 to 1 for a large health plan serving an underserved urban population.
The fuller picture, though, comes from quality-of-life gains. The median cost per quality-adjusted life year saved was $17,670, well below the $50,000 threshold that health economists generally consider a good value. In plainer terms, CHW programs produce meaningful improvements in people’s health and daily functioning at a price that compares favorably to many standard medical interventions. The diabetes program in Appalachia estimated potential annual savings of $384,000 just from 96 patients who brought their blood sugar under control, based on avoiding even one hospitalization per person per year.
How CHWs Differ From Social Workers
Because the roles can look similar on the surface, people often confuse community health workers with social workers. The key difference is scope and training. Social workers hold professional licenses, complete graduate or undergraduate degree programs, and are trained to provide clinical services like mental health assessments, therapy, and formal care plans. CHWs focus on health education, resource navigation, and building clients’ capacity to manage their own health.
In practice, the two roles complement each other. In a healthcare setting, a social worker might develop a care plan based on a clinical assessment, while the CHW implements that plan by meeting with the client regularly, teaching self-management skills, and connecting them to community resources. When social workers carry large caseloads, CHWs improve access to services and allow social workers to focus on the clinical work only they’re qualified to do. The collaboration works best when each role operates within its own strengths rather than duplicating the other’s work.
Education and Certification
One of the defining features of the CHW profession is that it doesn’t require a college degree. Most positions require a high school diploma or equivalent, though some employers prefer candidates with some college coursework in health or social services. What matters more is lived experience in the community being served and strong interpersonal skills.
Certification varies significantly by state. Many states have developed formal certification programs built around a national set of eleven core competencies that cover areas like communication, advocacy, care coordination, and cultural competency. States like Arizona, Texas, Massachusetts, and North Carolina offer multiple pathways to certification. One pathway typically involves completing an approved training program, while a second allows experienced CHWs to qualify based on work or volunteer history. Some states even offer a temporary “legacy” pathway for seasoned workers to get certified based on their practical experience alone.
At least four states have created tiered certification systems that support career advancement. Nevada and New Mexico offer two tiers, with the second requiring specialty training hours. North Carolina has four tiers and South Carolina has three, each demanding increasing levels of professional and lived experience. These tiered systems are relatively new and reflect a broader push to professionalize the field while preserving its community roots. Certification is not the same as completing a training program or earning a college certificate, though some states, like Minnesota, treat completion of a foundational CHW certificate program as meeting the certification requirement for Medicaid reimbursement.
Who Becomes a Community Health Worker
CHWs are often people who have personally navigated the same challenges their clients face: poverty, chronic illness, immigration, language barriers, or gaps in healthcare access. That lived experience is considered a professional asset, not a limitation. It’s what allows CHWs to build relationships that clinical staff cannot, and to understand barriers that don’t show up in a medical chart. Many CHWs enter the field after volunteering in their communities, working as peer support specialists, or serving as informal health advocates for family and neighbors.
The workforce itself tends to be racially and ethnically diverse, reflecting the communities served. This creates both a strength and a tension within the healthcare system: CHWs bring cultural knowledge and trust that improve outcomes, but they are also among the lowest-paid members of care teams, often with less job security than their licensed colleagues. The growing push for state certification and Medicaid reimbursement is partly aimed at addressing this gap by formalizing the profession and creating more stable career paths.